The following is the latest health policy news from the federal government for May 8-14.  Some of the language used below is taken directly from government documents.

Congress
  • The Ways and Means Committee has circulated a discussion draft of a bill that would require non-profit hospitals and health systems to report more of their community benefit-related spending activity.  Under the draft bill, non-profit hospitals and health systems would be required to report on charity care spending, their process for patients to apply for financial assistance, and spending associated with community benefits.  They also would be required to report on subsidized service lines, community health needs assessments, and more.  Affected hospitals and health systems would be required to estimate the taxes they would have to pay if they did not have tax-exempt status.  The committee is expected to schedule a markup for this bill next week.  Find the draft bill here.
  • The House Energy and Commerce Committee’s Health Subcommittee conducted markups for several public health reauthorization bills and measures to strengthen FDA oversight and improve Medicare outcomes for patients and providers.  For the full list of marked-up bills, see the news release here and a memo here.
  • The House Energy and Commerce Committee will hold a hearing titled “Examining the Medicare Physician Fee Schedule, MACRA, and Opportunities for Payment Reforms” on Tuesday, May 19.  Lawmakers will examine efforts under the Medicare Access and CHIP Reauthorization Act (MACRA) to reform Medicare physician payment and explore current challenges in the Medicare physician fee schedule.  For more information see the news release here.  A recording of the hearing will be uploaded here.
  • Congressional Republicans hope to pass a reconciliation package to provide funding for Immigration and Customs Enforcement (ICE) and Customs and Border Protection before June 1.  Following that effort, lawmakers are expected to turn to a third reconciliation measure addressing health care affordability before the midterm elections.  Health care provisions in a potential third reconciliation bill could include expanded access to health savings accounts (HSAs); changes to the rate at which the federal government matches state Medicaid spending (FMAP); changes to pharmacy benefit manager (PBM) spread pricing; expanded site-neutral payment policies; and others.
Centers for Medicare & Medicaid Services (CMS) 
  • CMS has announced a six-month, nationwide moratorium on new Medicare enrollment for hospices and home health agencies, enabling the agency to temporarily halt the enrollment of new providers into care categories that it considers to be at high risk of waste, fraud, and abuse.  During the six-month moratorium, CMS will intensify targeted investigations, deploy advanced data analytics, and accelerate the removal from the Medicare program of hospice and home health providers suspected of committing fraud.  The moratorium will apply to all applications for initial Medicare enrollment by such providers and certain changes in majority ownership but will not affect current enrollments.  Existing providers can continue to care for their Medicare patients.  Learn more about the moratorium from this CMS news release.
  • CMS has announced that 30 health care organizations, including health systems, electronic health record developers, physician practices, networks, and digital health developers, have joined others as early participants in its newly established Electronic Prior Authorization Acceleration initiative to address major challenges and drive solutions ahead of new electronic prior authorization requirements that will take effect in 2027.  They will join other organizations that are already working with CMS to identify and address workflow, technical, and operational barriers that have slowed adoption of electronic prior authorization.  Learn more about the latest organizations to join this effort, and about what these early adopters are doing, from this CMS news release.
  • CMS has asked the Office of Management and Budget (OMB) for permission to streamline the process for entities requesting meetings with CMS officials by establishing a new “CMS Meeting Request Portal” through which parties will seek meetings with CMS officials.  The proposed portal would gather only necessary information for representatives of the applicant to meet with a representative of the federal government.  Learn more about CMS’s proposed new process through this formal notice.  The deadline for interested parties to submit comments is June 8.
  • CMS has extended the deadline for stakeholder comment on its April 22 notice titled “Medicaid and Children’s Health Insurance Program (CHIP) Generic Information Collection Activities:  Proposed Collection; Comment Request” from the original May 6 until May 26.  Learn more from this CMS notice.
