The following is the latest health policy news from the federal government for November 7-13.  Some of the language used below is taken directly from government documents.

Please note that during the federal government shutdown, most HHS and other health care-related agencies, with limited exceptions, engaged in little public activity such as announcements, the publication of new regulations, and updating their web sites.  Now that the shutdown has ended, normal activity can be expected to resume shortly.

The End of the Federal Government Shutdown

On Wednesday night the House passed the Senate-amended version of the continuing resolution (CR) in a 222-209 vote, ending the 43-day government shutdown.  The measure extends federal funding through January 30, 2026, which includes restoring the delay of reductions of Medicaid disproportionate share hospital (DSH) payments; the extension of telehealth flexibilities and the Medicare Acute Hospital Care at Home program; and the extension of the low-volume hospital adjustment program and the Medicare-dependent hospital program all through that same date.  The bill waives the pay-as-you-go requirements (PAYGO) that would have resulted in a new four percent Medicare sequester beginning in January of 2026, although it extends the existing two percent sequester for an additional month into 2032.   It also provides full-year appropriations for a three-bill “minibus” covering Agriculture, Rural Development, the Food and Drug Administration, and related agencies; Military Construction and Veterans Affairs; and the Legislative Branch.  Additionally, the legislation includes provisions to reverse federal layoffs enacted during the shutdown and ensures backpay to all federal employees who worked during the shutdown.  Only six House Democrats voted in favor of the CR and President Trump signed the bill into law later Wednesday evening.  See the section-by-section summary of the Senate’s bill here.

Affordable Care Act Enhanced Premium Subsidies

To secure enough Democratic support for the CR, Senate Majority Leader Thune (SD) promised Democrats a vote in the Senate on extending enhanced Affordable Care Act subsidies before they expire at the end of year.  Along with an Affordable Care Act subsidies vote, members of Congress are discussing including other health care provisions in a potential year-end bill.  Although the Senate is committed to discussing solutions to the expiring subsidies in December, Speaker Mike Johnson (LA) has not yet agreed to put a health care bill on the House floor.

Now That the Shutdown has Ended

As the shutdown ends, a number of major Medicare and Medicaid regulations remain with the Office of Management and Budget for review; even though the shutdown has now ended, it is not yet clear when they will be addressed.  By statute, the following regulations must be implemented by January 1.

  • CY 2026 Hospital Outpatient Prospective Payment System Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates
  • CY 2026 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System and Quality Incentive Program
  • CY 2026 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement
  • CY 2026 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts
  • Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2026

CMS traditionally gives 60 days’ notice before the January 1 implementation date.  That has not happened this year.

The following regulation must be implemented sometime in 2026 but has no specific implementation date.

  • Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities

Rules currently with OMB for final review that do not have a statutory deadline for release and implementation include:

  • Medicaid Managed Care-State Directed Payments
  • Medicaid Program; Prohibition on Federal Medicaid Funding for Sex Trait Modification Procedures Furnished to Children and Youth
  • Medicare and Medicaid Programs; Hospital Condition of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children
  • Center for Medicare & Medicaid Innovation Payment Models
  • Transparency in Coverage
  • Amendments to Rules Governing Organ Procurement Organizations
  • Contract Year 2027 Policy and Technical Changes to Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly Programs
  • Global Benchmark for Efficient Drug Pricing (GLOBE) Model
  • Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model

The progress of proposed and final regulations with OMB for review are listed and can be tracked on this OMB web page.

Centers for Medicare & Medicaid Services
  • Last week CMS updated its guidance for providers submitting telehealth and Acute Hospital Care at Home to Medicare.  Under this guidance, the MACs would no longer hold telehealth claims on behalf of providers but providers still had the option of holding their claims if they wished.  This change involved CMS returning certain telehealth claims that were currently being held and that were submitted on or before November 10 with dates of service on or after October 1.  CMS also outlined providers’ options to continue holding their own claims or submitting them to their MAC for a claim denial.  That guidance, found here, noted that should Congress act in the future and retroactively extend the waivers – as it did yesterday when the CR funding the federal government was adopted and included extension of authorization for telehealth flexibilities and the Acute Hospital Care at Home program – CMS will provide future guidance on whether hospitals will need to resubmit Acute Hospital Care at Home claims previously submitted for non-covered days or denial.  Now that the shutdown has ended, CMS can be expected to issue new guidance on both programs in the very near future.
  • Noting that last year an average of 1.2 million Americans each month appeared to be enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in more than one state and others are enrolled in Medicaid or CHIP and a health exchange plan with the help of premium tax credits or cost-sharing reductions, CMS has sent an informational bulletin to state Medicaid programs outlining the steps it will be taking and the tools it will be providing to help states reduce the incidence of multiple program enrollments.  Find that bulletin here.
  • CMS has selected six contractors to develop an AI-driven process for administering prior authorization decisions under its WISeR (Wasteful and Inappropriate Service Reduction) Model.  Under the model’s pilot program, prior authorization will be required for selected Medicare-covered services in Arizona, Washington, New Jersey, Texas, Ohio, and Oklahoma.  Learn more about the WISeR model from the program’s web page and scroll down to and click on “Participant Information” to find a list of the chosen vendors.
  • CMS has added the following items to its Quality Payment Program resource library. (Note:  clicking these links may give a prompt to download a file, some of which may be zip files.)
Food and Drug Administration (FDA)

The FDA and CDC are investigating a multistate outbreak of infant botulism preliminarily associated with the product ByHeart Whole Nutrition Infant Formula.  Between August 9 and November 10, 15 infants with suspected or confirmed infant botulism were reported in 12 states.  All 15 infants were hospitalized but no deaths have been reported.  Learn more about infant botulism and this outbreak from this FDA announcement.

Stakeholder Events

MedPAC – Commissioners Meeting  December 4-5

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, December 4 and Friday, December 5.  An agenda and registration information are not yet available but when they are they will be posted here.  MedPAC notes that this meeting is contingent on enactment of funding for the federal government.

MACPAC – Commissioners Meeting – December 11-12

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, December 11 and Friday, December 12.  An agenda and registration information are not yet available but when they are they will be posted here.

HHS/Office of the Assistant Secretary for Technology Policy – ASTP Annual Meeting – February 11-12, 2026

HHS’s Office of the Assistant Secretary for Technology Policy will hold its annual meeting in Washington, DC on February 11-12, 2026.  The meeting will include in-person education and plenary sessions and networking opportunities for the health IT community.  The main stage plenary sessions will also be available for viewing online.  ASTP will soon post information on the meeting’s agenda, how to register, and how to reserve a hotel room through ASTP’s room block.  When it does, that information will be posted here.