The following is the latest health policy news from the federal government for September 19-25.  Some of the language used below is taken directly from government documents.

Federal Funding for Fiscal Year 2026

Telehealth and Acute Hospital Care at Home Program Flexibilities

Many current telehealth flexibilities and authorization for the Acute Hospital Care at Home program will expire on September 30 unless Congress extends them.  The following is CMS’s current guidance on these programs if they are not extended by September 30:

  • The CMS Acute Hospital Care at Home web page advises stakeholders that

The Acute Hospital Care at Home (AHCAH) initiative was launched in response to the COVID-19 Public Health Emergency and extended by the Full Year Continuing Appropriations and Extensions Act, 2025, through September 30, 2025. For all hospitals with active AHCAH waivers, all inpatients must be discharged or returned to the hospital on September 30, 2025 [emphasis in original], in the absence of Congressional action to extend the initiative.

  • For telehealth, the proposed 2026 physician fee schedule states that

Absent Congressional action, beginning October 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services. These include geographic and location restrictions on where the services are provided. 

Find that passage in the proposed rule here, on page 266.

The statutory limits that would take effect if the telehealth flexibilities are not extended include the prohibition against patients receiving telehealth services in their homes except for the diagnosis or treatment of mental health issues and the limit on non-rural facility settings serving as originating sites.

In the Event of a Government Shutdown

The following programs are expected to remain operational during a shutdown:  Social Security, Medicare, veterans’ benefits, military operations, law enforcement, Immigration and Customs Enforcement, Customs and Border Protection, and Air Traffic Control.  Historically, the Office of Management and Budget (OMB) has released contingency plans outlining agency operations during lapses in appropriations.

CMS has not yet issued directives about authority or billing for services in the event of a federal government shutdown.

Office of Management and Budget (OMB)

OMB has issued a memorandum to department leaders instructing them to prepare reduction-in-force (RIF) plans in the event of a government shutdown.  An OMB memo, labeled “draft,” advises agencies that in situations in which a program’s funding would lapse and is neither statutorily required nor consistent with the administration’s priorities, agencies should consider reductions in force and not just temporary furloughs and that after appropriations are eventually enacted, agencies should retain only the minimal number of employees necessary to carry out statutory functions.  This could lead to potential short-term challenges for some health care programs and, in theory, to a major reduction of the federal workforce over the long run.  Find that OMB memo here.

Congress and the Budget

  • In anticipation of the October 1 budget deadline, the House passed a Republican-led continuing resolution (CR) in a party-line vote of 217-212 last Friday.  The seven-week extension sought to temporarily prolong several health care extenders that are set to expire on September 30, including delays to Medicaid disproportionate share (Medicaid (DSH) cuts, telehealth and Acute Hospital Care at Home program flexibilities, the low-volume hospital adjustment program, and more.  The Democratic-led alternative, which proposed permanent extensions to Affordable Care Act tax credits, reversals of H.R. 1 Medicaid cuts, limits to future executive branch rescissions, and the health care extenders noted above for the duration of the CR was voted down, as expected.  The Senate failed to move along the House Republican bill, voting 44-48 in opposition.
  • Congress is in recess until September 29, leaving limited time for CR negotiations leading up to the September 30 budget deadline.  President Donald Trump cancelled a planned negotiating session with Democratic leaders Senator Chuck Schumer and Majority Leader Hakeem Jeffries.  With the Senate’s 60-vote requirement, Republicans must garner the support of at least seven Democrats to advance a CR bill and prevent a government shutdown.
H-1B Visas