  • CMS has published a new coverage guide:  “Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Guide for States:  Coverage in the Medicaid Benefit for Children.”  CMS intends for the guide to help states understand the scope of services that are covered under EPSDT.  It does not establish new EPSDT policy but rather compiles into a single document various EPSDT policy guidance that CMS has issued over the years.  Find the guide here.
  • 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.)
Department of Health and Human Services (HHS)
  • HHS has extended the deadlines that recipients of federal financial assistance face for complying with requirements set forth in section 504 of the Rehabilitation Act for the accessibility of their web and mobile applications (“apps”).  The compliance deadline for such recipients with 15 or more employees, including health care providers and organizations, is currently May 11, 2026 but has been extended to May 11, 2027 and the deadline for recipients with fewer than 15 employees has been extended from May 10, 2027 to May 10, 2028.  Learn more from this HHS notice.
  • HHS, the Department of Labor, and the Treasury Department have proposed amending current regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code, and the Public Health Service Act to establish certain fertility benefits as a new category of limited excepted benefits that employers can offer to their workers; among such benefits would be the diagnosis and treatment of fertility challenges.  Excepted benefits are generally exempt from the market requirements that were added to those laws by the Health Insurance Portability and Accountability Act, the Patient Protection and Affordable Care Act, the No Surprises Act, and certain other federal laws specifically related to group health plans and group and individual health insurance coverage.  Learn more from this notice.  The deadline for stakeholders to submit comments is July 13.
  • HHS has launched a new web site, Moms.gov, for new and expecting mothers, that will offer guidance and information to support the health and well-being of mothers and their families.  The site also will support expecting parents who are navigating difficult or unexpected pregnancies.  It features information about pregnancy centers, Federally Qualified Health Centers, nutritional guidance, Trump accounts, breastfeeding, preconception health, mental health, adoption, and more.  Learn more from this HHS news release and the new moms.gov web site.
  • HHS and its Office on Women’s Health have entered into a memorandum of understanding with the organization Heartland Forward to advance maternal health outcomes and improve care for women and families.  Through this partnership, HHS and Heartland Forward will exchange information, align strategies, and collaborate on evidence-based initiatives to reduce maternal morbidity and mortality and strengthen care across the lifespan, including before, during, and after pregnancy.  Learn more about this new relationship from this HHS news release.
  • HHS and CMS will hold the first meeting of their new Healthcare Advisory Committee on Monday, May 18 at 2 p.m. (eastern).  The committee was established earlier this year as a federal advisory body consisting of leaders from across the health care system to provide advice on improving, strengthening, and modernizing health care and will advise the Secretary and CMS Administrator on ways to improve the financing and delivery of care through Medicare, Medicaid, the Children’s Health Insurance Program, and the health insurance marketplace.  Learn more about the committee and its first meeting from this CMS news release and the March 2026 announcement of its creation (which includes a list of the committee’s members) and go here to find the meeting agenda and to learn how to participate virtually.
HHS/Office of the Inspector General
  • Unclear Medicare requirements are leading to differing interpretations of inpatient rehabilitation facility documentation, coverage, and billing requirements, HHS’s Office of the Inspector General (OIG) has concluded after a recent audit.  Because these requirements are unclear, the OIG, inpatient rehabilitation facilities, and CMS sometimes have differing opinions on the allowability of the claims the OIG sampled, raising concerns about increased risk of financial loss to the program, compromised program integrity, and operational inefficiency in the Medicare program.  Learn more about what the OIG found and its recommendations for changes – some of which CMS has rejected – from this OIG report.
  • Utilization trends and Medicare Part B billing for office-based peripheral vascular procedures raise questions about program integrity, the OIG has concluded after a recent audit.  Learn more about the problems the OIG identified and its recommendations for addressing them from this OIG report.
  • The OIG has launched a new weekly video program it calls “This Week at HHS-OIG.”  Find the first program here; the video is only a little more than a minute long.  In the future, find links to the week’s video below, in the “HHS Newsletters, Reports, and Videos” section of this update.
Medicaid State Plan Amendments

