The following is the latest health policy news from the federal government for October 31 – November 6.  Some of the language used below is taken directly from government documents.

Please note that most HHS and other health care-related agencies have indicated that they will not be announcing new policies, publishing proposed regulations, or updating their web sites during the current federal government shutdown; some are engaging in limited exceptions.

Congress and the Shutdown

Senate Majority Leader John Thune (R-SD) today told his caucus that he plans to bring the House-passed CR to yet another vote in the Senate on Friday but that this time he will seek to amend it with a new, later expiration date and three full-year spending bills – the Agriculture-FDA, Military Construction-Veterans Affairs, and Legislative Branch bills.  This, he believes, may be enough to persuade enough Democrats to support the CR and vote to end the government shutdown.  Senators are expected to remain in Washington over the weekend, though it is not clear that enough Democratic senators will join Republicans to support a bill that does not address the ACA enhanced premium subsidies.

Medicare Physician Fee Schedule Regulation for CY 2026

CMS has published its final physician fee schedule rule for CY 2026; the rule also addresses other changes to Part B payment and coverage policies, Medicare Shared Savings Program requirements, and the Medicare Prescription Drug Inflation Rebate Program.  Highlights of the final rule, which takes effect on January 1, 2026, include:

  • An increase in the conversion factor for qualifying alternative payment model (APM) participants to $33.57 – a 3.7 percent increase – and an increase for those not participating in APMs to $33.40, a 3.26 percent increase.  The Medicare conversion factor is a national dollar multiplier used to calculate payment for physician services under the Medicare physician fee schedule, converting a service’s geographically adjusted Relative Value Units (RVUs) into a dollar amount for reimbursement.
  • A 2.5 percent efficiency adjustment – that is, a reduction – to the RVUs of physician time for non-time-based services.  CMS explains this adjustment by noting that it “… targets services that have likely become able to be furnished more efficiently over time but still retain valuations based on outdated assumptions.  Examples include surgical procedures, diagnostic imaging interpretation, outpatient interventions, interventional pain management, and orthopedic services.  These tend to benefit from technological advancements or standardized workflows that reduce time and resource use….”
  • An update of the Medicare practice expense methodology to recognize the greater indirect costs for practitioners in office-based settings in comparison to facility settings.  This new methodology will reduce the portion of facility practice expense RVUs allocated based on work RVUs to 50 percent of the amount allocated to non-facility practice expense RVUs beginning in CY 2026.
  • A streamlined process for adding services to the Medicare telehealth services list; removal of frequency limits for subsequent inpatient and nursing facility visits and critical care consultations; and adoption of a definition of “direct supervision” of telehealth services that provides for such supervision through real-time audio and visual interactive communications.
  • Official adoption of the new Ambulatory Specialty Model, a mandatory payment model focused on specialty care for Medicare beneficiaries with heart failure and low back pain.  CMS will notify clinicians of their mandatory participation early in 2026 and the program will launch in January of 2027.
  • Reversal of a proposal to delete a payment code for performing social determinants of health patient assessments but a narrower assessment of those factors.
  • Reversal of a proposal to restrict virtual resident supervision by teaching programs located in only rural areas.  Any teaching program can continue virtually supervising patient visits conducted by residents when all three parties (patient, resident, and physician) are connected virtually.
  • New, optional add-on codes for Advanced Primary Care Management services to facilitate providing complementary behavioral health integration or psychiatric Collaborate Care Model services.
  • A series of changes in the Medicare Shared Savings Program involving risk assumption, the elimination of a health equity adjustment, quality performance standards and other quality reporting requirements, and more.
  • Changes in Medicare reimbursement for skin substitute products.
  • Changes in the Medicare Diabetes Prevention Program.

Learn more about these and other aspects of the physician fee schedule rule for CY 2026 from the following sources:

The White House

The White House today announced agreements with pharmaceutical manufacturers Eli Lilly and Novo Nordisk to reduce prices for selected drugs to “most-favored nation” level.  Under the agreement, four GLP-1 drugs, a migraine treatment, a medication to treat diabetes, and two widely-used insulin products will be offered at dramatically lowered prices when purchased through TrumpRX.  Prices for Medicare patients also would be reduced and state Medicaid programs would have access to these medications at reduced prices as well.  In addition, the companies have indicated that they will guarantee most-favored nation prices on all new medicines they bring to market and give state Medicaid programs access to most-favored nation drug prices on their products.  It is not yet clear how this agreement might affect those with private health insurance.

