THIS WEEK’S DOSE
- Healthcare debate continues. The House passed an extension of the expired enhanced advanced premium tax credits, but it remains unclear what, if anything, will advance in the Senate, where bipartisan negotiations continue.
- House Energy and Commerce Health Subcommittee reviews 10 bills. The hearing focused on legislation to support patient access to Medicare services.
- CMS announces Rural Health Transformation Program awards. The Centers for Medicare & Medicaid Services (CMS) allocated funds to all 50 states.
- Administration announces most-favored nation agreements, three prescription drug payment models. The actions focus on implementing most-favored nation policies and increasing access to GLP-1s.
- CMS, Departments of Labor and Treasury propose healthcare price transparency updates. The proposed rule builds on action from President Trump’s first term.
- CDC updates childhood immunization schedule. The Centers for Disease Control and Prevention (CDC) reduced the number of routinely recommended immunizations from 17 to 11.
- HHS, USDA issue new dietary guidelines. The new guidelines focus on protein and change previous recommendations.
- ASTP/ONC releases HTI-5 proposed rule. The rule proposes to remove certification criteria while tightening information blocking exceptions.
CONGRESS
Healthcare debate continues. To kick off the week, President Trump hosted House Republicans for a discussion on wide-ranging topics, including how to address healthcare. The president emphasized that he wants to give money directly to the people for health coverage and urged the caucus to be flexible on the abortion issue (Hyde amendment), which has been a sticking point in negotiations. Later in the week, the House voted 230 – 196 to extend the Affordable Care Act (ACA) enhanced advanced premium tax credits (APTCs) for three years. Seventeen Republicans (Reps. Bresnahan (PA), Carey (OH), De La Cruz (TX), Fitzpatrick (PA), Garbarino (NY), Hurd (CO), Joyce (OH), Kean (NJ), LaLota (NY), Lawler (NY), Mackenzie (PA), Miller (OH), Nunn (IA), Salazar (FL), Valadao (CA), Van Orden (WI), and Wittman (VA)) joined all Democrats to pass the legislation.
A straight three-year extension of the enhanced APTCs failed in the Republican-controlled Senate in December 2025, so this legislation is not expected to move forward in the Senate. However, a bipartisan group of senators continues to negotiate a possible agreement that would extend the enhanced APTCs for two years with new minimum premium payments and income restrictions, along with broader cost-sharing reductions. Senate Majority Leader Thune (R-SD) has made it clear that any bipartisan deal must include the following:
- Minimum premium payments.
- A health savings account component.
- A prohibition on any federally subsidized insurance plan covering abortion services (Hyde amendment).
Even if the bipartisan group of senators reached agreement on a compromise policy, it is unclear whether it would address each of those measures. If the Senate did pass a compromise bill, it would need to go back to the House for consideration, and it is unknown how Speaker Johnson might handle that potential situation.
House Energy and Commerce Health Subcommittee reviews 10 bills. The legislation discussed was:
- H.R. 1703, the Choices for Increased Mobility Act of 2025, which would allow patients with Medicare Part B to pay out-of-pocket for wheelchair upgrades if they choose.
- H.R. 2005, the DMEPOS Relief Act of 2025, which would require the US Department of Human Services (HHS) to provide certain adjustments to Medicare payment for certain durable medical equipment items.
- H.R. 2172, the Preserving Patient Access to Home Infusion Act, which would allow nurse practitioners and physician assistants to establish and review home infusion plans of care.
- H.R. 2477, the Portable Ultrasound Reimbursement Equity Act of 2025, which would provide for separate payment for portable ultrasound transportation and set-up services under Medicare.
- H.R. 2902, the Supplemental Oxygen Access Reform (SOAR) Act of 2025, which would reform Medicare’s payment for oxygen and oxygen-related equipment, supplies, and services.
- H.R. 5243, to amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage, which would require enrollee-level utilization reporting of supplemental benefits by Medicare Advantage plans.
- H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act of 2025, which would reform Medicare’s payment for certain clinical laboratory tests under the Clinical Laboratory Fee Schedule.
- H.R. 5347, the Health Care Efficiency Through Flexibility Act, which would make adjustments to collection types for certain accountable care organization quality measures.
- H.R. 6210, the Senior Savings Protection Act, which would extend funding benefits available for older Americans under federal and state programs.
- H.R. 6361, the Ban AI Denials in Medicare Act, which would prohibit implementation of the WISeR model and prohibit any future CMS Innovation Center models that would test prior authorization in traditional Medicare.
ADMINISTRATION
CMS announces Rural Health Transformation Program awards. Under the Rural Health Transformation Program, $10 billion is available each fiscal year (FY) from FY 2026 to 2030. CMS’s announcement provides first-year awards for 2026. All 50 states received funds, with awards ranging from $147 million to $281 million, with Texas and Alaska receiving the most funding ($281 million and $272 million, respectively) and Connecticut and New Jersey receiving the least ($147 million and $154 million, respectively). CMS will recalculate each state’s workload funding amount for each subsequent FY based on the information the state provides in required annual reporting.
