The following is the latest health policy news from the federal government for May 23-29.  Some of the language used below is taken directly from government documents.

Congress

The House and Senate are out of Washington, D.C. this week for the Memorial Day holiday and will return to Washington on June 3.  Senate Republican staff is working on the House-passed reconciliation bill to identify provisions that may need to change or be excluded to comply with the Senate’s rules for reconciliation bills.  At the same time, some Republican senators have expressed opposition to the House reconciliation bill; some maintain that it cuts Medicaid too much while others want deeper spending cuts.  Majority leader Thune hopes to pass the Senate bill by July 4, though some senators believe that date may slip.

Centers for Medicare & Medicaid Services
  • CMS has issued updated guidance on hospital price transparency requirements and a request for information on improving compliance and enforcement with transparent reporting of hospital pricing data.  The guidance presents specific instructions for some coding practices and guidance on encoding payer-specific standard charge dollar amounts and contract methodologies.  The new guidance also includes illustrative scenarios and examples of how to encode standard charge data.  In its request for information, CMS seeks comments on “transparent reporting of complete, accurate, and meaningful pricing data by hospitals.”  CMS presents questions regarding the definition of “accuracy” and “completeness” of data, what concerns affect the ability to use hospital pricing information effectively, external sources of data that could be leveraged, suggestions for improving compliance and enforcement, and other suggestions to improve the quality of the data.  The request for information poses specific questions to stakeholders.  Learn more from this CMS news release.  In addition, find the CMS guidance here; the illustrative scenarios and examples here; and the request for information here.  The latter includes a specific form on which responses must be submitted.  The deadline for those submissions is July 25.
  • CMS has informed providers beginning on September 1, Medicare Administrative Contractors (MACs) will perform hospital short stay patient status reviews for acute-care inpatient hospitals, long-term-care hospitals, and inpatient psychiatric facilities.  The MACs will perform reviews on a sample of Medicare pre-payment Part A claims as part of CMS’s Targeted Probe and Educate program.  Learn more about this initiative and find an FAQ and links to additional resources from this CMS announcement.
  • CMS’s Center for Medicare and Medicaid Innovation is revising the financial methodology and participation options and extending the Kidney Care Choices Model to help address concerns about spending while continuing quality improvements through 2027.  Changes, such as new discounts for participants that meet certain benchmarks, reducing the chronic kidney disease quarterly capitation payment, and eliminating the kidney transplant bonus, will begin in 2026.  The model will be extended through 2027.  According to the agency, the model has shown significant improvements in quality of care, including an increase in home dialysis and home dialysis training, but also an increase in net spending. The changes to the model are expected to result in reduced net spending.  Learn more about the changes and why they are being made from this Center for Medicare and Medicaid Innovation announcement.
  • CMS has announced that it will increase federal oversight to ensure that states are not using federal Medicaid money to cover health care for individuals who are in the country illegally.  Under federal law, federal Medicaid funding is generally only available for emergency medical services for non-citizens with unsatisfactory immigration status who would otherwise be Medicaid-eligible.  CMS intends to strengthen enforcement through a combination of  evaluating selected state Medicaid spending reports; in-depth reviews of selected states’ financial management systems; and assessment of existing eligibility rules and policies.  The agency also is urging states to examine and update internal controls, eligibility systems, and cost allocation policies to ensure full compliance with federal law, warning that any improper spending on non-citizens will be subject to recoupment of the federal share.  Learn more from this CMS news release and CMS’s letter to state governments explaining its actions.
  • CMS has announced an oversight initiative on hospitals performing experimental sex trait modification procedures.  The agency launched this initiative by sending a letter to an unspecified number of selected hospitals performing pediatric sex trait modification procedures outlining its concerns about both quality standards adherence and profits for these procedures.  The letter inquires about how hospitals obtain informed consent for such procedures, how they document adverse outcomes, their billing practices and revenue projections, and more.  Learn more from this CMS news release, which includes a link to the letter CMS sent to selected hospitals.
  • CMS has posted a bulletin presenting its national coverage determination for implantable pulmonary artery pressure sensors for heart failure management.  The bulletin outlines criteria for coverage, claims processing requirements, and more.  Find the bulletin here.
  • CMS has announced that it has received applications from 35 states to participate in its Cell and Gene Therapy Access Model and that those states serve 84 percent of Medicaid beneficiaries with sickle cell disease, the initial group of patients to be served by the program.  Learn more about the program from the Cell and Gene Therapy Access Model web page.
  • CMS has updated the 2025 Supplemental Security Income (SSI) and spousal impoverishment standards that are used to help determine Medicaid eligibility.  See the new standards in this CMS memo to state Medicaid and CHIP directors.
  • CMS has added the document 2023 Doctors and Clinicians Preview Period Documents, as a direct downloads of zip files, to its Quality Payment Program resource library.
Department of Health and Human Services
  • HHS and the departments of Labor and the Treasury have issued a request for information (RFI) seeking public input on how to improve prescription drug price transparency.  The RFI seeks input regarding prescription drug price disclosure requirements, including information on existing prescription drug file data elements and information on implementation generally, such as the ability of health plans to obtain necessary data for reporting, as well as state approaches and innovation.  Learn more from this HHS news release  and find the RFI here; the deadline for submitting comments will be 30 days after the RFI’s official publication in the Federal Register, which has not yet been scheduled.  The agencies also released updated guidance for health plans and issuers that sets a February 2, 2026 deadline for publishing an enhanced technical format for disclosures.  These improvements are designed to eliminate “meaningless” or duplicative data and make cost information easier for consumers to understand and use.  Find that guidance here.
  • The Presidential Commission to Make America Healthy Again (MAHA) has released an assessment that identifies “key drivers” behind childhood chronic diseases.  The report describes a range of factors, including poor diet, accumulation of environmental toxins, insufficient physical activity, chronic stress, and “overmedicalization,” that contribute to childhood chronic diseases.  HHS intends to use the report’s findings to support the development of policy interventions.  Learn more from this HHS news release and “The MAHA Report:  Make Our Children Healthy Again.”
  • Medicare payments for evaluation and management services provided on the same day as eye injections are at risk for non-compliance with Medicare requirements, HHS’s Office of the Inspector General has concluded in a new audit report.  Find that report here.
  • HHS’s Health Resources and Services Administration (HRSA) has published a notice that it is updating its methodology for determining full-time equivalent resident counts for children’s hospital graduate medical education payments.  This updated methodology may result in adjustments to the weighted FTE resident three-year rolling average used to determine direct medical education payment amounts for the eligible children’s hospitals participating in the children’s hospital graduate medical education payment program.  Find that notice here.  The new methodology will be implemented beginning in the FY 2026 application cycle.
  • HRSA’s Substance Use Disorder Treatment and Recovery Loan Repayment Program is accepting applications for assistance with the repayment of student loans.  Licensed, full-time substance use disorder professionals and support staff can receive up to $250,000 in student loan repayment aid.  Go here to learn more about the program, eligibility, how to apply, and information about upcoming webinars about how to prepare applications.  The deadline for applying is July 10.
  • HHS has canceled its contract with Moderna to develop an avian (bird) flu vaccine.  Learn more from Moderna’s news release on HHS’s decision.
Approved Medicaid State Plan Amendments and State-Directed Medicaid Payments

