Congress Heads Towards August Recess. The House left for August recess this week, and the Senate is slated to join them at the end of next week. Both chambers are expected to reconvene on September 2, after the Labor Day holiday. When they return, Congress will need to address government funding by September 30 or risk a government shutdown. At present, it seems unlikely Congress will pass all twelve appropriations bills, so some kind of extension of current funding through a Continuing Resolution—or a shutdown—are possible. This week, lawmakers began publicly discussing a second reconciliation package that may include Medicare items, such as Medicare Advantage (MA) risk adjustment and pharmacy benefit manager (PBM) reforms. A4H is working over the recess to assess opportunities to advance accountable care policies as part of these conversations between now and the end of the year.

House Lawmakers Hold Hearing on MA. At the joint hearing held by House Ways and Means Subcommittees on Health and on Oversight, lawmakers pressed witnesses on prior authorization, the role of supplemental benefits, Stars ratings, overpayments, and coding. While there is some bipartisan support to address concern with the MA program, it remains to be seen how and if Members will work towards advancing MA reform in the near future. While Trump has repeatedly instructed Congress not to cut Medicare benefits the Administration has placed a focus on eliminating waste, fraud, and abuse in the program. This may lead lawmakers to seek a more nuanced approach as they consider additional legislative packages targeting deficit reduction.

CMS Releases the Proposed CY26 Physician Fee Schedule. The rule would implement the split conversion factor, resulting in a slightly higher boost (3.83 percent) for providers in qualifying APMs than for those not in such arrangements (3.62 percent). The proposal also includes changes to payment for skin substitutes, proposing a flat reimbursement of $125 per square centimeter. The agency anticipates that the payment change will reduce spending on these products by nearly 90 percent. Other changes in the proposed rule include changes to ACO participation in the Medicare Shared Savings Program (MSSP) that accelerate the move to two-sided risk, coding options for in-home primary care, and two new mandatory Ambulatory Specialty Models (ASM) to improve upstream management of heart failure and low back pain by rewarding specialists for improving patient outcomes and coordination with primary care providers. A4H strongly supports the provisions in the proposed PFS and welcomes CMS’ continued dedication to improving health care quality and efficiency through the transition to accountable care. A4H continues to work with its members to develop comments in response to the proposed rule. A fact sheet on the rule can be found here, and a fact sheet on the MSSP provisions in the rule can be found here.

CMS Releases the Proposed CY26 Hospital Outpatient Department and ASC Payment Rule. CMS proposes to boost payment for hospital outpatient departments (HOPD) and ambulatory surgical centers (ASC) by 2.4 percent. The proposed rule also includes policy changes which would introduce site-neutrality to drug administration reimbursement and eliminate the Inpatient Only List, accelerate 340B hospital repayments by increasing hospitals’ annual payment reduction, tighten hospital price transparency requirements, and other changes. CMS reiterated its interest in deregulation, reminding stakeholders of the Medicare Deregulation Request for Information, separate from its broad request for comments on the proposed rule. A fact sheet is available here.

33 States, D.C. and Puerto Rico, to Participate in CGT Access Model. CMS announced that 33 states, Washington D.C., and Puerto Rico will participate in the Cell and Gene Therapy (CGT) Access Model. 84 percent of Medicaid beneficiaries with sickle cell disease (SCD) are represented by the participating states. The CGT Access Model will test outcomes-based agreements between states and manufacturers for cell and gene therapies, beginning with therapies for SCD. The first state began participating in the Model in March of this year, and all states are expected to begin participation by January 1, 2026.

WISeR Application Closes Today. CMS opened the application period on June 27 and requests all applications by 11:59 ET on July 25. The Wasteful and Inappropriate Service Reduction (WISeR) Model will test technology-enabled prior authorization in fee-for-service Medicare on a set of identified “low-value” medical services vulnerable to fraud, waste, and abuse. A fact sheet on the model can be found here.

A4H Institute and the West Health Policy Center Outline Core Competencies of Accountable Care. The paper, jointly released by A4H and the West Health Policy Center, identifies six core competencies to define what accountable care should be: access to advanced primary care, care management programs tailored to the population served, financial responsibility and flexible payment methods, quality accountability, modern data capabilities, and whole person care delivery. The framework aims to clarify the purposes of accountable care – encouraging coordinated, patient-centered care focused on prevention, chronic disease management, and overall well-being. A4H CEO Mara McDermott published an opinion piece in Modern Healthcare discussing the paper and the framework. Thank you to the A4H members who participated in developing the framework.

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. Details to follow.

• Tuesday, September 30
• Tuesday, December 9

Virtual Value-Based Payment Summit, September 3-5: Register for this online event that will bring together CMS leaders, organizations, stakeholders, and policymakers to discuss value-based care initiatives. Confirmed speakers are listed here.