Stay ahead of the latest regulatory shifts and healthcare breaking news with Headlines from the Hill.
In this month’s edition you will find:
- Open Government Compromise: Passed funding through January 30.
- Remote Patient Monitoring Access Act: What to Expect.
- Inpatient Rehabilitation Facility Priority Issues: AHA committee meeting update.
- Level of Severity Inpatient Payment Policy: Aetna modified policy.
Open Government Compromise: Passed funding through January 30.
Congress passed a funding package to reopen the government on November 12, with President Donald Trump signing the legislation to make it official. The House voted 222-209, with six Democrats siding with Republicans. Two Republicans voted against the agreement. The legislation includes a Continuing Resolution (CR) that maintains funding for most federal agencies at current levels through Jan. 30, 2026, and a “minibus” consisting of three fiscal year (FY) 2026 appropriation bills.
In addition, the bill fully funds Supplemental Nutrition Assistance Program (SNAP) benefits. Majority Leader John Thune promised a Senate vote on extending the expiring Affordable Care Act (ACA) enhanced Advance Premium Tax Credits (eAPTCs) sometime in December. Package details:
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- Delays the Medicaid Disproportionate Share Hospital (DSH) cuts through Jan. 30, 2026.
- Medicare Extenders -- several healthcare extenders were incorporated, including, but not limited to, an extension of Medicare Low-Volume Hospital (LVH) payment adjustments, the Medicare-Dependent Hospital (MDH) program, Acute Hospital Care at Home waiver authorities, add-on payments for ambulance services and Medicare telehealth flexibilities through Jan. 30, 2026.
- Healthcare Extenders — the CR includes several public health extenders through Jan. 30, 2026, including extension for Community Health Centers (CHCs), the National Health Service Corps and the Teaching Health Center Graduate Medical Education program. It also reauthorizes the Special Diabetes Program and certain existing authorities related to emergency preparedness and response activities and functions through Jan. 30, 2026.
- Extends funding for quality measure endorsement, input and selection for the Centers for Medicare and Medicaid Services (CMS).
- It includes a revised phase-in of Medicare clinical laboratory test payment changes by delaying pending payment reductions to the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act.
- It incorporates a temporary inclusion of authorized oral antiviral drugs as covered Part D drugs and reduces the amount of funding in the Medicare Improvement Fund from $1.804 billion to $1.403 billion.
- It waives the statutory PAYGO sequestration order and extends by one month the mandatory Medicare payment reductions under sequestration.
- The package also reauthorizes the Over-the-Counter Monograph Drug User Fee (OMUFA) for FY 2026 to FY 2030. Reauthorization of the program includes a negotiated agreement on performance goals and procedures between the FDA and industry for the upcoming five-year period, as well as provisions to improve transparency and accountability of the FDA relating to its regulation of over-the-counter (OTC) products and allow for increased innovation and access to OTC products.
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Remote Patient Monitoring Access Act: What to Expect.
The Rural Patient Monitoring (RPM) Access Act (S. 1535/H.R. 3108) would ensure Medicare patients in rural and underserved communities have access to remote physiologic monitoring services, which lower costs and improve access to care by using technology to collect and transmit patient health data to healthcare providers.
Inpatient Rehabilitation Facility Priority Issues: AHA committee meeting update.
Russ Bailey, President - Rehabilitation Services at Lifepoint Health and the American Hospital Association (AHA) Post-acute Care Steering Committee met with Rachel Dolin, House Ways and Means Committee Minority Staff to discuss issues impacting for post-acute care providers and the following AHA committee priority issues:
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- IRF Review Choice Demonstration — Prevent further expansion of demo and encourage early termination in existing states.
- Medicare Advantage: Prior Authorizations & Network Adequacy — Ensure proper access for MA beneficiaries by stopping use of inappropriate criteria and other behavior that delays and denies access to post-acute care.
- Medicare Market Basket — Improve annual payment updates to better reflect increasing cost of care.
- Home Health PPS Payment Reductions — Limit budget neutrality cuts due to PDGM implementation
- Medicare Post-Acute Transfer Rules — Prevent changes in payment policy that will disincentive.
- Outpatient Therapy — Ensure access to intensive outpatient therapy for both Fee-for-Service and MA beneficiaries.
- Medicare Star Ratings for IRF — Discourage development by demonstrating lack of utility, lack of credibility of singular star system due to post-acute care facility characteristics.
- SNF Oversight — Reduce reliance on Special Focus Facility program.
- Post-acute Care Value-based Purchasing Programs (HH, SNF) — Advocate for programs to pay out highest possible percentage of withhold and uses equitable methodology.
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Level of Severity Inpatient Payment Policy: Aetna modified policy.
The Federation of American Hospitals (FAH) have been engaging with Aetna’s new “Level of Severity Inpatient Payment Policy" and received communications related to their somewhat modified policy which will begin January 1, 2026.
Despite some modifications, overall, the policy remains fundamentally the same and will likely result in a reduction in some inpatient payments. It also will mask prior authorization and payment denials, likely to enhance scores for Aetna’s Star Ratings while limiting the hospital appeals process. The FAH discussions with CMS and in some communications with state hospital associations, CMS has initially indicated they believe the new policy is a payment — and not a coverage — policy, and thus by law are not able to intervene. FAH will continue to pursue CMS to reverse the policy, especially emphasizing that the policy games the Star Ratings System as well as CMS’s duty to mitigate untoward treatment of providers.