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

  • To Florida, updating buy-back provisions for intermediate care facilities for individuals with developmental disabilities outlined within its state plan.
  • To Rhode Island, authorizing the state to enter into value-based supplemental drug rebate agreements on a voluntary basis.
  • To Utah, updating the state’s bed hold days methodology.
  • To Illinois, updating the state plan to clarify Illinois’ compliance with federal requirements for travel-related expenses for long-distance transportation funded by Medicaid.
  • To New York, increasing the state resource standards for its medically needy, ticket to work basic, and ticket to work medical improvement eligibility groups.
  • To Georgia, establishing coverage of Certified Community Behavioral Health Clinics (CCBHC) and reimbursement of CCBHC services.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – May 29
  • AHRQ News Now – May 20
  • CMS – on May 23, CMS held a webinar to answer questions about its health technology ecosystem request for information.  Find a video of that webinar here.
Centers for Disease Control and Prevention (CDC)

The CDC has removed the COVID vaccine for healthy children and healthy pregnant from its recommended immunization schedule.  Learn more from this X announcement.

Government Accountability Office (GAO)

CMS oversight of prior authorization criteria among Medicare Advantage plans should target behavioral health, the GAO has concluded after a recent study.  Eight of the nine plans the GAO reviewed required authorization but CMS review of prior authorization criteria did not target behavioral health services to determine any effects on enrollees’ access to care.  Learn more from this GAO report.

Medicare Payment Advisory Commission (MedPAC)

The Government Accountability Office (GAO) has announced the appointment of two new members to MedPAC and the reappointment of four current members.  The new members are Thomas Diller, M.D., MMM, Vice President of the Population Health Services Organization at AdventHealth and President of the AdventHealth Provider Network in Maitland, FL, and Gokhan Metan, M.Sc., Ph.D., NACD.DC., Co-founder and Chief Executive Officer of WiseCareAI and founder and Chief Technology & Analytics Officer of Full Spectrum Insights in St. Louis, MO.  The reappointed members are Robert Cherry, M.D., M.S., Chief Medical and Quality Officer at UCLA Health in Los Angeles, CA; Kenny Kan, FSA, CPA, CFA, MAAA, Vice President and Chief Actuary of Horizon Blue   Cross Blue Shield of New Jersey in Newark, NJ; Gregory Poulsen, MBA, Senior Vice President at Intermountain Healthcare in Salt Lake City, UT; and Scott Sarran, M.D., founding Chief Medical Officer of Harmonic Health.  Learn more about the new members from this GAO announcement.

Stakeholder Events

CMS – HCPCS Public Meeting – June 2

CMS will hold its first Healthcare Common Procedure Coding System (HCPCS) public meeting of 2025 to discuss CMS’s preliminary coding, Medicare benefit category, and Medicare payment determinations, if applicable, for new revisions to the HCPCS Level II code set for non-drug and non-biological

items and services.  The meeting will be held on Monday, June 2 from 9:00 to 5:00 (eastern), with the following day, June 3, available to address unfinished business.  Interested parties can attend the meeting in person at the CMS campus in Baltimore or participate virtually.  Learn more about the meeting and how to participate from this CMS notice.

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.