Don’t Miss:

The following is the latest health policy news from the federal government for July 17-23.  Some of the language used below is taken directly from government documents.

Congress
  • The House Energy and Commerce Committee held a markup for 29 bills, advancing the following health care transparency measures with bipartisan support:
    • H.R. 9390, Prices on the Wall Act of 2026
    • H.R. 9393, Lower Costs, More Transparency Act of 2026, part of a package that also includes:
      • H.R. 3514, Improving Seniors’ Timely Access to Care Act of 2025
      • H.R. 9397, Premium Transparency Act
      • H.R. 9396, Prior Authorization Accountability Act
      • H.R. 9392, Medicare Advantage Cost Transparency Act
      • H.R. 5243, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage

For more information, see the chairman’s opening remarks here, the press release here, and a recording of the markup and the full list of considered bills here.

  • The Senate Health, Education, Labor and Pensions (HELP) Committee advanced various bills, notably S. 2355, the Patients Deserve Price Tags Act.  If enacted, the bill would require hospitals to publish standard charges and shoppable services in a standardized, machine-readable format, with penalties of up to $10 million for persistent violators.  For more information, see the chairman’s opening remarks here and the bill’s section-by-section summary here.
  • Representatives John Joyce (R-PA), Kim Schrier (D-WA), and Greg Murphy (R-NC) have introduced the bipartisan Patients First Act (H.R. 9693), which seeks to reform the Medicare Access and CHIP Reauthorization Act (MACRA).  The bill would tie Medicare physician reimbursement to an inflation measure, address seniors’ access to care by creating incentives for independent practices, and reverse consolidations that affect the cost of care.
    • Lawmakers hope to include this bill in a possible end-of-year health care package.  For more information see the bill’s press release here, a section-by-section summary here, and bill text here.
  • The House passed a continuing resolution (CR) to fund the federal government from October 1 through December 4.  The House’s bill maintains agency funding at current levels and does not include any of the spending increases for specific accounts (“anomalies”) requested by the White House.  The Senate may take up a CR before adjourning next week but it will likely be different from the House bill.
  • The House advanced a budget resolution that outlines instructions for a third party-line budget reconciliation bill to provide funding for the military, farm aid, and to enact portions of the president’s election security proposals.  The only mention of health care in the resolution is directed at expanding the administration’s focus on fraud, waste, and abuse in Medicare and Medicaid.  The Senate does not appear likely to take up a budget resolution before August recess.
  • The House now departs for a five-week recess, leaving on July 23 and returning on August 31, and the Senate will leave on August 7 and return on September 14.
CMS – Proposed Provider Tax Rule

CMS has published a proposed rule that would implement a portion of H.R 1, last year’s federal budget reconciliation bill, that called for establishing new indirect hold-harmless thresholds for health care-related taxes – primarily, provider taxes, which are currently employed in 49 states and the District of Columbia.

Major changes include replacing the six percent safe harbor with state-specific thresholds based on July 4, 2025 structures; prohibiting states from introducing new provider taxes or increasing existing provider taxes that were in effect on that same date; phasing down the provider tax ceiling to 3.5 percent for expansion states starting October 1, 2027; and eliminating the alternative 75/75 compliance test, which CMS uses to assess whether at least 75 percent of the taxed taxpayers receive back 75 percent or more of their tax costs in the form of Medicaid or other state payments.

As proposed, this regulation would limit the ability of states to fund their Medicaid programs and providers to serve their Medicaid and low-income patients and could lead to dramatic reductions in Medicaid services and payment rates.  CMS projects that this rule would reduce federal Medicaid spending by an estimated $246 billion from 2026 through 2035, potentially leaving large gaps in state Medicaid budgets.  Learn more about the proposed rule from this CMS fact sheet and the proposed rule.  The deadline for submitting comments is September 21.

