The following is the latest health policy news from the federal government for January 9-15.  Some of the language used below is taken directly from government documents.

The White House

The White House has unveiled “The Great Healthcare Plan,” which it describes as “… a broad healthcare initiative that will slash prescription drug prices, reduce insurance premiums, hold big insurance companies accountable, and maximize price transparency in the American healthcare system.”  The major components of the plan, and the key steps for each, are:

  • lower drug prices
    • slash prescription drug prices
    • allow more over-the-counter medicines
  • lower insurance premiums
    • send the money directly to the American people
    • fund cost-sharing reduction program
    • cut kickback costs
  • hold big insurance companies accountable
    • create the “plain-English insurance” standard
    • publish costs of overhead vs. claim payments
    • display claim denial rates
  • maximize price transparency
    • post prices on the wall

Learn more about the plan from this White House announcement; an accompanying fact sheet; and a new White House Great Healthcare Plan” web site that includes a video of President Trump introducing the plan.

At this point, the Great Healthcare Plan is a proposal; there is not yet legislative language translating these concepts into potential laws.  We will present such information as it becomes available.

Congress

Congress continues to advance additional appropriations bills ahead of the January 30 continuing resolution (CR) expiration but it appears that certain departments, including Health and Human Services, may require another CR to remain funded.  Lawmakers are also considering longer-term extensions of several key policies, such as telehealth flexibilities, delays to Medicaid DSH cuts, funding for community health centers and those with teaching programs, low volume hospital adjustments, ambulatory services, home health provisions, and others.  These could be addressed either in spending bills, a new CR, or as part of a separate health care package.

Last week the House passed a Democratic-led three-year clean extension for Affordable Care Act premium tax credits with support from 17 Republicans.  Meanwhile, a bipartisan group of senators is developing their own legislation that could include a two-year extension with guardrails, including a minimum monthly premium, immigration status restrictions, and income eligibility criteria; the measure may also include changes that would give individuals access to subsidies via a health savings account or similar mechanism.  Even though the bill text was expected to be released this week, the Senate will leave tomorrow for a 10-day recess without agreeing on a solution for the expanded subsidies.

340B

Last week a federal court issued a preliminary injunction preventing HHS’s Health Resources and Services Administration (HRSA) from implementing its 340B Rebate Model Pilot Program, a limited model that would test replacing the discounts pharmaceutical companies give providers participating in the 340B drug program when they purchase eligible prescription drugs with post-purchase rebates for those products.  HHS appealed that decision and the court immediately rejected that appeal.  Now, the agency reportedly has indicated that it will drop its appeal of the decision.

