The following is the latest health policy news from the federal government for January 30 through February 5.  Some of the language used below is taken directly from government documents.

Congress

On Tuesday Congress passed, and the president immediately signed, a package of appropriations bills that, among other government operations, funded the Department of Health and Human Services for the rest of federal FY 2026.  Major provisions include:

  • The extension of telehealth flexibilities through the end of 2027.
  • The elimination of $8 billion cuts in Medicaid disproportionate share (Medicaid DSH) allotments to the states for both FY 2026 and FY 2027.  An $8 billion cut is still scheduled for FY 2028.
  • The extension of the Medicare Acute Hospital Care at Home program through the end of September of 2030.
  • The extension of the Medicare low-volume hospital adjustment and the Medicare dependent hospital program through the end of 2026.
  • The continuation of graduate medical education grants for community-based, ambulatory patient care centers to train residents in primary care through FY 2029.
  • Extension of the Geographic Practice Cost Index (GPCI) floor of 1.0 on the work GPCI through the end of 2026.
  • A requirement that all off-campus hospital outpatient departments obtain an individual national provider identifier (NPI) by the end of 2027.
  • Pharmacy benefit manager (PBM) reforms.
  • A requirement that Medicare Advantage provider directories be accurate.
  • New flexibility to permit the delivery of cardiopulmonary rehabilitation services through real-time audio and video communication through the end of 2027.
  • Extension of the two percent sequestration of Medicare payments for an additional six months, through February of 2033.
  • The inclusion of congressionally earmarked appropriations.
Centers for Medicare & Medicaid Services
  • CMS has sent a bulletin to state governments outlining upcoming changes in states’ use of state-directed payments in their Medicaid managed care programs as a result of legislation passed in 2025 (variously referred to as H.R. 1, the One Big Beautiful Bill Act, and Public Law 119-21).  That legislation took effect for Medicaid managed care rating periods beginning on or after July 4, 2025.  The bulletin, which CMS notes that it is providing to assist states until the agency promulgates a final rule implementing the legislation, presents background information about state-directed payments and outlines the limited criteria under which CMS may grandfather some state-directed payment programs until 2028 depending on the status of their state-directed payment preprint application; a state-directed payment preprint is a mandatory pre-approval document submitted by state Medicaid agencies to CMS that details how states require Medicaid managed care plans to pay providers.  In one modification from its previous guidance, CMS has changed its interpretation of “180 days” to mean 180 business days rather than the previously stated 180 calendar days; this change broadens the span of years for which CMS will grandfather applications, potentially making state-directed payment preprints submitted for calendar years 2024 and 2026 eligible for grandfathering.  Learn more from this CMS bulletin.
  • In the wake of the passage of appropriations legislation extending current Medicare telehealth flexibilities through the end of 2027, CMS has updated its telehealth FAQ.  Find the updated FAQ here.
  • CMS has selected its targeted sample of hospitals for data validation of measures within the Hospital Inpatient Quality Reporting Program and the Hospital-Acquired Condition Reduction Program for the FY 2028 payment determination/program year.  Selected hospitals will receive a direct email from the CMS hospital quality reporting validation support coordinator.  Learn more about the program and find a link to the list of chosen hospitals in this CMS announcement.
  • CMS has posted a bulletin presenting updates of the ambulatory surgical center payment system, including changes that took effect on January 1.  The update addresses new device categories, CPT and HCPCS codes, drugs and biologics, skin substitutes, and non-opioid treatments for pain relief.  Find that bulletin here.
  • CMS has posted a bulletin announcing the completion of changes to remove reliance on the AX modifier to pay end-stage renal disease treatment claims.  Find that bulletin here.  The changes it describes take effect on July 1.
  • CMS has updated its “Behavioral Health Integration Services” booklet to reflect the addition of three new optional add-on HCPCS codes for general behavioral health integration and psychiatric collaborative care model services when provided as part of advanced primary care management services.  Find the updated resource here.
  • CMS has updated its “Information for Rural Health Clinics” booklet with a series of changes.  Find the updated resource here.
  • CMS has updated its “Medicare Preventive Services” education tool to reflect billing codes added as of January 1, 2026.  Find the updated resource here.
  • CMS has posted a bulletin presenting changes in coding for Medicare-covered home-based non-invasive positive pressure ventilation to treat chronic respiratory failure due to chronic obstructive pulmonary disease.  Find the updated information here.
  • CMS has proposed revisions of current data collection for the Certified Community Behavioral Health Clinic (CCBHC) 2024 state proposal demonstration application, which is required of  current CCBHC grantee states and submitted to CMS and HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) to determine state readiness and eligibility for the CCBHC demonstration and every two years thereafter.  The information collection includes three components:  the CCBHC state proposal demonstration application; an application to add additional CCBHCs to existing state demonstration programs, providing updates to the information previously submitted in the state’s original state application; and guidance for states reporting changes in their demonstration programs.  The proposed changes could affect the data states seek from CCBHC participants.  Learn more from this proposed data collection revision announcement.  The deadline for stakeholders to submit comments is February 17.