The Courts
  • The federal district court for Maryland has issued a temporary stay in the implementation of eight provisions in CMS’s Affordable Care Act marketplace rule – provisions that were to take effect on July 20.

Acting because it concluded that the plaintiffs were likely to succeed in their challenge to the provisions in question, the court vacated the following provisions:  the expansion of eligibility for catastrophic plans through an income-based hardship exemption; expansion of annual maximum out-of-pocket limits and revised cost-sharing requirements for some bronze and catastrophic plans; an easing of federal network adequacy requirements; creation of a means for non-network plans to qualify as marketplace plans; the elimination of standardized plans; a policy disqualifying individuals from receiving subsidies if they fail to reconcile premium tax credits with their income; selected income verification requirements; and the introduction of stricter eligibility checks prior to special enrollment periods.  Some of these provisions, though, were included in last year’s budget reconciliation bill, H.R. 1, and therefore will be implemented beginning on July 1, 2027.  Learn more from the court’s ruling in the case of City of Columbus v. Kennedy.

  • A federal court of appeals for the District of Columbia has upheld a lower court ruling that pharmaceutical companies may not impose rebate models for the 340B drug pricing program without the approval of the Department of Health and Human Services.  Learn more from the court’s ruling in the case.
Department of Homeland Security

The Department of Homeland Security has issued a final rule changing the non-immigrant visa admission period in the F, J, and I classifications from “duration of status” – that is, the anticipated length of a specific training program – to admission for a fixed period of time.  As a result, students in some medical education programs may need to apply for extensions of their visas.  Learn more from the final regulation, which will take effect on September 15.

Department of Health and Human Services (HHS)
  • States have missed some opportunities to improve Medicaid managed care organizations’ provider fraud referrals, HHS’s Office of the Inspector General (OIG) has concluded after a recent audit.  Learn more about the findings that led to this conclusion, the OIG’s recommendations for addressing these problems, and CMS’s reaction to those recommendations from this OIG report.
  • HHS’s Health Resources and Services Administration (HRSA) has issued a news release on behalf of is Organ Procurement and Transplantation Network (OPTN) explaining that it is shortening the required testing windows in living and deceased donors for human immunodeficiency virus (HIV) and West Nile virus nucleic acid testing from the current 28 days and 14 days, respectively, to a uniform requirement that testing be performed within seven days prior to organ recovery.  Learn more from this news release.
Centers for Medicare & Medicaid Services (CMS)
  • CMS has published guidance on required remittance advice remark codes, or RARCs, and claim adjustment reason codes, or CARCs, that insurers must use in the No Surprises Act’s independent dispute resolution process for out-of-network claims; CARCs explain why a claim or service line was paid differently from how it was billed and RARCs provide additional explanation for the remittance.  The guidance applies to out-of-network services and items provided on or after January 1, 2027.  Learn more about the RARCs and CARCs and their intended use in the No Surprises Act’s independent dispute resolution process from this CMS announcement and this CMS guidance.
  • CMS has issued draft guidance providing detailed processes and requirements for manufacturer implementation of the maximum fair price (MFP) for 2028 under the Medicare Drug Price Negotiation Program, which calls for pharmaceutical companies to negotiate MFPs for certain high-expenditure, single-source drugs and biological products.  When issued later this year, the final guidance will supersede portions of guidance that cover 2026 through 2028.  Find the draft program guidance here and the current (2026-2028) guidance here.  The draft guidance also describes procedures that may apply to drug manufacturers, Medicare Part D plan sponsors, Medicare Advantage organizations, pharmacies, mail order services, and other entities that dispense drugs covered under Medicare Part D in addition to hospitals, physicians, and other providers of services and suppliers that furnish or administer drugs payable under Medicare Part B.  The deadline for submitting comments is September 18.
  • CMS has posted an updated FAQ on Protecting Access to Medicare Act of 2014 (PAMA) reporting requirements for private payer clinical diagnostic laboratory data under its Clinical Laboratory Fee Schedule.  Find the updated FAQ here.
  • CMS has written to state survey agency directors rescinding two 2020 memos that sought to ensure the ability of nursing home residents to vote and replacing them with new guidance on the subject.  The new memo, titled “Protecting the Voting Rights and Autonomy of Vulnerable Residents in Long-Term Care (LTC) Facilities,” reiterates past guidance by reminding nursing facilities of their obligation to promote participation in the democratic process for residents while complying with all applicable federal and state laws and regulations and warns them to avoid instances of coercion or otherwise violating resident rights or voter protection laws, citing specific instances of such coercion and violations in recent years.  Learn more from the new memo from CMS to state survey agencies.
  • CMS has posted updated resources for requirements and best practices for its hospice quality reporting program.  Find them here.
  • CMS is offering web-based training that provides an overview of the Home Health Quality Reporting Program, including its purpose, reporting requirements, and quality data sources.  The course reviews Outcome and Assessment Information Set and Home Health Consumer Assessment of Healthcare Providers and Systems Survey reporting requirements, explains how quality measures and star ratings are calculated and publicly reported, and highlights key CMS resources, help desks, and subscription options to support compliance with home health quality reporting requirements.  Go here for further information about the program and how to participate in it.
  • CMS has announced the upcoming release of public data assets in open, machine-readable formats under an open license.  This data, according to the agency, is “…intended to support public engagement in identifying and preventing fraud, waste, and abuse, and to promote transparency and accountability.”  Learn more about the specific data CMS will be releasing and how to find it from this CMS notice.
  • CMS has added the following item 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.)
Medicaid State Plan Amendments

