The House and Senate are in recess and will return on April 28. 

Reconciliation Negotiations Continue with Congress in Recess. Republican lawmakers plan to use reconciliation to push key Trump Administration policy priorities forward, including extending tax cuts and other spending items. As a reminder, reconciliation is a unique legislative tool requiring a simple majority in the Senate instead of the typical 60-vote threshold. Before Congress went into recess, House and Senate Republicans agreed to a unified path forward. Importantly for health care stakeholders, the House Energy and Commerce and House Ways and Means committees are expected to hold markups – a key step in deciding and revising the language they might include in the final package – in the first full week of May. However, that timeline may slip to later in the month. Senate health committees have not indicated a date for this step. A4H will continue to monitor this process and provide updates.

Senate Introduces Legislation to Preserve Patient Access to Accountable Care. Senators John Barrasso (R-WY) and Sheldon Whitehouse (D-RI) introduced the bipartisan Preserving Patient Access to Accountable Care Act. The bill would extend the incentive payments for qualifying participants in advanced alternative payment models through payment year 2027 at an increased amount of 3.53 percent and would freeze the qualifying participant thresholds. This bill is the Senate companion to an identical bill introduced in the House earlier this year. A4H is grateful for the bipartisan commitment to the policy that incentivizes the adoption of accountable care.  

New CMS Administrator Dr. Mehmet Oz Shares His Vision for the Agency, Including Strong Alignment to Accountable Care Goals. Administrator Oz highlighted his focus on modernizing Medicare, the Affordable Care Act (ACA) Marketplaces, and Medicaid. Among other goals under the broad umbrella of modernizing CMS’ programs, Administrator Oz emphasized the importance of holding providers accountable for their patients’ health outcomes, streamlining access to care and treatment, eliminating fraud, waste, and abuse, and shifting the health care paradigm from “sick care” to one which centers on prevention, wellness, and disease management. A4H sent a letter to Administrator Oz’s supporting his commitment to driving patient-centered care and accountable care arrangements. A4H will continue working with the Administration and other policymakers to advance the transition to better health outcomes at a lower cost.

CMS Finalizes Pay Increase for MA Plans. The Centers for Medicare and Medicaid Services (CMS) recently finalized the Medicare Advantage (MA) and Part D Policy and Technical Rule, and the MA and Part D Rate Announcement. The Rate Announcement finalizes a 5.06 percent average pay bump for MA plans, slightly higher than the 4.33 percent proposed in the Advance Notice and substantially higher than the 3.7 percent payment increase plans saw for 2025. The increase was largely due to the incorporation of additional fee-for-service data contributing to a greater effective growth rate. The Policy and Technical Rule finalizes provisions intended to ensure MA plans abide by prior authorization determinations and closes a series of MA appeals process “loopholes” CMS states adversely affect providers and patients, among other provisions. However, CMS opted not to finalize a change in policy interpretation on anti-obesity medications (AOMs), which would have allowed Medicare to cover these medications. Additionally, CMS chose not to finalize AI guardrails, which would have clarified MA plans’ obligation to comply with certain regulations if they use AI. There has been increasing bipartisan concern about MA plans’ use of prior authorization and artificial intelligence and the quality and cost of care on MA versus traditional Medicare, so policymakers may still seek broader reforms to the program.

CMS IPPS Rule Proposes Updates to TEAM, Seeks Input on Deregulation. CMS issued the proposed FY26 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule last week. CMS proposed increasing the IPPS operating payment rates by 2.4 percent, resulting in an estimated $4 billion increase in payments to hospitals and increasing the LTCH standard payment rate by 2.6 percent. In the rule, CMS proposed changes to the Transforming Episode Accountability Model (TEAM), a previously finalized mandatory bundled payment model. While maintaining the foundational structure of the model, CMS proposed expanding the three-day skilled nursing facility waiver, modifying policies affecting participation of new hospitals, quality measure, and assessment, payment methodology and risk adjustment, and removing certain health reporting elements. The rule also included a Request for Information on streamlining regulations and reducing administrative burdens in Medicare, in line with the executive order on “Unleashing Prosperity Through Deregulation.” A4H supports CMS’ commitment to testing models like TEAM and will continue engaging with stakeholders on the role of value-based care in our healthcare system.

EO on Lowering Drug Prices Instructs Action on Payment Model. This week, President Trump issued an executive order (EO) titled “Lowering Drug Prices by Once Again Putting Americans First.” The EO directs agencies to take several actions designed to lower drug prices, including reforming the Medicare Drug Price Negotiation Program, addressing pharmacy benefit manager transparency, developing a model to test value-based payment for drugs in Medicare, reforming Medicare payment to account for hospital drug acquisition cost and to align with certain site-neutral policies, promoting innovation and value in Medicaid drug payment, and preventing anti-competitive behavior, among other policies. A4H will continue to monitor value-based drug model activity, including potential CMMI activity.

NYT Article Highlights Dramatic Rise in Skin Substitute Spending. A recent article from the New York Times investigates increased spending on skin substitutes in Medicare. The Times investigation highlights how accountable care organizations have played a critical role in alerting the government about the potential overuse of skin substitutes. The investigation found that spending on skin substitutes exceeded $10 billion in 2024, more than double the figure in 2023. Notably, CMS recently announced that it will delay until January 2026, the effective date of the Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers Final Local Coverage Determinations, which was originally set to go into effect in February.

MMA One-Pagers on Medicaid by Congressional District. The Modern Medicaid Alliance (MMA) recently published one-pagers for all 435 congressional districts, highlighting key data points on Medicaid’s impact in the district. Each one-pager includes information on enrollment (broken out by eligibility category), health conditions experienced by Medicaid patients in the district, and funding from state and federal sources supporting Medicaid. The one-pagers, intended to support advocacy efforts across a wide range of impacted stakeholders, are located on MMA’s Medicaid Dashboard, here.

Save the Dates for our Upcoming Double Click Meetings. Our in-person quarterly meetings are for policy-focused audiences in Washington, DC.

Each meeting will be held at the Kaiser Center for Total Health (700 2nd St, NE, Washington, DC) from 11am to 2pm ET. Please note the separate registration links. More details to follow.

• Tuesday, May 20 – register here
• Tuesday, September 30 – register here (please note new date)
• Tuesday, December 9 – register here