  • In a memo to Medicare Advantage organizations, the Audits and Vulnerabilities Group within CMS’s Center for Program Integrity has updated those organizations on the status of contract-specific risk adjustment data validation efforts.  The memo notes that CMS is aware that it has made overpayments to some Medicare Advantage organizations; has developed a strategy for using past audits to identify those overpayments; outlines changes it expects to make in its auditing methodology; and will soon begin overpayment recovery efforts for plan years 2011 through 2013 while it continues to acquire new tools, including some powered by artificial intelligence, to streamline and improve its auditing practices.  Learn more from this CMS memo to Medicare Advantage organizations.
  • CMS has added the following items to its Quality Payment Program resource library.  (Note:  clicking these links may give a prompt to download a file that may be a zip file.)
Department of Health and Human Services
  • HHS’s Health Resources and Services Administration (HRSA) has issued a request for public comment on revised criteria for determining maternity care health professional target areas.  In 2022, HRSA published the final criteria that are used to identify and score maternity care target areas.  One of the criteria selected was the Social Vulnerability Index, which was used to assign points based on the relative level of social vulnerability within an area.  HRSA now proposes changing the criteria and point scales for maternity care health professional target areas by removing the criterion for Social Vulnerability Index and reallocating its two points:  one point to population-to-full-time-equivalent maternity care health professional ratio and one point to travel distance/time to nearest source of accessible care outside of the maternity care target area.  Learn more about how HRSA proposes revising criteria for determining maternity care health professional target areas from this HRSA request for public comment.  The deadline for submitting comments is March 5.
  • HHS has announced a plan to spend $100 million to address long-standing homelessness issues, fight opioid addiction, and improve public safety by strengthening prevention efforts and expanding treatment that emphasizes recovery and self-sufficiency.  The Safety Through Recovery, Engagement, and Evidence-based Treatment and Supports Initiative (STREETS) will fund targeted outreach, psychiatric care, and medical stabilization and crisis intervention while connecting Americans experiencing homelessness and addiction to stable housing with a focus on long-term recovery and independence.  The announcement is part of a response to President Trump’s “Addressing Addiction Through the Great American Recovery Initiative” executive order.  Learn more about STREETS and its origins from the president’s executive order; a White House fact sheet; and this HHS news release.
  • In the same news release unveiling STREETS, HHS announced a $10 million Assisted Outpatient Treatment grant program to support adults with serious mental illness.  The program is a civil court-ordered, community-based outpatient mental health treatment program for adults with serious mental illness who are unable to engage with conventional outpatient treatment and are unlikely to be able to live safely in their community.  The program is designed to work within the civil court system to support engagement with community-based treatment as an alternative to more costly restrictive levels of care, homelessness, and interaction with the criminal justice system.
  • HHS’s Administration for Children and Families announced that three FDA-approved medications for opioid use disorder have been added as prevention services eligible for funding under Title IV-E, which supports children and families involved with the child welfare system.  States and tribes can now receive a 50 percent federal match to provide buprenorphine, methadone, and naltrexone to parents when children are at imminent risk of entering foster care but can remain safely in the home or in a kinship placement with access to these treatments.  Learn more from this Administration for Children and Families news release.
  • HHS’s Office of the Assistant Secretary for Technology Policy (ASTP)/Office of the National Coordinator for Health Information Technology (ONC) has issued a request for information seeking input from the public regarding the potential adoption of diagnostic imaging technical standards and certification criteria for health information technology under the ONC Health IT Certification Program to better enable the access, exchange, and use of diagnostic images by health care providers and patients.  Learn more about the kinds of input the agency seeks, the specific questions to which it seeks answers, and how to submit comments from the ASTP/ONC request for information.  The deadline for submitting comments is March 16.
  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) has distributed $794 million in block grant funding for community mental health services and substance abuse treatment and prevention.  The allocations include $319 million for SAMHSA’s Community Mental Health Services Block Grant, which provides comprehensive community mental health services for adults with serious mental illness and children with serious emotional disturbance, and $475 million for the agency’s Substance Use Prevention, Treatment, and Recovery Services Block Grant program to prevent and treat substance abuse.  This funding represents the first allocation for the annual block grant awards.  Learn more about the recent grants SAMHSA awarded from this HHS news release.
  • HHS’s Office of the Inspector General has published “Medicare Advantage Industry Segment-Specific Compliance Program Guidance,” which serves as its updated and centralized source of voluntary compliance program guidance for Medicare Advantage plans.  Entities and individuals can use the guide to help identify their own risks and implement effective compliance and quality programs to reduce those risks.  Find the guidance here.
Medicaid State Plan Amendments