Centers for Medicare & Medicaid Services
  • CMS has issued a request for information (RFI) seeking input from large-scale claims processing and adjudication vendors that can help the agency improve beneficiary experience, reduce provider burden, and improve administrative efficiency in original Medicare.  The RFI notes that CMS seeks to replace its current Medicare fee-for-service claims adjudication system with a real-time, cloud-based platform capable of sub-second adjudication, improved real-time fraud prevention, and transparent interoperability, forming the basis of all future Medicare fee-for-service claims processing and facilitating the consolidation of the current, separate systems for Medicare Part A, Part B, and durable medical equipment into a single system.  Learn more from this CMS RFI.  The deadline for submitting responses is January 23.  CMS anticipates using the information it gathers in a future request for proposals.
  • CMS has updated its Medicare master list of items potentially subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements; updated the required face-to-face encounter and written order prior to delivery list; and updated the required prior authorization list.  It also has updated Healthcare Common Procedure Coding System (HCPCS) codes on the master list and updated HCPCS codes on the required face-to-face and written order prior to delivery list and the required prior authorization list.  Learn more about the updated Medicare lists and the individual items added to these lists from this CMS notice.  The update takes effect on April 13.
  • CMS has posted a bulletin presenting its CY 2026 update of Medicare travel allowance fees for specimen collection.  Find that bulletin here.  The changes it describes took effect on January 1.
  • CMS has posted a brief report documenting enrollment activity on Affordable Care Act marketplaces since the start of the 2026 marketplace open enrollment period on November 1.  The report documents enrollment activity based on categories of people enrolling and enrollment data by state.  Find the report here.
  • CMS has updated its Rural Emergency Hospital fact sheet.  The update includes revised information about how to become a Rural Emergency Hospital, how they bill and are paid by Medicare, and monthly facility payments while also directing readers to additional resources.  Find the updated fact sheet here.
  • CMS announced that it has selected Nevada Donor Network to assume responsibility for organ procurement services in its southern Florida donation service area, which spans approximately seven million people in six southern Florida counties and the Bahamas.  Learn more about the competitive bidding process, the responsibilities of the new vendor, and the transition to the new vendor from this CMS news release.
  • CMS has announced that it will be discontinuing the legacy Internet Quality Improvement and Evaluation System (iQIES) front-end user interface (data entry software for manually creating assessments) used by inpatient rehabilitation facilities and long-term-care hospitals as of October 1.  Facilities will be required to use different software after that date.  Learn more from this CMS announcement, which also directs users to information about how to upload the affected data in the future.
  • 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 Substance Abuse and Mental Health Services Administration (SAMHSA) has published a notice of funding opportunity announcing the availability of a $231 million contract to administer the agency’s 988 Suicide & Crisis Lifeline.  The 988 Lifeline consists of a national network of more than 200 local crisis contact centers managed by a SAMHSA-funded 988 network administrator.  SAMHSA intends to award one contract for the entire $231 million for an administrator to maintain a network of crisis contact centers and to implement and oversee the national standards of care and quality.  The contract will run for up to five years and all non-profit organizations are eligible to apply.  Learn more about the available funding from this HHS news release and the official notice of funding opportunity, which includes instructions, program contact information, and application forms.  The deadline for submitting proposals is February 27.
  • HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) has published a preview of the 2026 federal poverty guidelines.  These guidelines are used to determine eligibility for Medicaid and other health care programs and public benefits.  Find the updated 2026 guidelines here.
  • HHS’s Administration for Strategic Preparedness and Response (ASPR) has released its strategic plan for 2026 to 2029.  The plan outlines goals to strengthen state and local readiness, secure America’s medical supply chain, address emerging health security threats, advance science, and execute rapid and efficient federal response.  Its major stated goals are to strengthen ASPR’s workforce and reinforce the agency’s culture; to strengthen preparedness through state and local resiliency; to execute rapid, efficient, and adaptive federal response; to secure America’s medical supply chain; and to address emerging health security threats.  Learn more from this ASPR news release and its ASPR Strategic Plan Fiscal Year 2026-2029.
  • HHS’s Office of the Assistant Secretary for Technology Policy (ASTP) has posted a blog article on the growth of patient engagement with their online health care data.  Find that post here.
Medicaid State Plan Amendments 

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

  • To Washington, to bring the state’s Medicaid program into compliance with Section 201 of the Consolidated Appropriations Act, 2024, which made the mandatory medication-assisted treatment for opioid use disorders benefit permanent by amending Section 1905(a)(29) of the Social Security Act (the Act), to remove the end date of September 30, 2025.
  • To New Hampshire, removing the end date of September 30, 2025, as required by section 201 of the Consolidated Appropriations Act, 2024, and making medication-assisted treatment a permanent service.
  • To New Hampshire, updating the nursing home reimbursement rate account based on state FY 2026.
  • To Arizona, updating fee-for-service reimbursement rates for long-term acute-care and rehabilitation hospitals effective October 1, 2025.
  • To Utah, providing for mandatory coverage for eligible juveniles who are incarcerated in a public institution post-adjudication of charges.
  • To Utah, adding coverage and reimbursement for doula services.
  • To Minnesota, eliminating Medicaid coverage of chiropractic services for individuals older than 21.
  • To Minnesota, providing increases to the outpatient treatment coordination and residential treatment (high and low intensity) rates for adult substance use disorder services.
  • To Kansas, updating DMEPOS annual preventive maintenance services.
  • To Connecticut, updating the Community First Choice program to comply with the collective bargaining agreement.
  • To California, resuming the evaluation of resources in the determinations of eligibility for its non-MAGI eligibility groups.
State-Directed Medicaid Payments

CMS has approved the following state preprints for Medicaid state-directed payments.