CMS also announced the establishment of the Office of Rural Health Transformation within the Center for Medicaid and Children’s Health Insurance Program Services. This office will oversee the program, assist states in implementing their plans, provide technical assistance, and coordinate federal and state partnerships.
Administration announces most-favored nations agreements, three prescription drug payment models. The Trump administration announced most-favored nation (MFN) agreements with an additional nine drug manufacturers. The nine companies will offer their drugs to state Medicaid programs at MFN prices, implement MFN pricing on any new prescription drug they bring to market, and repatriate increased foreign revenue on existing products. The companies also agreed to offer discounted prices on many prescription drugs when purchased using TrumpRx, which is expected to launch this month and will allow drug companies to sell drugs directly to consumers. The nine drug companies committed to investing at least $150 billion collectively in US-based manufacturing. Several companies will also donate active pharmaceutical ingredients for key products to the Strategic Active Pharmaceutical Ingredients Reserve for emergency preparedness purposes.
The administration also announced three prescription drug payment models:
- The proposed Global Benchmark for Efficient Drug Pricing (GLOBE) model would test whether an alternative method for calculating Part B inflation rebate amounts for certain separately payable Part B drugs and biological products reduces costs for Medicare fee-for-service beneficiaries and the Medicare program while preserving quality of care. If finalized, the model would have a seven-year test period consisting of five performance years (October 1, 2026 – September 30, 2031). The model would focus on a set of Part B rebate-eligible drugs that are used to treat beneficiaries with conditions where access barriers such as high costs likely contribute to deficits in care. CMS estimates that the GLOBE model would result in overall savings of $11.9 billion in Medicare Part B net spending during the seven-year period. Comments are due on February 23, 2026.
- The proposed Guarding US Medicare Against Rising Drug Costs (GUARD) model would test an alternative payment method for calculating inflation rebates for certain Part D drugs and biological products. The model proposes to test whether changing the calculation of the Part D inflation rebate would reduce costs for the Medicare program while preserving or enhancing quality of care for Part D enrollees. Currently the Part D inflation rebate program requires drug manufacturers to pay a rebate to the government if they raise prices for certain drugs faster than the rate of inflation. If finalized, the model would have a seven-year test period consisting of five performance years (January 1, 2027 – December 31, 2033). CMS estimates that the GUARD model would reduce Medicare spending by $14.1 billion from 2028 to 2033.
- The voluntary Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model aims to increase access to GLP-1 medications and healthy lifestyle interventions. CMS will facilitate the development and implementation of negotiated pricing agreements (key terms) between state Medicaid agencies, Medicare Part D plan sponsors, and GLP-1 manufacturers that include evidence-based lifestyle interventions to promote health behaviors. The key terms may include guaranteed rebates and manufacturer-provided lifestyle support. The performance period for state Medicaid agencies is May 2026 to December 2031, and for Part D plans it is January 2027 to December 2031. The request for manufacturer applications contains detailed information on the model. CMS also released a state Medicaid agency notice of intent and a Part D plan notice of intent.
CMS, Departments of Labor and Treasury propose healthcare price transparency updates. In the first Trump administration, CMS established price transparency requirements for hospitals and health plans. On February 25, 2025, President Trump issued an executive order on price transparency that directed additional actions. This new rule proposes the following policies for health plans that aim to improve the standardization, accuracy, and accessibility of information:
- Reduce the size of files by requiring health plans to exclude from their in-network rate files certain provider-rate combination services. To reduce duplicative data, the departments propose to change the level at which health plans must report data.
- Increase the amount of “usable data” from health plans by requiring health plans to aggregate their allowed amount files by insurance market type, lowering the claims threshold, and increasing the period of reporting.
- Require the inclusion of additional data elements to provide context around the data being reported. The departments also propose to require health plans to publicly disclose a new “change-log” machine-readable file which would reflect changes in data from one in-network rate file to the publishing of the next in-network rate file.
- Make data easier to locate by requiring that health plans include a plain text file on their website that provides the specific location of the machine-readable files and contact information. The departments also propose to require health plans to add a link in the footer of the home page of the plan’s website titled “Price Transparency” or “Transparency in Coverage” that routes directly to the data.
- Reduce administrative burden by requiring health plans to update and post the in-network rate and allowed amount files quarterly rather than monthly.
Comments are due on February 21, 2026.