CMS has approved state plan amendments for Medicaid and CHIP programs in the following states:

  • Arkansas, adding rehabilitation services rates for acute inpatient hospitals
  • California, establishing a reimbursement rate methodology for community health worker services
  • Washington, addressing per diem payments for acute inpatient withdrawal management services
Health Policy Newsletters, Reports, and Videos
  • CMS – MLN Connects – July 23
  • CMS – CMS blog entry “Strengthening Original Medicare” – a summary of recent CMS actions – July 16
  • CMS – CMS has posted a brief video demonstrating how providers can submit their data for PRO-PM (Patient-Reported Outcome-Based Performance) measures
  • CMS – CMS has posted a video of the July 14 meeting of the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests
  • HHS – “This Week at HHS/OIG” – video –July 17
  • HHS/Administration for Strategic Preparedness and Response (ASPR) – ASPR TRACIE newsletter “The Express” – July
  • HHS/Health Resources and Services Administration (HRSA) – Office for the Advancement of Telehealth – announcements, July 23
  • HHS/HRSA – HRSA has posted videos of three recent Organ Procurement and Transplantation Network (OPTN) events – an April 10 executive committee meeting, an April 16 ad hoc board of directors meeting, and an April16 board of directors meeting
  • HHS/ Office of the Assistant Secretary for Planning and Evaluation (ASPE) – “The Changing Insulin Affordability Landscape:  Lower Out-of-Pocket Costs and Expanded Access Pathways” – July 2026 issue brief
  • HHS/ASPE – “Harnessing the Value of Electronic Health Record Data for Research” – report
  • Government Accountability Office (GAO) – “Program Integrity:  Actions Needed to Reduce Improper Payment and Fraud Risks in VA Community Care and Medicare Advantage” – July 21 report
Department of Labor