The White House has issued a proclamation establishing new guidelines for the H-1B visa program under which highly qualified immigrants are admitted to the U.S. to perform work that is in high demand that is not being met by American workers.  Effective September 21, H-1B visa guidelines require a new, one-time $100,000 payment from employers for petitions filed after this date unless the employee is already in the U.S.  This payment requirement does not apply to renewals or individuals with previously issued visas.  In addition, a new, beneficiary-centered selection process will count each unique beneficiary once and stricter fraud detection measures are being implemented.  The Secretary of Homeland Security may grant exceptions in certain situations if it is deemed to be in the “national interest.”  As of this writing the new guidelines apply to doctors and other health care professionals but there have been published reports, including reporting on a statement attributed to a named White House spokesperson, that some professions, including in the health care field, may at some point be exempted from these requirements.  These restrictions will last for one year.  Learn more from this White House proclamation and this U.S. Citizenship and Immigration Services FAQ, which includes links to additional resources.  In addition, the Department of Homeland Security has published a proposed regulation that calls for a weighted selection process for new H-1B petitions and registrations.  Find that announcement here.  The deadline for submitting written comments in response to this proposed regulation is October 24 for some aspects of the proposed regulation and November 24 for other aspects.

Centers for Medicare & Medicaid Services
  • CMS has issued a final rule updating a rule it issued in April primarily establishing new requirements for the publication and regular updating of provider directories by Medicare Advantage plans.  The rule establishes a requirement for Medicare Advantage provider directory data to be submitted to CMS for publication online in accordance with CMS guidance.  In addition, CMS finalized its proposal that Medicare Advantage provider directory data be updated within 30 days of when plans become aware of changes to that data.  CMS also finalized a requirement that Medicare Advantage organizations attest at least annually that their Medicare Advantage provider directory information is accurate.  Learn more from the final CMS rule.  CMS also has issued a clarifying memo explaining its intent to issue an operational guide soon after issuing this final rule that will include technical specifications on how Medicare Advantage plans will prepare provider directory data for the purpose of meeting these requirements and the timing of various milestones.  In addition, the memo outlines CMS’s plans for populating its own online directory of Medicare Advantage plans’ provider directories.  Find that memo here.
  • CMS has published a fact sheet describing the steps it is taking to ensure that people are not enrolled in more than one state Medicaid program or enrolled both in Medicaid and a marketplace plan.  Find that fact sheet here.
  • CMS has added two new organizations to its list of Independent Dispute Resolution entities certified to adjudicate No Surprises Act disagreements:  Capitol Bridge and Livanta.  Find them on CMS’s updated list of Independent Dispute Resolution entities.
  • In the face of a backlog of unresolved No Surprises Act disputes, CMS has published a fact sheet describing its efforts to clear that backlog.  Find that fact sheet here.
  • CMS has opened a limited, two-day window for health plans on the federal marketplace to adjust their premium rates.  The rerating is in response to an August 22 federal court decision that struck down key parts of a recent CMS rule affecting 2026 plans.  The window for plans to update their filings is open from September 30 to October 1, 2025.
  • CMS has posted a bulletin presenting an October 2025 update of its Medicare ambulatory surgical center payment system.  Find that bulletin here.
  • CMS has posted a bulletin for providers presenting its claims processing update for hepatitis C virus preventive and screening services.  Find that bulletin here.
  • CMS has sent a memo to state survey agencies that updates certain enforcement discretion it had been exercising under 2023 Clinical Laboratory Improvement Amendments of 1988 post-public health emergency guidance.  Find the updated memo here.
  • CMS has updated its bulletin on national coverage determination 20.37, for transcatheter tricuspid valve replacement.  Find the updated bulletin here.
  • CMS has posted a bulletin presenting its FY 2026 changes in the Medicare inpatient and long-term-care hospital payment systems.  Find it here.
  • CMS has posted a bulletin presenting its FY 2026 Medicare severity diagnosis-related groups subject to inpatient prospective payment system replaced devices policy.  Find that bulletin here.
  • CMS has published a bulletin presenting its FY 2026 update for Medicare hospice payments.  Find that bulletin here.
  • CMS is seeking feedback from individuals and organizations that submitted payment year 2024 data to the Quality Payment Program (QPP), including through Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), Traditional MIPS, or other options.  It hopes to use the insights it gains from a voluntary, 15-minute survey to improve the MIPS MVP reporting experience and identify what is working well.  Learn more about the survey and how to participate from this CMS notice.
  • CMS’s Hospital Quality Reporting (HQR) system is now accepting electronic clinical quality measure (eCQM) data for the calendar year 2025 reporting period.  The HQR system now accepts Quality Reporting Document Architecture (QRDA) Category I test and production files using CY 2025 requirements.  The data submission deadline is Monday, March 2, 2026, at 11:59 p.m. Pacific Time.  Learn more from this announcement.
  • CMS has added the following items to its Quality Payment Program resource library.  (Note:  clicking these links automatically downloads files.)
Department of Health and Human Services
  • HHS and the White House have announced a multi-faceted approach to addressing autism.  Among its steps:
  • The FDA has initiated the process for a label change for acetaminophen (Tylenol and similar products) to reflect evidence it believes suggests that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children.  Learn more about the FDA’s action from this agency news release.  In support of this action, the FDA also has issued a “Notice to Physicians on the Use of Acetaminophen During Pregnancy;” find that letter here.
  • The FDA has initiated the approval of leucovorin calcium tablets for patients with cerebral folate deficiency, a neurological condition that affects folate transport into the brain.  Individuals with cerebral folate deficiency have been observed to have developmental delays with autistic features (e.g., challenges with social communication, sensory processing, and repetitive behaviors), seizures, and problems with movement and coordination.  The FDA reports on its actions and its underlying justification for those actions in this news release.
  • The NIH has launched the Autism Data Science Initiative (ADSI), a research effort that will seek to harness large-scale data resources to explore contributors to the causes and rising prevalence of autism spectrum disorder.  More than $50 million in awards will support 13 projects that draw on genomic, epigenomic, metabolomic, proteomic, clinical, behavioral, and autism services data.  These projects will integrate, aggregate, and analyze existing data resources, generate targeted new data, and validate findings through independent replication hubs.  Learn more from this NIH news release, which includes links to the project web page and a list of grant recipients.

