The following is the latest health policy news from the federal government for May 30 to June 5.  Some of the language used below is taken directly from government documents.

Congress

Congress returned to Washington D.C., where Republican senators continue to work on their version of a reconciliation bill with a goal of passage by the full Congress by July 4.  Some Senate committees have begun releasing their portions of the bill but the committees with jurisdiction over Medicaid – the Finance and Health, Education, Labor, and Pensions (HELP) committees – have not committed to a timeline for their bills.  Among the majority party in the Senate, fault lines around the House-passed reconciliation bill remain around Medicaid provider taxes, state and local tax (SALT) deductions, food stamps, clean energy provisions, the overall cost of the bill, and more.  Any changes made to the bill to gain enough votes for passage in the Senate will have to pass the House’s equally slim majority before it can become law.

Congressional Budget Office – Projected Impact of House Reconciliation Bill

In response to a request from the ranking members of the House Energy and Commerce Committee, House Ways and Means Committee, and the Senate Finance Committee, the Congressional Budget Office (CBO) has analyzed the potential effect of the House-passed budget reconciliation bill on the uninsured rate in the U.S. and concluded that “CBO estimates that enacting H.R. 1 [note:  the House reconciliation bill], as passed by the House, would increase the number of people without health insurance by 10.9 million in 2034, relative to baseline projections under current law.”  Of that 10.9 million, 7.8 million would lose Medicaid coverage; 1.3 million would lose coverage because of Title IV changes in health insurance marketplace policies; 2.3 million would lose coverage because of Title VI changes in federal health insurance practices; and 500,000 people would gain insurance as a result of other provisions in the bill.  The CBO also projects that two other policies incorporated into its baseline budget projections under current law would add another 5.1 million people to the ranks of the uninsured, raising the total to 16 million people to be newly uninsured by 2034.  Learn more from this CBO analysis letter (the link on this page leads to a direct download).

The CBO also estimates that implementation of the House reconciliation bill would add $2.4 trillion to the federal deficit.  Learn more from this CBO analysis  (the link on this page leads to a direct download).

Proposed HHS Budget

The Department of Health and Human Services has released a new, expanded version of its proposed FY 2026 budget.  In some areas this version provides more detail than the administration shared in early May when it released a so-called “skinny budget” and some aspects of the budget proposal differ from the May release.  Highlights of the most recent proposal include:

  • A reduction of 25 percent, from $126 billion to $94.7 billion, in HHS’s overall discretionary (non-mandatory) spending.
  • The consolidation of HHS’s 28 current operating divisions into 15 divisions.
  • A reduction of $661 million, or 11 percent, in discretionary spending for CMS.
  • The shifting of the 340B prescription drug pricing program into CMS.
  • The elimination of the Health Resources and Services Administration (HRSA, which currently administers 340B), the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute for Occupational Safety and Health, some CDC programs, and others and the absorption of their responsibilities under a new “Administration for a Healthy America.”  This reorganization would include a reduction of funding for some current SAMHSA programs.
  • The consolidation of the Community Mental Health Services Block Grant, the Substance Use Prevention, Treatment and Recovery Support Services Block Grant, and State Opioid Response grants into a single new $4 billion Behavioral Health Innovation Block Grant.
  • A reduction of $3.9 billion in the CDC’s budget.
  • A reduction of $18 billion in the NIH’s budget – about one-half of its current budget – and the consolidation of its current 27 institutes and centers into eight such entities.
  • A reduction of $409 million in the FDA’s budget.
  • The creation of a new “Administration for Children, Families, and Communities” that would include the current Administration for Children and Families and the Administration for Community Living.
  • The absorption of the Agency for Healthcare Quality Research into the Office of the Secretary.

As we noted when the first version of this budget was released last month, administration budget proposals have historically received little serious consideration before being dismissed by Congress – a circumstance that has not varied based on the party of the president submitting the budget or the party in the majority in Congress.  Their significance is generally that they present a statement of an administration’s priorities and plans.  Learn more from HHS’s proposed FY 2026 budget.  Also, this will not be the final word from the administration on its FY 2026 spending plans for HHS; it has indicated that when an FY 2025 budget reconciliation bill is adopted it will provide further information on its FY 2026 plans.