  • To Washington, renewing a uniform increase established by the state for publicly funded sexual and reproductive health family planning providers as designated by the Department of Health for the rating period covering January 1, 2026 through December 31, 2026, to be incorporated into capitation rates through a risk-based rate adjustment of up to $100,000.
  • To Massachusetts, renewing the Hospital Performance Improvement Initiative program for the rating period covering January 1, 2025 through December 31, 2027, which is incorporated into capitation rates through a separate payment term of up to $125 million for CY 2025, $125 million for CY 2026, and $125 million for CY 2027.
  • To Massachusetts, renewing a uniform increase established by the state for behavioral health urgent care for the rating period covering January 1, 2025 through December 31, 2025, which was incorporated in the capitation rates through a risk-based rate adjustment.
  • To Arizona, renewing the uniform percentage increase established by the state for differential adjusted payments program-eligible providers for the rating period covering October 1, 2025 through September 30, 2026, incorporated into the capitation rate through a risk-based adjustment.
  • To Ohio, renewing a population-based payment established by the state for mobile response and stabilization services providers for the rating period from January 1, 2026 through December 31, 2026, to be incorporated into capitation rates through a separate payment term of up to $48.9 million.
  • To Ohio, establishing a uniform percentage increase for qualified practitioner services at a non-academic medical center and a value-based performance payment to providers who attain quality performance target(s) for the rating period covering January 1, 2025 through December 31, 2025, which was incorporated into capitation rates through a separate payment term of up to $$10.7 million.
  • To Ohio, establishing  a uniform percentage increase for qualified practitioner services at a non-academic medical center and a value-based performance payment to providers who attain quality performance target(s) for the rating period covering January 1, 2025 through December 31, 2025, which was incorporated into capitation rates through a separate payment term of up to $9.8 million.
  • To Ohio, establishing a uniform percentage increase for qualified practitioner services at a non-academic medical center and a value-based performance payment to providers who attain quality performance target(s) for the rating period covering January 1, 2025 through December 31, 2025, which was incorporated into capitation rates through a separate payment term of up to $7.1 million.
  • To Utah, renewing a uniform percentage increase for professional services at an academic medical center for state teaching hospitals for the rating period covering July 1, 2024 through June 30, 2025, which was incorporated into capitation rates through a separate payment term of up to $49.5 million.
  • To Utah, renewing a uniform percentage increase for inpatient hospital services for privately owned hospitals for the rating period covering July 1, 2024 through June 30, 2025, which was incorporated into capitation rates through a separate payment term of up to $215.2 million.
  • To Utah, renewing a uniform percentage increase for inpatient hospital services for state teaching hospitals for the rating period covering July 1, 2024 through June 30, 2025, which was incorporated into capitation rates through a separate payment term of up to $72.4 million.
  • To Utah, renewing a uniform percentage increase for outpatient hospital services for privately owned hospitals for the rating period covering July 1, 2024 through June 30, 2025, which was incorporated into capitation rates through a separate payment term of up to $236.9 million.
  • To Utah, renewing a uniform percentage increase for outpatient hospital services for state teaching hospitals for the rating period covering July 1, 2024 through June 30, 2025, which was incorporated into capitation rates through a separate payment term of up to $78.5 million.
  • To Georgia, renewing  a uniform percentage increase and performance improvement initiative for inpatient hospital services and outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, to be incorporated into capitation rates through a risk-based rate adjustment of up to $385.5 million.
  • To Michigan, renewing a uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering October 1, 2025 through September 30, 2026, to be incorporated into capitation rates through a risk-based rate adjustment.
  • To Nebraska, renewing a uniform increase for staff and faculty dental providers at an academic dentistry institution of a public university established by the state for dental services for the rating period from January 1, 2025 through December 31, 2025, which was incorporated into the capitation rates through a risk-based adjustment of up to $3.3 million.
  • To Nebraska, renewing a uniform increase for faculty or staff members of an academic medical institution of a public university established by the state for the rating period from January 1, 2025 through December 31, 2025, which was incorporated into capitation rates through a risk-based rate adjustment of up to $25.1 million.
  • To Nevada, approving a uniform percentage increase for professional services at an academic medical center for rating periods covering January 1, 2024 through December 31, 2024, which was incorporated into capitation rates through a separate payment term amount of up to $56 million.
  • To Nevada, renewing a uniform percentage increase for eligible professional services at an academic medical center for rating periods covering January 1, 2026 through December 31, 2026, to be incorporated into capitation rates through a separate payment term amount of up to $56 million.
  • To Florida, renewing a minimum fee schedule for dental services for the rating period covering October 1, 2024 through January 31, 2025, which was incorporated into capitation rates through a risk-based rate adjustment amount of up to $28,000.
  • To Florida, renewing a minimum fee schedule for dental services for the rating period covering February 1, 2025 through September 30, 2025, which was incorporated into capitation rates through a risk-based rate adjustment amount of up to $59,000.
  • To Florida, renewing a minimum fee schedule for primary care services and specialty physician services for the rating period covering October 1, 2024 through January 31, 2025, which was incorporated into capitation rates through a risk-based rate adjustment of up to $75.4 million.
  • To Florida, renewing a minimum fee schedule for primary care services and specialty physician services for the rating period covering February 1, 2025 through September 30, 2025, which was incorporated into capitation rates through a risk-based rate adjustment amount of up to $150.7 million.
  • To Arizona, renewing a uniform increase established by the state for acute inpatient and ambulatory outpatient services provided by Hospital Enhanced Access Leading to Health Improvements Initiative program-eligible hospitals for the rating period covering October 1, 2025 through September 30, 2026, to be incorporated into capitation rates through a separate payment.
  • To South Carolina, renewing a uniform percentage increase established by the state for inpatient and outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, to be incorporated into capitation rates through a separate payment term of up to $2.6 billion.
  • To Pennsylvania, renewing a uniform dollar amount for eligible providers that provide private duty nursing services to members under age 21 for the rating period covering January 1, 2026 through December 31, 2026, to be incorporated into capitation rates through a risk-based rate adjustment of up to $1.7 million.
  • To Texas, establishing a quality improvement payment program for the rating period covering September 1, 2024 through August 31, 2027, which has been incorporated into capitation rates through a risk-based rate adjustment of up to $1.8 billion for each rating period.
  • To New Mexico, establishing a uniform increase introduced by the state for inpatient and outpatient hospital services for the 20 smallest rural hospitals for the rating period covering January 1, 2025 through December 31, 2025, which was incorporated into capitation rates through a separate payment term amount up to $56 million.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – January 15
  • Agency for Healthcare Research and Quality – AHRQ News Now – January 13
Food and Drug Administration (FDA)