Learn more about the overarching approach from this HHS news release and this White House article.

  • HHS’s Health Resources and Services Administration (HRSA) has proposed a new “Behavioral Health Integration Evidence Based Telehealth Network Program Integration Telehealth Evidence Collection Tool.”  Under the Behavioral Health Integration Evidence Based Telehealth Network Program, HRSA administers grants that seek to integrate behavioral health services into primary care settings using telehealth technology and to evaluate the effectiveness of such integration.  This program supports evidence-based projects that use telehealth technologies through telehealth networks in rural and underserved areas to improve access to integrated behavioral health services in primary care settings and to expand and improve the quality of health information available to providers by evaluating the effectiveness of integrating telebehavioral health services into primary care settings and establishing an evidence-based model that can assist health care providers.  Participants in the program would be required to submit 27 data elements that were developed in cooperation with grant recipients.  Learn more about the proposed data collection from this HRSA announcement.  The deadline for stakeholders to submit comments is November 24.
  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) announced it has awarded more than $45 million in new supplemental funding to State Opioid Response program recipients to focus on sober or recovery housing among young adults.  Learn more about the funding and how recipients will be required to use this one-year supplemental funding from this HHS news release.
  • Most of the selected hospitals audited by HHS’s Office of the Inspector General (OIG) did not comply or may not have complied with the Provider Relief Fund balance billing requirement.  Learn more about the extent of the problem and the OIG’s recommendations for responding to patients who may have been billed for care inappropriately from this OIG report.
  • Medicare Part B payment trends for skin substitutes raise major concerns about fraud, waste, and abuse, the OIG concludes in a new report based on a recent audit.  Learn more about what the OIG found in this report.
  • HHS’s information and communications technology service contractors must report any suspected or confirmed incidents or breaches to HHS but are not doing so in the required, timely manner, the OIG has concluded after a recent audit.  Learn more about what the OIG found and how it recommends addressing the problems it uncovered in the report “Deficiencies With Incorporating Required Cybersecurity Language in HHS Contracts and Timeliness of Contractor Incident Reporting.”
  • As part of two roundtable events about Long COVID, HHS announced new actions aimed at improving care for Long COVID:  a public awareness and education campaign, an open source medical resource platform, and a new Agency for Healthcare Research and Quality (AHRQ) report “Sources of Health Insurance among Adults with Long COVID:  Estimates from the Medical Expenditure Panel Survey.”  Learn more about the roundtable events and HHS’s actions from this HHS news release.
  • HHS will mobilize more than 70 public health service officers from the U.S. Public Health Service Commissioned Corps to Indian Health Service facilities across the country to help fill staffing vacancies at those facilities and improve access to care.  Learn more from this HHS news release.
  • At the same time, HHS and SAMHSA have allocated more than $1.5 billion in FY 2025 continuation funding awards for State Opioid Response and Tribal Opioid Response grants.  This funding will provide resources to states and Tribal communities to address the overdose crisis through prevention, opioid overdose reversal medications, treatment (including medications for opioid use disorder), and recovery support.  Learn more about the funding programs and the resources the money is expected to provide from this HHS news release.
Medicaid State Plan Amendments