CMS has approved the following state plan amendments for Medicaid and CHIP programs.

  • To Nevada, increasing rates for certain rehabilitative services and adding clarifying language for psychologist services offered under 1905(a)(6) of the Social Security Act.
  • To Illinois, increasing reimbursement rates for residential substance use disorder services and early intervention services.
  • To Massachusetts, updating the methods and standards used by the state for payment for hearing services.
  • To Massachusetts, updating the methods and standards used by the state for payment for family planning clinic services.
  • To Oregon, updating the rates and effective date for the eyeglasses contract with qualified rehabilitation facilities.
  • To Louisiana, establishing doula services as a covered benefit under the state plan, including service definitions, provider qualifications, and payment methodologies.
  • To Louisiana, implementing Section 201 of the Consolidated Appropriations Act of 2024 by permanently establishing medication-assisted treatment for opioid use disorders under the state plan.
  • To Alaska, removing the September 30, 2025 sunset date for the medication-assisted treatment benefit and making that benefit permanent under the Medicaid state plan in accordance with federal statue.
  • To South Carolina, updating the inpatient hospital changes effective October 1, 2024 and Medicaid DSH changes for federal FY 2025.
  • To Utah, adding coverage and reimbursement of targeted case management services for eligible juveniles in accordance with Section 5121 of the Consolidated Appropriations Act of 2023.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – February 5
  • CMS – CMS has published a fact sheet with data documenting 2026 participation in Medicare accountable care organization (ACO) programs, including figures quantifying participation in some of the individual ACO models.  Find that fact sheet here.
  • CMS – CMS Digital Quality Measure Public Comment Webinar – on January 21, CMS held a webinar presenting an overview of how the agency is modernizing quality reporting through digital quality measurement (dQM), highlighting the transition to FHIR‑based digital measures, increased interoperability, improved data accuracy, and reduced reporting burden.  The session sought to prepare stakeholders for changes in measure development, implementation, and reporting while providing guidance for participating in the dQM public comment period, reviewing available artifacts, and offering meaningful feedback.  Now, CMS has posted a video and transcript of that webinar; find them here.
  • HRSA eNews – January 26
  • CDC – Morbidity and Mortality Weekly Report – “Measles Outbreak Associated with an Infectious Traveler — Colorado, May–June 2025” – January 29
  • CDC – The 2024 annual “National and State Healthcare-Associated Infections (HAI) Progress Report” – a summary of selected health care-acquired infections across four health care settings: acute-care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term acute-care hospitals.
Centers for Disease Control and Prevention (CDC)

The CDC reports 588 confirmed measles cases in 17 states as of January 30.  Only two were new outbreaks and three were among international visitors; there have been no measles-related deaths this year.  Learn more from the CDC’s Measles Cases and Outbreaks website.