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

  • To Arkansas, revising reimbursement for continuous glucose monitors and related diabetic supplies by clarifying that effective May 1, 2026, durable medical equipment medical claims will no longer be reimbursed at wholesale acquisition cost plus the applicable professional dispensing fee and will instead revert to the Medicare non-rural rate for Arkansas.  Pharmacy claim types will continue to be reimbursed at wholesale acquisition cost plus the applicable professional dispensing fee.
  • To Colorado, removing references to the Colorado Indigent Care Program consistent with its legislative repeal effective June 30, 2025 and aligning disproportionate share hospital (DSH) eligibility with participation in the hospital discounted care program, the remaining state-only qualified charity care program.
  • To Nebraska, extending pregnancy-related and postpartum services from 60 days to 12 months after a pregnancy ends for Medicaid beneficiaries.
  • To Oklahoma, removing visit limits for adults for physician services, office visits, and nursing facilities.
  • To Oklahoma, providing separate reimbursement of rapid whole genome sequencing in the inpatient hospital setting.
  • To Oklahoma, updating Rural Health Center and FQHC core service definitions and adding marriage and family therapist services and mental health counselor services consistent with the Consolidated Appropriations Act of 2023.
  • To Oregon, implementing a three percent cost-of-living increase in reimbursement rates for fee-for-service dental services.
  • To Pennsylvania, authorizing the state to continue making Medical Assistance day one incentive payments to non-public nursing facilities.
  • To Vermont, adding supported employment services to Vermont’s alternative benefit plan and amending the alternative benefit plan to reflect the benefit changes approved in SPAs 25-0009 and 25-0015.
  • To Wisconsin, modifying the maximum amount allowed for the maintenance of home of institutionalized beneficiaries to reflect the Social Security cost-of-living adjustment.
  • To Wisconsin, memorializing new income standards for the state’s optional state supplement program, the beneficiaries of which are eligible for Medicaid under Wisconsin’s state plan.
State-Directed Medicaid Payments

CMS has approved the following state preprints for Medicaid state-directed payments.

  • To Colorado, introducing a new, uniform increase for inpatient and outpatient hospital services and behavioral health inpatient and outpatient services for rating periods covering July 1, 2025 through June 30, 2026, which has been incorporated into capitation rates through a separate payment term amount of up to $725 million.
  • To Florida, renewing the state’s performance improvement initiative, value-based purchasing model, and uniform percentage increase for inpatient hospital services and outpatient hospital services for the rating period covering February 1, 2025 through September 30, 2025, which had been incorporated into capitation rates through a separate payment term amount up to $5.4 billion.
  • To Florida, renewing the state’s performance improvement initiative, value-based purchasing model, and uniform percentage increase for inpatient hospital services and outpatient hospital services for the rating period covering October 1, 2024 through January 31, 2025, which had been incorporated into capitation rates through a separate payment term up to $2.5 billion.
  • To Kansas, renewing value-based payments to meet or exceed performance measure benchmarks on specific provider quality metrics for outpatient hospital services to receive incentive payments for the rating period covering January 1, 2026 through December 31, 2027 for a multi-year period, which has been incorporated into capitation rates through a separate payment term of up to $60 million.
  • To Mississippi, renewing a uniform percentage increase for professional services at an academic medical center for rating periods covering July 1, 2025 through June 30, 2026, which has been incorporated into capitation rates through a separate payment term amount of up to $31 million.
  • To Mississippi, renewing a uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician services for the rating period covering July 1, 2025 through June 30, 2026, which has been incorporated into capitation rates through a separate payment term amount of up to $7 million.
  • To Missouri, establishing a quality payment/pay for performance (Category 2 APM, or similar) for inpatient and outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, which has been incorporated into capitation rates through a separate payment term in the amount of $234 million.
  • To New Mexico, renewing a uniform increase and value-based payment arrangement established by the state to implement the Healthcare Delivery Access Act for inpatient and outpatient hospital services for the rating period January 1, 2026 through December 31, 2026, which has been incorporated into capitation rates through a separate payment term up to $1.5 billion.
  • To Pennsylvania, renewing a quality payment/pay for performance (Category 2 APM, or similar) and performance improvement initiative for nursing facility services for rating periods covering January 1, 2026 through December 31, 2026, which has been incorporated into capitation rates through a separate payment term amount of up to $15 million.
  • To Washington, renewing a uniform percentage increase for hospitals owned and operated by or operated by a state university established by the state for inpatient and outpatient hospital services for the rating period from January 1, 2026 through December 31, 2026, which has been incorporated into capitation rates through a separate payment term up to $480 million.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – May 14
  • CMS – CMS recently held a webinar providing an overview of the short-term acute-care hospital PEPPER (Program for Evaluating Payment Patterns Electronic Report) for the fourth quarter of FY 2025 and has now posted a video and transcript of that webinar.  Find them here.
  • CMS – CMS recently held a webinar during which it addressed questions about the notice of funding opportunity for its Make America Healthy Again Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (ELEVATE) Model and has now posted a video and transcript of that webinar.  Find them here.
  • CMS – CMS recently held a webinar during which it provided information about the doctors and clinicians preview period for CY 2024 Quality Payment Program performance information and has now posted a video and transcript of that webinar.  Find them here.
  • CDC – Morbidity and Mortality Weekly Report (MMWR) – May 7
  • HHS – Administration for Strategic Preparedness and Response (ASPR) – ASPR TRACIE Express (newsletter) – May
  • HHS/Health Resources and Services Administration (HRSA) – HRSA has posted a series of videos presenting January and February meetings of the Organ Transplantation and Procurement Network (OPTN) executive committee and board of directors.  Find those videos here.