Learn more from this White House fact sheet.

Centers for Medicare & Medicaid Services
  • CMS has announced a new Medicaid drug payment model.  Under the Center for Medicare and Medicaid Innovation’s new GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model, participating state Medicaid programs will be able to purchase drugs at prices aligned with those paid in other selected countries.  To be launched in 2026, the model will enable CMS to negotiate with participating manufacturers for lower prices while implementing uniform, transparent coverage criteria.  CMS is releasing a Request for Applications for drug manufacturers interested in participating in the GENEROUS Model and will seek letters of intent from state Medicaid agencies interested in participating.  States that express interest will later have the opportunity to apply and opt into the terms and prices CMS negotiates with participating drug manufacturers whose applications are accepted.  Learn more about the GENEROUS Model from this CMS news release; the new model’s web page; and CMS’s Request for Applications from interested pharmaceutical companies.
  • CMS announced that all 50 states have submitted applications for funding from the $50 billion Rural Health Transformation Program.  The program invited every state to design a plan for transforming its rural health care system, with each proposal required to outline how states intend to expand access, enhance quality, and improve outcomes for patients through sustainable, state-driven innovation.  States that meet these requirements and have approved applications will receive baseline funding representing 50 percent of total available program funds, to distribute equally among approved states.  Applications that meet baseline criteria will then undergo review for the remaining 50 percent of available program funds.  CMS will announce approved awards by December 31, with funding distributed over five years beginning in FY 2026.  Learn more from this HHS news release.
  • CMS has updated its guidance to state survey agencies about state survey and certification activities during the current federal government shutdown.  The guidance identifies functions that are not affected by the shutdown; those that are to continue during the shutdown; and those that are directly affected but are not legally authorized to be performed during the shutdown.  Find the revised guidance here.
  • CMS has updated its Rural Health Transformation Program FAQ.  Find the updated FAQ here.
  • 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.)
Department of Health and Human Services
  • HHS’s Health Resources and Services Administration (HRSA) has approved eight plans from pharmaceutical companies to participate in the 340B Rebate Model Pilot Program beginning on January 1.  Under the 340B Rebate Model Pilot Program, covered entities continue to make purchases through their 340B wholesaler and may only seek rebates on the ten affected drugs dispensed to 340B-eligible patients after a purchase is made.  Learn more about the program, the participating pharmaceutical companies, and the specific drugs that will be included in the pilot program from the program’s updated web page.
  • HRSA has published an update on its continuing modernization of the Organ Procurement and Transplantation Network.  Find the update here.
  • Last week, HRSA held a webinar on Nurse Corps Scholarship Program participants’ transition to service.  The webinar addressed questions about transitioning to service, finding employment, and more.  Now, HRSA has posted a video of that webinar. Go here for the video and a transcript.
Centers for Disease Control and Prevention (CDC)
  • The CDC has issued a media alert warning of a multistate outbreak of Salmonella infections linked to moringa leaf powder.  According to the CDC, 11 people from seven states have become sick from the same strain of Salmonella; three people have been hospitalized but no deaths have been reported.  Learn more about the source of the outbreak, symptoms, and Salmonella from this CDC media alert and this CDC food safety alert.
  • The CDC has issued a media alert describing a multistate outbreak of Listeria infections.  According to the CDC, the cases can be linked to people eating foods that have been recalled.  Learn more about the problem and the symptoms of Listeria from this CDC media alert and an accompanying food safety alert that identifies specific foods associated with the outbreak.
Food and Drug Administration (FDA)

 The FDA announced actions to restrict the sale of unapproved ingestible fluoride prescription drug products for children.  The agency sent notices to four companies outlining its intention to take enforcement action against those marketing unapproved fluoride-containing ingestible drugs labeled for use in children under age three or older children at low or moderate risk for tooth decay.  Learn more about why the FDA has taken this action and find a sample letter the agency sent to the four companies from this FDA news release.

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.