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

  • To Massachusetts, increasing the high Medicaid volume safety-net hospital supplemental payment by $20 million for inpatient acute hospital services in rate year 2025.
  • To Massachusetts, updating the Care Plus Alternative Benefit Plan to add licensed mental health counselors and licensed marriage and family therapists to the other practitioners’ service provider type.
  • To Wisconsin, updating reimbursement for outpatient or professional claims to be allowed if billed by a provider other than the admitting inpatient hospital.
  • To Indiana, attesting to the state’s compliance with the third-party liability requirements in Section 1902(a)(25)(1) of the Social Security Act.
  • To West Virginia, calling on the state to disregard from countable resources certain Medicare premium refunds.
  • To West Virginia, providing for mandatory coverage for eligible juveniles who are incarcerated in a public institution post-adjudication of charges.
  • To New Mexico, updating the rates for non-institutional outpatient services, maternal and child health services, primary care, behavioral health services, and other services and adding a supplemental payment for institutional services for intermediate-care facilities.
  • To Utah, extending funding for American Rescue Plan Act (ARPA) spending plan supplemental payments and limiting the final quarter’s supplemental payment to no less than zero and no greater than five percent, effective June 2, 2025.
  • To Ohio, providing for mandatory coverage in accordance with section 1902(a)(84)(D) of the Social Security Act for eligible juveniles who are incarcerated in a public institution post-adjudication of charges.
  • To Texas, updating the ambulatory surgical center reimbursement fee schedule.
  • To Arizona, bringing the state into compliance with the mandatory exception to the Medicaid clinic services benefit “four walls” requirement for Indian Health Service and Tribal clinics and electing the optional exceptions for behavioral health clinics and clinics located in rural areas.
HHS Newsletters, Reports, and Videos
Centers for Disease Control and Prevention
  • The CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that vaccination for COVID-19 be determined by individual decision-making.  The ACIP recommendation applies to all individuals six months and older and includes an emphasis that the risk-benefit of vaccination in individuals under age 65 is most favorable for those who are at an increased risk for severe COVID-19 and lowest for individuals who are not at an increased risk, according to the CDC list of COVID-19 risk factors.  “Individual decision-making” is referred to on the CDC’s adult and child immunization schedules as vaccination based on shared clinical decision-making, which references providers including physicians, nurses, and pharmacists.  It allows for immunization coverage through all payment mechanisms, including entitlement programs such as the Vaccines for Children Program, CHIP, Medicaid, and Medicare, and insurance plans through the federal health insurance marketplace.  Learn more from this CDC news release.
  • The ACIP also voted to adopt a new recommendation for the child immunization schedule, calling for toddlers through age three to be immunized for varicella (chickenpox) through standalone vaccination rather than through the combination measles, mumps, rubella, and varicella (MMRV) vaccine.  Learn more from this CDC announcement.
  • A new report from the CDC published in the Annals of Internal Medicine highlights a dramatic increase in a dangerous type of drug-resistant bacteria called NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE).  Learn more about the bacteria in question, why it has proliferated and why that proliferation is significant, and how the CDC recommends that providers respond to it from this CDC news release and the Annals of Internal Medicine note “Changes in Carbapenemase-Producing Carbapenem-Resistant Enterobacterales, 2019 to 2023.”
  • The CDC has issued a report presenting the latest national data on syphilis in newborns and sexually transmitted infections.  Learn more from this CDC news release.
Food and Drug Administration (FDA)

