Don’t Miss:

  • CMS posts a new presentation on Medicaid eligibility under HR 1
  • House health subcommittee marks up health care price transparency bills
  • Cassidy proposes 340B bill
  • HRSA announces two maternity-related funding opportunities

The following is the latest health policy news from the federal government for June 19-25.  Some of the language used below is taken directly from government documents.

Congress
  • The House Energy and Commerce Committee’s Oversight Subcommittee held a hearing to discuss integrity and fraud risk in state Medicaid programs; witnesses included state Medicaid directors from California, Minnesota, New York, and Ohio.  For more information, see the press release here, a live recording here, the witnesses’ testimonies here, and the chairman’s opening statement here.
  • The House Energy and Commerce Committee’s Health Subcommittee marked up bills seeking to expand health care price transparency – bills that might be included in a reconciliation package before the end of July, in an FY 2027 spending bill, or in an end-of-year bill.  Find a list of these measures here.
  • House Republican leaders continue to discuss the potential timeline and content of a third reconciliation bill, though the path forward for such a bill is not clear.
  • Senator Bill Cassidy, M.D. (R-LA), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, has released a legislative discussion draft that seeks to strengthen the 340B Drug Pricing Program to better serve vulnerable patients and families.  The proposed 340B Drug Pricing Integrity and Affordability for Patients Act would allow pharmaceutical companies to offer retroactive rebates, narrow the definition of “patient,” add new restrictions to contract pharmacies, and more.  Learn more about the bill and the reports, hearings, and investigations that led to it from
  • Only the House is scheduled to be in session next week; both chambers of Congress will return after the Independence Day recess on July 13.
 H.R. 1 Medicaid Eligibility

CMS has posted a new slide deck providing technical and operational guidance to help Medicaid and CHIP agencies implement the “Alien Medicaid Eligibility” portion of last year’s budget reconciliation bill, H.R. 1.  Find that presentation here.  (These slides are an updated version of the slide presentation CMS posted in May.)

The White House

 The White House has released “President Trump’s America First Resilience Strategy,” stating that its objective is to reduce risk, improve reliability of infrastructure and continuity of key services, deliver faster response and recovery, and promote investments that bring value and opportunity for Americans.

The document acknowledges the role of public health and safety in driving resilience, and states that “We must incentivize states and localities to develop durable fiscal and operational capacity to independently fund professional emergency management staff and first responders, scale capabilities, and bolster mutual assistance networks rather than relying persistently on federal intervention to address low-threshold events.  Find the resiliency strategy here.

Centers for Medicare & Medicaid Services (CMS)
  • CMS has posted a pre-publication draft of a proposed rule to update rates and policies under its Medicare end-stage renal disease (ESRD) prospective payment system and for acute kidney injury (AKI) dialysis payments for CY 2027.  CMS proposes increasing the Medicare ESRD base rate to $299.55.  CMS also proposes updating requirements for the ESRD Quality Incentive Program; changes in the low-volume payment adjustment and the payment adjustments for pediatric patients; an increase in the home and self-dialysis training add-on amount; and technical modifications of the transitional drug add-on payment adjustment (TDAPA) and a post-TDAPA add-on payment adjustment.  Learn more from this CMS news release and this pre-publication draft of the proposed rule.  The deadline for submitting comments will be 60 days after the official publication of the proposed rule, which is currently scheduled for June 26.
  • CMS has sent a change request to the MACs providing updates for the GUIDE Model’s Appendix A.  Find that change request here.  The changes it lists take effect on July 1.
  • CMS has posted a bulletin presenting the July 2026 update of its Medicare hospital outpatient prospective payment system.  The update, intended for hospitals, physicians, and others that bill Medicare, includes new billing codes and information about revised codes.  Find the bulletin here.
  • CMS’s Office of the Actuary has released health spending data and projections through 2034.  The office noted that total health care spending of $5.3 trillion in 2024 represented approximately 18 percent of the economy and projects that this figure will rise to $9 trillion, or 20.6 percent of the economy, by 2034.  Learn more from these Office of the Actuary resources and from the Health Affairs article “National Health Expenditure Projections, 2025–34:  Strong Utilization Growth Initially, Legislative Impacts Later,” which was written by CMS Office of the Actuary staff.
Department of Health and Human Services (HHS)
  • HHS has announced a coordinated department-wide effort to strengthen clinical research, accelerate the development of life-saving treatments, and ensure that patients have access to innovative therapies.  The major components of this effort are presented in a new department-wide strategy document that involves the FDA, the NIH, the Office of the National Coordinator for Health Information Technology (ONC), the Advanced Research Projects Agency for Health (ARPA-H), and HHS’s Office of the Inspector General.  Learn more from this HHS news release and the department’s strategy document.

