The following is the latest health policy news from the federal government for April 25 – May 1.  Some of the language used below is taken directly from government documents.

Congress

Reconciliation

The House and Senate returned to Washington D.C. this week and House committees have begun marking up reconciliation legislation for submission to the House Budget Committee by May 9.  The Energy and Commerce Committee is expected to seek nearly $550 billion in cuts to Medicaid spending and the most likely targets for cuts continue to be work requirements for Medicaid eligibility; more frequent review of Medicaid eligibility; reducing the federal Medicaid matching rate (FMAP) or capping funding for the Medicaid expansion population; and tightened limits on Medicaid provider taxes and state-directed payments.

House Republicans continue to seek agreement on which Medicaid cuts will be acceptable, with moderate Republicans publicly stating that they will not vote for a bill if it includes certain cuts or if the cuts exceed a specific amount.   Earlier this week, Rep. Don Bacon (NE-02) stated that he does not support Medicaid cuts over $500 billion and he would like Medicaid cuts to be limited to three aspects of the program:  work requirements, making non-citizens ineligible for Medicaid, and increased frequency of eligibility redeterminations.

The Energy and Commerce Committee intends to mark up its reconciliation bill next week, although the mark-up date has not yet been set.

Medicare Provisions Under Consideration

Members of Congress are simultaneously working on a health care package that could include legislation to eliminate the current 2.83 percent reduction of Medicare payments to physicians; health care extenders – including telehealth, the Medicare Acute Hospital Care at Home program, rural policies, and other policy changes; and changes in how pharmacy benefit managers are paid.  Whether a health care package will be part of reconciliation remains unclear.

The Courts 

The Supreme Court has rejected the appeal of a lower court ruling that found that CMS did not undercalculate hospitals’ Medicare disproportionate share (Medicare DSH) payments between 2006 and 2009.  In the suit, the hospitals maintained that the calculation of Medicare DSH payments should be based on all hospitalized patients who qualify for both Supplemental Security Income (SSI) and Medicare.  The Supreme Court disagreed, confirming in a 7-2 decision the ruling of lower courts that SSI should only be included in DSH calculations when Medicare patients receive SSI payments during the same month they are admitted to the hospital.  Learn more from the Supreme Court decision in this case.

Centers for Medicare & Medicaid Services
  • CMS has posted a bulletin presenting April 2025 updates of its ambulatory surgical center payment system.  Find that bulletin here.  The updates it presents took effect on April 1.
  • CMS has posted a bulletin presenting the quarterly update of its clinical laboratory fee schedule and laboratory services subject to reasonable charge payment.  Find that bulletin here.  The updates its presents take effect on July 1.
  • CMS has posted a bulletin with its July 2025 quarterly update to Healthcare Common Procedure Coding System (HCPCS) codes used for skilled nursing facility consolidated billing enforcement.  Find that bulletin here.  The changes it presents take effect on July 1.
  • CMS has approved the following state plan amendments for Medicaid and CHIP programs.
    • To New Hampshire, to increase the state’s medically needy income level.
    • To Wisconsin, to modify the maximum amount allowed for the maintenance of a home of institutionalized beneficiaries to reflect the Social Security cost-of-living adjustment.
    • To Wisconsin, memorializing the new income standards for its optional state supplement program, the beneficiaries of which are eligible for Medicaid under Wisconsin’s state plan.
    • To Pennsylvania, establishing a new class of supplemental payments to qualifying Medicaid-enrolled acute-care general hospitals that serve a disproportionate share of elderly individuals and rely primarily on government payers.
    • To Texas, updating the clinical diagnostic laboratory services fee schedules and removing language related to COVID-19 lab rates that is no longer relevant.
    • To Oregon, increasing the rate for children’s foster care under the 1915(k) state plan option.
    • To Washington, updating the fee schedule effective dates for several Medicaid programs and services.
    • To Washington, adding certified peer support specialists and trainees as providers of rehabilitative behavioral health services.
    • To New Mexico, moving away from cost-based reimbursement for accredited residential treatment centers for adults with substance use disorders services and introducing a prospective fee schedule system.
    • To Kansas, to reimburse pharmacists for medication therapy management intervention services.
    • To Nebraska, implementing a new prenatal plus program for eligible Medicaid and Children’s Health Insurance Plan mothers determined by a health care provider to be at risk of having negative maternal or infant health outcomes.
    • To North Dakota, clarifying language for existing benefits for those under the age of 21.  The amendment aligns the state’s alternative benefits plan with the changes to traditional Medicaid.
Department of Health and Human Services
  • HHS and the NIH have launched what they describe as a “next-generation universal vaccine platform” for the development of vaccines for “pandemic-prone viruses.”  According to HHS, “This initiative represents a decisive shift toward transparency, effectiveness, and comprehensive preparedness…”  Learn more from this HHS news release.
  • HHS has released a review of “…the evidence and best practices for promoting the health of children and adolescents with gender dysphoria.”  According to the agency, “This review, informed by an evidence-based medicine approach, reveals serious concerns about medical interventions, such as puberty blockers, cross-sex hormones, and surgeries, that attempt to transition children and adolescents away from their sex.”  Learn more about this initiative and find a link to the report in this HHS news release.
HHS Newsletters, Reports, and Videos
Medicaid and CHIP Payment and Access Commission (MACPAC)

In a new issue brief, MACPAC expands on the current literature on access to care for children, using data from the 2023 National Health Interview Survey to compare the population characteristics, health status, and difficulties of gaining access care for children covered by Medicaid and CHIP compared to children who either have private insurance or who are uninsured.  MACPAC stratifies the results by income to understand if individuals of similar income levels experience the same barriers regardless of coverage and stratified the data by age to understand how access and use differs by coverage type within each age group.  Learn more from the MACPAC report “Access in Brief:  Children’s Experiences in Accessing Medical Care.”

Congressional Research Service

The Congressional Research Service has published a report on Medicaid section 1915(c) home- and community-based services waivers.  The report includes an overview of Medicaid followed by a discussion of Section 1915(c) waivers and topics such as target populations, eligibility criteria, covered services, enrollment limits, waiver waiting lists, and administration.  Find the report here.

Government Accountability Office (GAO)

The GAO has published a report on the early stages of CMS’s implementation of the Medicare drug price negotiation program and Medicare prescription drug inflation rebate program established under the Inflation Reduction Act of 2022.  Find that report 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    provide 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 Federal Register notice.  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.  Further information is not yet available but when it is it will be posted here and elsewhere.