CDC updates childhood immunization schedule. Following a presidential memorandum directing the HHS secretary and CDC acting director to examine how peer nations structure childhood vaccination schedules, CDC Acting Director O’Neill signed a decision memorandum overhauling the US childhood vaccination schedule that cuts the number of routine vaccine recommendations from 17 to 11. The vaccines removed from the list of recommended vaccines for all children include immunizations for respiratory syncytial virus, hepatitis A, hepatitis B, rotavirus, meningococcal disease, and influenza. The recommendation for COVID-19 was already adjusted in 2025.
The CDC now recommends some of the formerly routine immunizations only for certain high-risk groups. Other immunizations will be given based on “shared clinical decision-making,” which means the decision to immunize a child is up to physicians and parents. Although the recommendations changed, all immunizations recommended as of December 31, 2025, will continue to be fully covered by ACA insurance plans and federal insurance programs. Read the press release here and the fact sheet here.
HHS, USDA issue new dietary guidelines. The dietary guidelines are updated every five years based on scientific reviews, public comments, and a report with recommendations from the external Dietary Guidelines Advisory Committee (DGAC). The DGAC report for the 2025 – 2030 guidelines was released in December 2024 under the Biden administration. In the guidelines, HHS and the US Department of Agriculture (USDA) note that they aimed to address and correct deficiencies in the DGAC report, which they stated was framed through a health equity lens.
More information can be found in the press release and fact sheet. HHS and USDA also launched realfood.gov, published appendices for the Scientific Foundation, and created a chart showing recommended daily servings by calorie level.
ASTP/ONC releases HTI-5 proposed rule. The HHS Assistant for Technology Policy/Office of the National Coordinator for Health IT (ASTP/ONC) released the Health Data, Technology, and Interoperability: ASTP/ONC Deregulatory Actions to Unleash Prosperity (HTI-5) proposed rule alongside another rule to withdraw non-finalized provisions of the 2024 HTI-2 proposed rule. Key proposals in HTI-5 include:
- Reducing or removing certification criteria for health information technology (IT). Out of 60 current criteria, ASTP/ONC proposes to remove 34 and revise seven criteria from the ONC Health IT Certification Program, stating they include capabilities that are already well established in health IT products in the market, duplicative of other regulatory requirements, or impede innovation.
- Information blocking. ASTP/ONC proposes to add language to the definitions of “access” and “use” to emphasize that the definitions include automated means of access, exchange, or use of electronic health information, including autonomous artificial intelligence systems. The agency proposes to remove or revise various exceptions in an effort to address potential misuse or abuse and to strengthen HHS’s ability to enforce the information blocking regulations.
- Fast Healthcare Interoperability Resources (FHIR). The proposed rule would enable ASTP/ONC to reset the Certification Program’s scope and establish a new foundation to build FHIR-based application programming interface requirements in the future.
- Conditions and maintenance of certification requirements for health IT developers. ASTP/ONC proposes to descope the “real world testing” condition and maintenance of certification requirements with deregulatory actions for real world testing plans, real world testing results, and the use of the Standards Version Advancement Process (SVAP). ASTP/ONC also proposes to remove and descope measures associated with the “insights” conditions and maintenance of certification requirements consistent with the enforcement discretion issued on April 29, 2025, which limits collection and reporting requirements to only the “use of FHIR in apps through certified health IT” measure.
Comments are due on February 27, 2026.
QUICK HITS
- GAO issues report on GME. The US Government Accountability Office (GAO) completed a statutorily mandated study on the Consolidated Appropriations Act, 2021, provision that required CMS to distribute additional graduate medical education (GME) residency positions. The study describes the number of hospitals that applied for and received additional positions, their characteristics, and benefits and challenges they have faced.
- DEA extends telemedicine flexibilities for prescribing controlled substances. The US Drug Enforcement Administration (DEA) provided a fourth extension of telemedicine prescribing flexibilities for controlled substances, through December 31, 2026. The flexibilities would have expired at the end of 2025 without additional action.
- CMS pauses Minnesota Medicaid funding. In an X post, CMS Administrator Oz announced that CMS is withholding Medicaid funding because of noncompliance amid allegations of fraud. The administrator’s letter to Minnesota Governor Walz states that CMS will conduct a focused review of past CMS-64 quarterly receipts and will defer funding based on findings of fraud, waste, and abuse. Vice President Vance also announced the creation of a new assistant attorney general to investigate allegations of fraud across the United States.
- GAO requests MedPAC nominations. Medicare Payment Advisory Commission (MedPAC) nominations will be accepted through February 6, 2026, and appointments will be effective May 2026.
NEXT WEEK’S DIAGNOSIS
Congress will be in session next week, and we await news of a possible ACA enhanced APTC extension agreement in the Senate. The House Oversight and Government Reform Subcommittee on Government Operations will hold a hearing on curbing federal fraud, and the Senate Health, Education, Labor, and Pensions Committee will hold a hearing on chemical abortion drugs and a markup on four bills. MedPAC will hold a two-day public meeting.