Related components of this effort include:

    • An FDA announcement about the availability of revised draft guidance titled “Demonstrating Substantial Evidence of Effectiveness for Human Drugs and Biological Products.”
    • An FDA request for information soliciting comments on a proposal to establish a pilot program to shorten the time it takes from drug identification to human study while protecting clinical trial participants.
    • The FDA announcement “FDA Actions to Accelerate and Modernize Early and Late-Stage Clinical Development” and an accompanying fact sheet.
    • An HHS Office of the Inspector General request for information seeking comments on whether any additions or modifications are needed to the safe harbor regulations under the federal anti-kickback statute or the exceptions to the civil monetary penalty provision prohibiting inducements to beneficiaries for remuneration provided to individuals in connection with their participation in clinical trials.
  • HHS has announced the conclusion of the federal public health response to the Hantavirus exposure event associated with the M/V Hondius cruise ship.  Learn more from this HHS news release.
  • HHS’s Office of the National Coordinator for Health Information Technology (ONC) released Draft USCDI+ Quality Version 2 for public comment.  This draft builds on USCDI+ Quality Version 1, published on January 30, and reflects public feedback received during the Draft V2 submission period from January 30 through March 20.  Learn more about the revised draft from this ONC announcement and from the draft itself.  The deadline to submit comments is July 17.
  • Medicare could have saved $255.1 million on services for some new hospice enrollees, HHS’s Office of the Inspector General (OIG) has concluded in a new audit report.  Learn more about the problems the OIG found and its recommendations for addressing them from this OIG report.
HHS/Health Resources and Services Administration (HRSA)
  • HRSA has announced a funding opportunity for its Maternal Produce Prescription Program, which will provide grants to develop and implement community-based produce prescription programs and related nutrition education for maternal populations at risk of poor health outcomes due to nutrition insecurity and other health-related factors.  The program will award up to $13 million in grants of up to $500,000 each.  Learn more about the program and eligibility to apply for grants and to find additional information about how to apply for funding from this notice of the funding opportunity.  The deadline for submitting applications is July 17.
  • HRSA has announced a funding opportunity for its Maternal Health Emergency Management Training program, which is designed to improve emergency preparedness and the quality of care for pregnant and postpartum women in non-delivery and low-resource settings.  HRSA will award up to $3 million in grants.  Learn more about the program, including eligibility and how to apply for funding, from this notice of the funding opportunity.  The deadline for submitting applications is July 20.
  • HRSA has issued a “dear colleague” letter encouraging HRSA-supported workforce training programs to strengthen nutrition education across their curricula to better prepare future health professionals to incorporate nutrition into patient care.  Learn more from this HRSA announcement and the “dear colleague” letter.
Medicaid State Plan Amendments

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

  • Colorado – updating physician Alternative Payment Model reimbursement
  • Connecticut – personal care attendant wages
  • District of Columbia – FQHC rate rebasing
  • Georgia – rates for selected newborn screening services
  • Maine – updating Rural Health Clinic payment methodology
  • Michigan – updating coverage and reimbursement policies for behavioral health services
  • New Hampshire – updating nursing facility quality improvement payments
  • New Hampshire – updating nursing facility per diem payments
  • New Jersey – Medicaid fee-for-service rates
  • New Jersey – graduate medical education payments
  • Ohio – updating the state’s Comprehensive Maternal Care Program
  • South Carolina – updated DRG system
  • Wisconsin – dental payments
  • Wisconsin – updating the state’s alternative benefit plan
  • Wisconsin – updating inpatient hospital rates, the behavioral health policy adjuster factor, and the outlier trim point
Health Policy Newsletters, Reports, and Videos
Centers for Disease Control and Prevention (CDC)

The CDC has issued an order continuing the suspension of the right to introduce certain persons from countries where an outbreak of a quarantinable communicable disease exists.  This order was issued on June 21 and will remain in effect through July 21.  Learn more from the CDC’s formal notice.

Justice Department

As part of an effort to address Medicaid fraud, the Justice Department has announced charges against 455 defendants, including 90 doctors and other licensed medical professionals, for their alleged participation in health care fraud and opioid abuse schemes involving more than $6.5 billion in false claims.  The prosecutions cross 56 federal districts and 45 U.S. states and territories.  Learn more about the types of cases the Justice Department is pursuing and the penalties it seeks from this Justice Department news release.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC published an issue brief titled “Students with Individualized Education Plans in Medicaid,” examining differences in reported health status, access to care, and use of services between students with special education plans covered by Medicaid or the State Children’s Health Insurance Program (CHIP), those covered by both Medicaid and private coverage, and those with private health insurance.  For more information, see the issue brief here and the press release here.

Congressional Budget Office (CBO)

The CBO has posted a presentation of its perspective on the drivers of growth in federal Medicare spending from 2000 to 2024.  Find that presentation here.

Stakeholder Events

CMS – HIPAA Administrative Transactions Listening Session – July 1

CMS’s National Standards Group is conducting a listening session to solicit perspectives from the Designated Standards Maintenance Organizations and Workgroup for Electronic Data Interchange.  During this three-hour session, to be held on Wednesday, July 1 at 1:00 (eastern), CMS will share information and provide feedback on a series of questions disseminated in advance regarding Version 8060 HIPAA Administrative Transactions.  Go here to register to participate.

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.

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.