The FDA has published draft guidance to facilitate the use of Bayesian methodologies in clinical trials of drugs and biologics.  The framework is intended to help drug developers better use available data, conduct more clinical trials, and deliver safe and effective treatments to patients sooner.  Find the draft guidance here.

Congressional Budget Office (CBO)

The CBO has published a report describing different approaches to addressing the ongoing opioid crisis and assessing their effectiveness and likely budgetary effects; among those approaches are expanding Medicaid coverage of treatment; enhancing monitoring programs for drug prescribing; expanding the use of telehealth for treatment; and increasing access to overdose reversal medications.  Learn more from the CBO report “The Opioid Crisis:  Federal Policy Approaches to Reduce Supply, Demand, and Harm.”

Stakeholder Events

CMS – Medicare Diabetes Prevention Program Webinar – January 22

CMS officials will discuss the Medicare Diabetes Prevention Program and changes in that program resulting from the CY 2026 final Medicare physician payment schedule rule during a webinar on Thursday, January 22 at 1:00 (eastern).  Go here for additional information about the webinar and to register to participate.

HHS/Administration for Strategic Preparedness and Response – Health Care and Public Health Preparedness for Mass Gatherings Webinar – January 27

HHS’s Administration for Strategic Preparedness and Response (ASPR) will hold a webinar on health care and preparedness for mass gatherings on Tuesday, January 27 at 2:30 (eastern).  The purpose of the webinar is to help health care organizations and local, state, and federal authorities anticipate the public health and medical issues presented by mass gatherings and to help them prepare adequately for a range of response operations.  Learn more about the webinar from this ASPR notice, which includes information about the issues to be discussed and the speakers and a link to register to participate.  Space is limited so ASPR encourages early registration.

MACPAC – Commissioners Meeting – January 29-30

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, January 29 and Friday, January 30.  An agenda is not yet available but go here to register to participate.

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; registration information is not yet available.

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.

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.

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 participate from this CMS announcement.