CMS proposed a new rule containing numerous reforms to the ACA Marketplace enrollment process, including shortening the open enrollment window by a month, limiting special enrollment periods, eliminating DACA eligibility, and other provisions. Comments are due a month after publication in the Federal Register. 

CMS is also ending four Innovation Center payment models, citing savings of $750,000,000. The four models are: 

• Maryland Total Cost of Care (2019 – 2026) 

• Primary Care First (2021 – 2026) 

• ESRD Treatment Choices (2021 – 2027; will propose termination through rulemaking)  

• Making Care Primary (2024 – 2034) 

Four CMS rules have recently moved to OMB review, which is the final step before publication. The one final and three proposed rules are: 

• Contract Year 2026 Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, and Medicare Cost Plan Programs, and PACE. Final rule (CTeL provided comments to the proposed rule in January). 

• FY 2026 Inpatient Psychiatric Facilities Prospective Payment System Rate and Quality Reporting Updates. Proposed Rule. 

• FY 2026 Skilled Nursing Facility (SNFs) Prospective Payment System and Consolidated Billing and Updates to the Value-Based Purchasing and Quality Reporting Programs. Proposed rule. 

• FY 2026 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Rate Update and Quality Reporting Program. Proposed rule. 

Former FDA Commissioner Scott Gottlieb called on the agency to reconsider its 2022 guidance suggesting that clinical decision support (CDS) devices, typically exempt from FDA oversight, should be premarket review when clinicians may be pressured to defer to them for judgement. He argues that the review process could prevent EMR vendors from incorporating AI technology, limiting the ability for insights to be gained from patient data that clinicians might not have themselves. 

Senate Democrats’ health package push has stalled after failing to garner enough support. The measure would have revived the health package scrapped in December which included a two-year telehealth extension and PBM reforms among other provisions. 

Representative Greg Murphy (R-NC) has said that he has received assurances that Medicare physician pay cuts will be addressed in any upcoming reconciliation bill, a policy commonly referred to as the “Doc Fix.” The House-passed continuing resolution notably left out a Medicare payment fix. 

House Oversight Committee held a hearing on Tuesday titled “Shifting Gears: Moving from Recovery to Prevention of Improper Payments and Fraud.” The hearing called for the modernization of federal payment systems, reforming payment methodologies, and improving data sharing. This comes on the heels of a GAO report that found Medicare accounted for the largest share of improper payments at $54.3 billion as part of a government-wide survey.