The following is the latest health policy news from the federal government for July 25-31.  Some of the language used below is taken directly from government documents.

Congress

The House recessed last week and the Senate is still in session.   When Congress returns in September its top priority will be funding the federal government before the fiscal year ends on September 30, likely requiring a continuing resolution to avoid a shutdown.  Several major health care programs and extenders are set to expire at the end of the fiscal year, including Medicaid DSH allotments, telehealth flexibilities, the Acute Hospital Care at Home program, and the Medicare-dependent hospital and low-volume hospital programs.  Lawmakers are preparing a broad health care package for action this fall that could address these expirations along with potential reforms in Medicare Advantage, pharmacy benefit manager regulation, Medicare site-neutral payment policies for hospitals, and Medicare reimbursement changes for long-term acute-care hospitals.

The White House

The White House has issued an executive order titled “Ending Crime and Disorder on America’s Streets” that includes references to the health care industry.  In describing the homeless population, it maintains that most of this population is addicted to drugs or suffers from a mental health condition and suggests that many should be moved into institutional settings.  It calls for providing technical guidance, grants, and more to treat those who pose a danger to others and cannot care for themselves; making greater use of assisted outpatient treatment and treatment centers; assessing the capacity of state and local jails and hospitals to accommodate such individuals; and ensuring that discretionary federal grants not support harm reduction or safe consumption programs.  It also calls on HHS to provide technical assistance to assisted outpatient treatment programs for individuals with serious mental illness or addiction during and after the civil commitment process and to ensure that federal funds for Federally Qualified Health Centers and Certified Community Behavioral Health Clinics reduce rather than promote homelessness by supporting comprehensive services for individuals with serious mental illness and substance use disorder, including crisis intervention services.  Learn more from this executive order and an accompanying fact sheet.

340B and Hospitals

CMS has issued a sample of the 340B drug acquisition cost survey it plans to use to collect hospital-specific data next year.  For a closer look at this Medicare outpatient prospective payment system survey, why CMS is undertaking it, and the type of data the agency will seek, see this CMS notice, which includes a link to an automatic zip file download with CMS’s explanatory statement and an Excel file that shows the data the agency will seek.