Centers for Medicare & Medicaid Services
  • Center for Medicaid and CHIP Services director and deputy administrator Drew Snyder has resigned from his position.  He reportedly will be replaced on an interim basis by Dr. Caprice Knapp, former director of North Dakota’s Medicaid program.
  • CMS has rescinded 2022 guidance advising hospitals that their obligations under EMTALA to provide emergency care to patients who are pregnant or experiencing pregnancy loss, including performing abortions under such emergency circumstances, supersede state laws prohibiting abortions and that the agency intended to enforce that requirement.  Now, CMS has issued two documents conveying this position:  one that rescinds the 2022 EMTALA policy enforcement memo CMS sent to state governments and another that rescinds a 2022 letter that the HHS Secretary sent to health care providers describing his agency’s policy.  The original documents convey a policy that, according to a CMS news release, “…do not reflect the policy of this Administration.”  Find that news release here.
  • CMS has issued a memo updating its guidance on the applicability of CLIA regulations to testing associated with blood, cells/tissue, and organs for transfusion, implantation, infusion, or transplantation.  Find the CMS memo here.
  • CMS has updated its recent bulletin about the implementation of changes in the end-stage renal disease (ESRD) prospective payment system and payment for renal dialysis services furnished to individuals with acute kidney injury for calendar year 2025.  Find the updated bulletin here.
  • CMS has hired a contractor to develop episode-based cost and value measures and is creating a technical expert workgroup to provide clinical input on each aspect of the specifications of the breast cancer screening episode-based cost measure.  This cost measure is being specified at the clinician group/clinician-level for potential use in the Merit-based Incentive Payment System (MIPS); this workgroup is separate from a similar panel CMS is convening for a facility-based breast cancer screening quality measure.  Learn more about the workgroup, its objectives, the specific background CMS seeks from workgroup members, the time commitment involved, and how to apply to participate from this CMS notice.  The deadline for applying is June 23.
  • CMS has announced its intent to initiate additional data collection from Medicare Part C and D plans as finalized in an April 2024 rule that addresses prior authorization and coverage determinations.  The data CMS seeks to collect would give the agency the ability to collect more granular data about plan activities regarding adjudicating requests for coverage and plan procedures for making service utilization decisions.  According to CMS, data elements it proposes collecting would provide data on the utilization of benefits, enhance audit activities to ensure that plans are operating in accordance with CMS guidelines, and ensure appropriate access to covered services and benefits.  Learn more about the data CMS seeks to collect from the Paperwork Reduction Act notice titled “Service Level Data Collection for Initial Determinations and Appeals,” which includes a direct download of a zip file.
  • CMS has added the following items to its Quality Payment Program resource library.  All of these links are direct downloads of zip files.
Department of Health and Human Services
  • Thomas Keane, MD, MBA, has been appointed Assistant Secretary for Technology Policy and National Coordinator for Health Information Technology.
  • HHS’s Health Resources and Services Administration (HRSA) is accepting applications for participation in its pediatric specialty loan repayment program.  Learn more about the program, how much aid is available, which pediatric disciplines are included by the program, and how to apply from this HRSA notice, which also offers information about webinars for interested applicants.  The deadline to apply is July 17.
  • HHS’s Office of the Inspector General has submitted its spring 2025 semi-annual report to Congress.  Find that report here.
Approved Medicaid State Plan Amendments and State-Directed Medicaid Payments

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

  • To Connecticut, updating the state’s excluded drug listing.
  • To Connecticut, updating the Community First Choice program to comply with a collective bargaining agreement.
  • To Nevada, adding community health representatives as reimbursable providers only through a Tribal Health Clinic operating under the Indian Self-Determinations and Education Act of 1975.
  • To Wyoming, providing an exemption to the state requirements to contract with a Medicaid Recovery Audit Contractor from July 1, 2025 – June 30, 2027.
  • To Washington state, addressing Medicaid and CHIP requirements for certain Medicaid- and CHIP-eligible juvenile beneficiaries who are pending disposition of charges.
  • To Washington state, adding certified anesthesiologist assistants and dental therapists to the “other licensed providers” section of the state plan.
  • To North Dakota, extending the exemption for a Recovery Audit Contractor.
  • To New Hampshire, updating the quarterly pool amount and total Medicaid day count for the state’s nursing facility supplemental payment for both private and non-state government-owned and operated facilities.
  • To New Hampshire, updating the process for setting rates for nursing facilities when ownership has changed.
  • To New Hampshire, updating the rates and clarifying methodology language for laboratory services, radiology services, and durable medical equipment.
  • To Louisiana, increasing payments to FQHCs by $50 per encounter, to be reimbursed through an alternative payment methodology.
  • To Maryland, adding the recently signed intra-agency agreement between Maryland Medicaid and the Office of Health Care Quality to the Maryland state plan.
  • To New Jersey, to reimburse opioid treatment programs for the delivery and provision of methadone medication-assisted treatment in a rehabilitation setting or long-term-care setting.
  • To North Carolina, revising hospital readmission review requirements from 30 days to 72 hours to align with clinical policy.
  • To Michigan, aligning the non-emergency transportation mileage rate with the Internal Revenue Service standard business rate.
  • To Texas, updating high-cost clinician-administered drugs and biologics, human breast milk processing storage and distribution, and long-acting reversible contraceptive devices to pay outside the all patient refined diagnosis-related group inpatient reimbursement.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – June 5
  • AHRQ News Now – June 3
  • HRSA – Office for the Advancement of Telehealth – Announcements – June 3
  • HRSA – a video providing step-by-step instructions for completing the IND-GEN form (which captures individual-level information about students, faculty, or other types of awardees who either received direct financial support through a HRSA grant or participated in specific types of HRSA-supported training) for providers’ annual performance reports using the offline Excel download feature.
Government Accountability Office (GAO)

HHS needs a coordinated national approach for diagnostic testing for pandemic threats, the GAO has concluded in a new report that also offers nearly 100 recommendations for improving that approach.  Find that report here.

Congressional Budget Office (CBO)

The CBO has announced the names of the people who will serve on its panel of health advisors for 2025.  Find that list here.

Stakeholder Events

CMS – Clinical Laboratory Fee Schedule Annual Public Meeting — June 27

CMS will hold a public meeting to receive comments and recommendations on the appropriate basis for establishing payment amounts for new or substantially revised Healthcare Common Procedure Coding System (HCPCS) codes being considered for Medicare payment under the clinical laboratory fee schedule for calendar year 2026.  This meeting provides a forum for those who submitted certain reconsideration requests regarding final determinations made last year on new test codes and for the public to provide comments on the requests.  The meeting will be held on Friday, June 27 from 10:00 to 4:00 and will be available both virtually and in person on the CMS campus in Baltimore.  Learn more about the meeting and its purpose and how to submit written comments from this CMS announcement.  Registration is only required for individuals giving a presentation during the meeting or attending the meeting at the CMS campus; go here to register.

CMS – CMS Quality Conference – July 1-2

CMS will hold a quality conference on Tuesday, July 1 and Wednesday, July 2 in Baltimore.  Go here for the conference agenda, an FAQ, and to register to participate.