The Department of Labor has published a proposed rule setting forth a new, additional safe harbor for group health plan administrators to use electronic media, such as email and web portals, to furnish documents and information to participants and beneficiaries of plans subject to the Employee Retirement Income Security Act of 1974 (ERISA).  This proposal would enable plan administrators that satisfy specified conditions to provide participants and beneficiaries with a notice that certain disclosures will be made available electronically on a website.  Learn more from the proposed rule.  The deadline for submitting comments is September 21.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC has submitted a comment letter in response to CMS’s proposed FY 2027 rule on Medicaid managed care state directed payments and fee-for-service targeted practitioner payments.  In the letter, MACPAC supports CMS’s proposal to ensure that Medicaid payments are consistent with the statutory principles of economy, efficiency, access, and quality but expresses concerns that the proposed application of the Medicare-based limits on state directed payments and targeted fee-for-service practitioner payments at the service level may limit states’ flexibility to use payment policy to achieve  the policy goals of access and quality.  The letter also notes that Medicare payment rates are not designed to support some of the different populations covered under Medicaid, such as children and pregnant women.  Find the MACPAC letter to CMS here.

Medicare Payment Advisory Commission (MEDPAC)

MedPAC has published “July 2026 Data Book:  Health Care Spending and the Medicare Program,” providing information on national health care and Medicare spending, Medicare beneficiary demographics, dually eligible beneficiaries, quality of care in the Medicare program, and Medicare beneficiaries’ supplemental coverage and financial liability.  Find the publication here.

Accreditation Council for Graduate Medical Education (ACGME)

The ACGME’s Common Program Requirements Major Revision Task Force is seeking the perspectives of the graduate medical education community on its common program requirements for fellowships and is asking stakeholders to help disseminate its Fellowship Stakeholder Survey, with a special interest in reaching residents and recent graduates.  Find the survey here.  The deadline for submitting responses is August 7.

Congressional Budget Office (CBO)

The CBO describes a new framework for allocating the budgetary effects of changes to Medicaid policies to households in its new report “Current Work on the Distributional Analysis of Household Income Resulting From Changes to Medicaid Policies:  Working Paper 2026-09.”  The framework accounts for changes in income for Medicaid enrollees, health care providers, and private insurers.  Find the report here.

Stakeholder Events

CMS – Overview of the 2027 Quality Payment Program Proposed Policy  – July 29

CMS will hold a webinar on Wednesday, July 29 at 1:00 (eastern) to provide an overview of quality payment program (QPP) policies in the proposed 2027 Medicare physician fee schedule rule.  Learn more about the webinar, including how to register to participate – registration is mandatory – from this CMS notice.

CMS – 2026 National Provider Compliance Conference – August 11–12

On Tuesday, August 11 and Wednesday, August 12, CMS will hold a national provider compliance conference that will bring together Medicare Administrative Contractors (MACs) and Center for Program Integrity experts to provide compliance professionals with the information and tools they need to submit Medicare Part A, Part B, home health and hospice, and durable medical equipment claims.  Learning opportunities will include individual presentations, Q&A segments, panel discussions, and a dedicated exhibit area for engagement between MACs and providers.  The target audience for this conference is Medicare fee-for-service providers only, including medical review contractors, compliance officers, nurse and billing managers, medical record staff, coders, and provider associations.  Go here to learn more about the conference and to register to participate.  The conference will be held in Charlotte and will have no virtual component and a limited number of participants.

CMS – Advisory Panel on Hospital Outpatient Payment – August 24

CMS’s Advisory Panel on Hospital Outpatient Payment will meet virtually on Monday, August 24 at 9:30 (eastern).  The purpose of this panel is to advise CMS on the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, which are major elements of the Medicare hospital outpatient prospective payment system and the ambulatory surgical center payment system and supervision of hospital outpatient therapeutic services.  Interested parties are invited to submit comment letters and presentations.  Learn more about submitting such materials and how to participate in the meeting from this CMS notice.

MedPAC – Commissioners Meeting – September 3-4

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, September 3 and Friday, September 4.  An agenda for the meeting and information about how to participate has not yet been posted; when they are, they will be found here.

MACPAC – Commissioners Meeting – September 24-25

MACPAC’s commissioners will hold their next public meeting on Thursday, September 24 and Friday, September 25.  An agenda for the meeting and information about how to participate has not yet been posted; when they are, they will be found here.