Centers for Medicare & Medicaid Services
  • CMS has published a notice to alert certain clinicians who are qualifying Alternative Payment Model (APM) qualified participants (QPs) and have earned an APM incentive payment that CMS does not have the current information it needs to disburse their payments.  This advisory provides information to QPs on how to update their Medicare billing information so CMS can disburse APM incentive payments.  Go here to find that advisory, which includes a link to a list of qualifying providers for whom CMS does not have adequate billing information and a phone number providers can call for further information.  The deadline for CMS to receive the information it needs to distribute these payments is September 1.
  • CMS and the administration have announced that they have secured commitments from major health care and information technology firms, including Amazon, Apple, Google, and OpenAI, to begin laying the foundation for a next-generation digital health ecosystem that will seek to improve patient outcomes, reduce provider burden, and drive value.  This effort will focus on two broad areas:  promoting a CMS interoperability framework to facilitate the sharing of information between patients and providers and increasing the availability of personalized tools for consumers.  More than 60 companies pledged to work collaboratively to deliver results in the first quarter of 2026; 21 networks pledged to meet the CMS interoperability framework criteria to become CMS aligned networks; 11 health systems or providers committed to participating in and supporting patient use; and seven electronic health record (EHR) companies committed to facilitating data exchange.  Learn more about this initiative from this CMS news release.
  • CMS has posted two videos about providers’ involvement with the Independent Dispute Resolution (IDR) process.  The first demonstrates how parties initiate a Notice of IDR Initiation web form to create a dispute and start the federal IDR process and can be found here and the second demonstrates how parties respond when they receive a Notice of IDR Initiation from an IDR entity; the latter can be found here.
  • CMS has updated its June 2025 Medicare bulletin “CD-10 & Other Coding Revisions to National Coverage Determinations:  October 2025 Update” to clarify when it will deny hepatitis C virus screening claims.  Find the updated bulletin here.
  • CMS has posted the bulletin “Medicare Acute Kidney Injury Renal Dialysis Billing:  Additional Revenue Codes.”  Find the bulletin here.
  • CMS has posted a bulletin with its Medicare laboratory national coverage determination (NCD) edit software updates for October of 2025.  Find the bulletin here.
  • CMS has released preliminary technical Medicare Part D bid information for contract year CY 2026 to help Part D plan sponsors finalize their Part D and Medicare Advantage offerings and prepare for Medicare open enrollment.  CMS also has released updated parameters for CY 2026 for the voluntary Part D Premium Stabilization Demonstration to continue supporting implementation of the redesigned Part D benefit and improve stability for people with Medicare in 2026.  Learn more from this CMS news release.
  • CMS should take additional actions to help hospitals prepare for a future emerging infectious disease outbreak, HHS’s Office of the Inspector General has concluded in a new report that includes recommendations for those additional actions.  Find that report here.CMS has released a fact sheet on the Medicare Advantage Risk Adjustment Data Validation (RADV) program, which it uses as its basis for payments to Medicare Advantage organizations.  The agency notes that to combat waste and abuse in Medicare Advantage it is significantly expanding and accelerating its RADV audits.  Find that fact sheet here.
  • CMS has revised its May 2023 memo to state Medicaid programs providing guidance for the expiration of the COVID-19 public health emergency to announce that focused infection control surveys are no longer part of the standard survey process for long-term care and acute and continuing care providers and that any COVID-19 or infection control concerns should be conducted through complaint investigations outside of the long-term care survey process.   Learn more from the revised CMS memo.
  • CMS has rescinded memorandum QSO-20-31-ALL, the Enhanced Enforcement for Infection Control Deficiencies, which applied to nursing homes, and replaced it with revised guidance for Strengthened Enhanced Enforcement for Infection Control Deficiencies, effective July 30.  This revised guidance strengthens enforcement for non-compliance with infection control deficiencies and includes enhanced enforcement actions that are more stringent for infection control deficiencies that result in actual harm or immediate jeopardy to residents.  Learn more from this CMS announcement.
  • Effective July 30, CMS has rescinded its guidance memo Enhanced Oversight and Enforcement of Non-Improving Late Adopters, which applied to nursing homes and the care of their long-stay residents, and has referred affected facilities to separate guidance introduced earlier this year.  Learn more about the rescinded guidance from this CMS notice and find the separate guidance that now takes precedence here.
  • CMS has granted exceptions for certain Medicare quality reporting and value-based purchasing program reporting requirement deadlines to providers and facilities located in areas of Texas affected by the recent severe storms, winds, and flooding.  Learn more about the parts of the state to which these exceptions apply and the measures for which exceptions have been granted from this CMS notice and the Texas waivers listed here.
  • CMS has added the following items to its Quality Payment Program resource library.  All of these links are direct downloads of zip files.
HHS and National Health Care Data

HHS has announced the publication of its “Living HHS Open Data Plan” and the rollout of a refreshed HealthData.gov website.  The Living HHS Open Data Plan will continue to be refined to provide stakeholders with HHS data with the goal of delivering improved services.  The refreshed HealthData.gov website features improved data quantity, enhanced data quality, and three new HHS assets for public use:  the HHS Open Data Plan (Version 1.0), the HHS Metadata Standard (Version 1.0), and the HHS Data Inventory (Version 1.0).  These resources bring together formerly siloed divisions under one HHS umbrella.   Learn more about these initiatives from this HHS news release and find the Living HHS Open Data Plan here.