Drug Enforcement Administration (DEA)

The Justice Department’s Drug Enforcement Administration (DEA) has issued a final rule to conform its regulations to the statutory amendments of the Controlled Substances Act adopted through the Protecting Patient Access to Emergency Medications Act of 2017.  This final rule adopts, with minor modifications, the notice of proposed rulemaking published on October 5, 2020 that provides for a new registration category for emergency medical services agencies that handle controlled substances.  It also establishes standards for registering emergency medical services agencies and sets forth new requirements for delivery, storage, and recordkeeping related to their handling of controlled substances.  The act also authorizes emergency medical services professionals to administer controlled substances outside the physical presence of a medical director or authorizing medical professional pursuant to a valid standing or verbal order.  Learn more from the final rule, which takes effect on March 9.

Department of Labor

The Department of Labor’s Employee Benefits Security Administration has proposed a regulation that would require providers of pharmacy benefit management services (PBMs) and affiliated providers of brokerage and consulting services to disclose information about their compensation to fiduciaries of self-insured group health plans subject to the Employee Retirement Income Security Act (ERISA).  The agency seeks these disclosures so that fiduciaries can assess the reasonableness of the contracts or arrangements with these service providers, including the reasonableness of the service providers’ compensation.  These disclosure requirements would apply for purposes of ERISA’s statutory prohibited transaction exemption for services arrangements.  If finalized, this regulation would affect sponsors and other fiduciaries of self-insured group health plans and certain service providers to such plans.  Learn more from the proposed regulation.  The deadline for submitting comments is March 31.

Stakeholder Events

CMS – Hospital Price Transparency Webinar – February 11

CMS will hold a webinar on Wednesday, February 11 to review with stakeholders the revised hospital price transparency requirements that were included in its 2026 Medicare hospital outpatient prospective system regulation and for which the agency will begin enforcement on April 1.  Go here to participate in that webinar.

HHS/Office of the Assistant Secretary for Technology Policy – ASTP Annual Meeting – February 11-12, 2026

HHS’s Office of the Assistant Secretary for Technology Policy will hold its annual meeting in Washington, DC on February 11-12, 2026.  The meeting will include in-person education and plenary sessions and networking opportunities for the health IT community.  The main stage plenary sessions will also be available for viewing online.  Find the meeting agenda here; go here to register to participate.

HHS Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology/Health Information Technology Advisory Committee – February 19

The Health Information Technology Advisory Committee of HHS’s Office of the Assistant Secretary for Technology Policy will hold its next meeting on Monday, February 19 at 10:00 (eastern).  This committee’s role is to identify priorities for standards adoption and make recommendations to the Assistant Secretary for Technology Policy.  Learn more about the committee, its structure, and its purpose from this HHS notice, which also outlines the meeting’s agenda.  Information about how to participate in the meeting is not yet available but when it is it will be posted here.  Other 2026 meetings will be held on May 7, September 24, and November 5,

CMS – 2026 CMS Burden Reduction Conference – February 25

CMS will hold its 2026 Burden Reduction Conference on Wednesday, February 25.  The conference will be held in Washington, D.C., with options for individuals to attend in person or participate virtually.  Learn more from this CMS notice.  Registration information is not available at this time.

CMS – eCQI Resource Center – Expert-to-Expert Webinars on eCQM Annual Updates for 2026 – February 26 and March 5

CMS’s eCQI Resource Center will hold expert-to-expert webinars offered in collaboration by the Joint Commission, CMS, and eCQM stewards.  The webinars will address the eCQM annual updates for 2026 implementation and offer continuing education credits for the live broadcast.  The webinar will address frequently asked questions and participants can submit questions for response.  There will be two sessions:  on Thursday, February 26 and the following Thursday, March 5 (both at 1:00 (eastern).  Learn more about the webinars, the specific subjects to be addressed at each, how to register to participate, and the availability of slides, recordings, and transcripts of the sessions from this CMS notice.

MedPAC – Commissioners Meeting – March 2-3

MedPAC’s commissioners will hold their next public meeting virtually on Monday, March 2 and Tuesday, March 3.  An agenda and registration information are not yet available but when they are they will be posted here.

MACPAC – Commissioners Meeting – March 5-6

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, March 5 and Friday, March 6.  An agenda and registration information are not yet available but when they are they will be posted here.

CMS – 2026 CMS Quality Conference – March 16-18

CMS will hold its 2026 Quality Conference on Monday, March 16 through Wednesday, March 18 in Baltimore.  The theme of the conference will be “Make America Healthy Again:  Innovating Together for Better Health.”  Interested parties can participate in person or virtually.  Learn more about the conference and how to register to participate from this CMS announcement.