The FDA has granted accelerated approval to Forzinity (elamipretide) injection as the first treatment for Barth syndrome for patients weighing at least 30 kg.  Barth syndrome is a rare, serious, and life-threatening disease of the mitochondria.  Barth syndrome primarily affects males, typically starts with severe heart failure in infancy, and causes premature death.  Learn more from this FDA news release.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC’s commissioners met virtually last week.  The commissioners’ discussions were structured around the following presentations from MACPAC staff:

Congressional Budget Office (CBO)

In a new analysis, the CBO estimates that permanently extending the expanded premium tax credit, nullifying a marketplace final rule, and repealing policies in the 2025 reconciliation act would increase deficits and the number of people with health insurance.  Learn about the projected extent of the impact of these changes in the CBO report “The Estimated Effects of Enacting Selected Health Coverage Policies on the Federal Budget and on the Number of People With Health Insurance.”

Congressional Research Service

The Congressional Research Service has published a report presenting information on selected health provisions that have expired or are scheduled to expire during the 119th Congress.  For purposes of this report, expiring provisions are defined as portions of law that are time-limited and will lapse once a statutory deadline is reached without further legislative action.  The expiring provisions included in this report are any identified provisions related to Medicare, Medicaid, CHIP, or private health insurance programs and activities.  Learn more from the report “Expiring Health Provisions of the 119th Congress.”

Government Accountability Office (GAO)
  • Based on a recent analysis, the GAO has identified five major reasons that urban hospitals close:
    • financial decline due to financial losses or declining profits
    • aging physical infrastructure that was outdated and costly to maintain
    • low or declining inpatient volume prior to closure
    • challenges operating as an independent hospital without the support of a multi-hospital system
    • poor management practices such as incorrect billing or lack of payment for services
    • separate ownership interests, such as one entity owning the hospital business but another owning the real estate

Learn more about the hospitals the GAO examined and how it reached these conclusions in its report “Urban Hospitals:  Factors Contributing to Selected Hospital Closures and Related Changes in Available Health Care Services.”

  • In recent years, the health care sector has become increasingly consolidated, raising concerns that such consolidation may result in decreased competition and increased costs for patients, employers, health insurers, and federal health care programs.  Among the sectors of the health care industry where consolidation has become increasingly prevalent is physician practices:  studies show that at least 47 percent of physicians were employed by or affiliated with hospital systems in 2024, up from less than 30 percent in 2012, with others physician practices now owned by insurers and private investors.  In a new report based on a review of relevant literature, the GAO examines this situation and its implications.  Learn more from the GAO report “Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation.”
Stakeholder Events

Populations Webinar – October 8

HHS’s Agency for Healthcare Research and Quality (AHRQ) will hold a webinar on digital solutions for aging populations on Wednesday, October 8 at 2:30 (eastern).  Presenters will discuss how tools such as remote monitoring, telehealth, and personalized health apps are transforming care for older adults by enabling timely interventions, improving access, and supporting independence and can help improve health outcomes, overcome adoption barriers, and ensure older adults benefit from accessible, user-friendly, and effective digital solutions.  Go here to register to participate and for additional information about the webinar and continuing education credits for a variety of health care professionals.

MedPAC – Commissioners Meeting – October 9-10

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, October 9 and Friday, October 10.  An agenda and registration information are not yet available but when they are they will be posted here.

MACPAC – Commissioners Meeting – October 30-31

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, October 30 and Friday, October 31.  An agenda and registration information are not yet available but when they are they will be posted here.