Centers for Disease Control and Prevention (CDC)

The CDC is responding to the hantavirus outbreak associated with the M/V Hondius cruise ship while emphasizing that the risk to the public remains extremely low.  The CDC issued health guidance for affected American passengers and is coordinating with international partners and state and local health departments to ensure consistent monitoring and action.  Eighteen of the Americans were evacuated to Offutt Air Force Base in Nebraska and two of them were moved to the National Quarantine Center in Georgia for closer monitoring.  CDC teams have been deployed to the Canary Islands to assess exposure risk among passengers and to Offutt Air Force Base to support public health evaluations of the passengers.  For more information, see the CDC’s news release here, its hantavirus information page here, its Andes virus (a type of hantavirus) information page here, and the CDC response transcript here.  The CDC’s Health Alert Network also posted an official health advisory; see that news release here.

Food and Drug Administration (FDA)

The FDA issued a request for information seeking input on priority disease areas and potential drug repurposing efforts.  The agency is particularly interested in areas with significant unmet medical needs, such as metabolic diseases, neurodegenerative conditions, women’s and men’s health conditions, substance use disorders, and rare diseases.  View the Federal Register and news release for more information.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC members met last week in Washington, D.C.  During the course of the deliberations, MACPAC’s staff made the following presentations to the commissioners:

Click the links for the individual subjects for a brief description of that subject and a link to the full presentation made by MACPAC staff during the meeting.

Congressional Budget Office (CBO)

The CBO has posted a February 2026 presentation it made to congressional staff with projections of federal subsidies for health insurance, with a focus on Medicare, Medicaid, and premium tax credits and projected enrollments in those and other programs.  The presentation also addresses factors that prompted changes in CBO projections since January of 2025.  Find the presentation here.

Congressional Research Service

The Congressional Research Service has prepared an overview of the Medicare Wasteful and Inappropriate Service Reduction (WISeR) Model.  Find that report here.

Stakeholder Events

HHS/CMS – Healthcare Advisory Committee Meeting – May 18

HHS and CMS will hold the first meeting of their new Healthcare Advisory Committee on Monday, May 18 at 2 p.m. (eastern).  The committee was established earlier this year as a federal advisory body consisting of leaders from across the health care system to provide advice on improving, strengthening, and modernizing health care.  Go here to find the meeting agenda and for information about how to participate virtually.

CMS – HCPCS Level II Public Meetings – June 1

CMS will hold its 2026 HCPCS level II public meeting, in person and virtually, on June 1, 2026 at 9:00 (eastern), with an overflow date of Tuesday, June 2, 2026 to be held virtually, if necessary, to discuss CMS’s preliminary coding, Medicare benefit category, and Medicare payment determinations.  Learn more about the meeting, including how to submit questions and comments and register to participate, 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 have not yet been posted; when they are, they will be found here.