Department of Health and Human Services
  • HHS has announced a $100 million pilot project to prevent, test for, treat, and cure hepatitis C in individuals with substance use disorders and or serious mental illness.  The program will seek to support communities severely affected by homelessness and to gain insight on effective ways to identify patients, complete treatment, cure infections, and reduce reinfection by hepatitis C.  The program will be administered by HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA).  Learn more about the program from this HHS news release and this notice of the funding opportunity.  The deadline for submitting application is August 1.
  • HHS’s Office of the Inspector General (OIG) has issued two reports criticizing the efforts of hospitals to capture and report patient harm events.  In the first, it found that hospitals did not capture half of patient harm events they experienced, limiting information needed to make care safer.  In addition, among the patient harm events that hospitals did capture they investigated few of those events and even fewer led to them making improvements for patient safety.  Go here to find that report, which includes the OIG’s recommendations.  In a related finding, the OIG concluded that even when hospitals captured such patient harm events it reported few of them to CMS and the states.  Go here to learn more about what the OIG found and what it recommends for addressing this shortcoming.
  • HHS’s Health Resources and Services Administration (HRSA) seeks input from industry and stakeholders to inform the development of a formal request for proposals for the Scientific Registry of Transplant Recipients to support ongoing evaluation of the scientific and clinical status of solid organ transplantation.  Learn more from this HRSA announcement and this notice.  The deadline for submitting comments is August 11.
  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) has released the results of its 2024 National Survey on Drug Use and Health, which shows how Americans reported their experience with mental health conditions, substance use, and their pursuit of treatment.  Find a summary of the study’s findings and a link to the complete report in this SAMHSA news release.
  • HHS’s Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology has published a bulletin about United States Core Data for Interoperability Version 6 (USCDI v6).  The USCDI sets the foundation for access, exchange, and use of electronic health information with the goal of enabling nationwide interoperable health information exchange.  This bulletin  \updates the USCDI, including the agency’s consideration of submissions of new data elements, stakeholder comments on previously submitted data elements, and the evolving maturity of data elements specified in the USCDI+ Program.  Find the bulletin here.
  • HHS’s Agency for Healthcare Research and Quality (AHRQ) has launched a brief survey about organizations’ use of its quality indicators  for quality improvement, benchmarking, reporting, or research.  The agency intends to use what it learns to improve those indicators.  Go here to learn more about AHRQ’s initiative and to take the survey.
  • HHS’s Office of the Assistant Secretary for Planning and Evaluation has published an issue brief on the use of participant compensation in clinical research studies.  Find that paper here.  A companion issue brief addresses some of the factors that influence the participation of individuals in clinical trials – factors that include but are not limited to participant compensation.  Find that paper here.
  • HHS, the FBI, the Cybersecurity & Infrastructure Security Agency (CISA), and the Multi-State Information Sharing & Analysis Center have issued a joint cybersecurity advisory presenting actions for organizations to take to mitigate cyber threats related to interlock ransomware activity.  The advisory describes the nature of these threats, which pose a threat to health care and public health organizations, and offers information about prevention, detection, and mitigation and directs readers to additional resources.  Find the advisory here.
Approved Medicaid State Plan Amendments

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

  • To Indiana, updating state plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures in the Adult Core Set.
  • To Oregon, confirming that the state allows retroactive enrollment of eligible providers.
  • To Arizona, updating the Standards for Coverage of Organ Transplant Services to include small bowel transplant as a covered service for adults aged 21 years and older.
  • To Tennessee, updating the state’s limitations on the amount, duration, and scope of coverage for prescribed drugs and updating the state’s excluded drug list.
  • To Delaware, updating the methodology for pediatric nursing facility care that currently applies only to participants up to age 21 to allow for the continuation of the existing reimbursement methodology for a limited number of individuals under specific circumstances.
  • To Kansas, adding reimbursement rates for the Women, Infants and Children (WIC) supplement.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects  – July 31
  • AHRQ News Now – July 29
  • CMS – in an introductory webinar for the CMS Qualified Health Plan (QHP) Directory Pilot, CMS demonstrates how participants log into the system, learn what is expected of National Provider Identifier (NPI ) Type 1 providers, NPI Type 2 organizations, and their designated delegates or surrogates, and receive a guided tour of the portal, including the key workflows used to review and verify information.  Find this video here.
  • CMS – CMS’s Center for Medicare and Medicaid Innovation has posted the fourth annual evaluation report for its Maternal Opioid Misuse (MOM) Model and a summary of that report.
Centers for Disease Control and Prevention (CDC)

The Senate has confirmed Susan Monarez, PhD, to serve as CDC director.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC has published an issue brief on spending and utilization for Medicaid-covered home- and community-based services.  Find that issue brief here.

Stakeholder Events

CMS – Advisory Panel on Hospital Outpatient Payment Meeting – August 25

CMS’s Advisory Panel on Hospital Outpatient Payment will meet virtually on Monday, August 25 at 9:30 (eastern).  The panel advises CMS on the clinical integrity of the Ambulatory Payment Classification (APC) groups and their associated weights.  Learn more about the panel and the meeting’s agenda from this CMS formal notice.  The deadline for submitting comments and questions is August 1.

MedPAC – Commissioners Meeting – September 4-5

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, September 4 and Friday, September 5.  An agenda and registration information are not yet available but when they are they will be posted here.

MACPAC – Commissioners Meeting – September 18-19

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, September 18 and Friday, September 19.  An agenda and registration information are not yet available but when they are they will be posted here.