24 November 2025 This Week in Health Policy for November 24 The House and Senate are both scheduled to be in recess this week for the Thanksgiving holiday. This Week in Health Policy will not publish this week. Congress resumes appropriations. While much of the attention in Congress this week has been on the expiring enhanced Affordable Care Act (ACA) premium tax credits (PTCs), lawmakers are facing another deadline at the end of January to pass nine of the 12 annual appropriations bills, another continuing resolution (CR) or "minibus" packages of multiple spending bills to avoid a second government shutdown. Typically, in recent years, House Republicans pass appropriations bills with deep spending cuts and partisan policy riders, while the Senate Appropriations Committee works in a more bipartisan fashion. The House and Senate must compromise and agree on the same bills, and the support of some Democrats is required because appropriations bills require 60 votes in the Senate. The table below reflects the current status of appropriations bills:
An appropriations tracker is available here. On Wednesday (November 19), Senate Majority Leader John Thune (R-SD) in a social media post wrote, "It is my intention this week to start the consideration of a package of up to five appropriations bills so that we can fund the government in a transparent and open way." Bills under consideration for a next Senate minibus are: Labor-HHS, Defense, Transportation-HUD, Interior, and Commerce-Justice-Science. Roll Call reported that the top Republican and Democratic members of the House and Senate appropriations committees — Reps. Tom Cole (R-OK) and Rosa De Lauro (D-CT) and Senators Susan Collins (R-ME) and Patty Murray (D-WA) — met November 20 to discuss the appropriations landscape without any breakthroughs on a bipartisan agreement. CMS issues OPPS final rule. On Friday (November 21), CMS issued the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule, which includes a 2.6% payment rate update for hospital outpatient and ASC services, up slightly from the proposed 2.4% rate. CMS in the rule finalized its proposals to expand site-neutral payments to include drug administration services furnished in excepted off-campus provider-based departments (PBDs), eliminate the inpatient only list (IPO) over a three-year period beginning in CY 2026, and add new services to the ASC covered procedures list. CMS also finalized several updates to hospital price transparency rules, quality programs and the star ratings program. CMS did not finalize a proposal to accelerate the recoupment of funds outlined in the 340B Final Remedy rule, but noted that it plans to move forward with the proposed 2% reduction in CY 2027. CMS also indicated they intend to complete the acquisition cost survey in time for results to be used to inform policymaking beginning with the CY 2027 OPPS/ASC proposed rule, setting up potential 340B reimbursement changes at that time. Click here for the press release. Click here for the fact sheet. Click here for the price transparency fact sheet. CMS issues ESRD payment rule. On Thursday (November 20), CMS issued the CY 2026 End-Stage Renal Disease (ESRD) Prospective Payment System Final Rule. The rule sets a base rate of $281.71 for ESRD facilities, up 2.2% from CY 2025. CMS projects hospital-based ESRD facilities will see a 1.5% increase in total payments, while freestanding facilities will see an increase of 2.2%. The rule also includes updates to streamline the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) and eliminates three health equity reporting measures from the ESRD quality incentive program. CMS also finalized its proposal to end the ESRD Treatment Choices Model at the end of the year. Click here for a fact sheet. CMS issues update on claims processing. On Thursday (November 20), CMS published a notice directing providers to resubmit Medicare claims submitted during the shutdown with the GY modifier for reimbursement. CMS in an updated FAQ also clarified that some telehealth providers can continue to list their physical practice locations instead of their home address on Medicare billing and enrollment forms. DHS issues 'public charge' proposed rule. On Wednesday (November 19), the Department of Homeland Security issued a notice of proposed rulemaking that rescinds a 2022 final rule on the public charge standard and gives immigration officers greater discretion when considering statutory and case-specific factors for determining whether non-citizens are likely to become dependent on the federal government. HHS report on pediatric gender-affirming care. On Wednesday (November 19), HHS released a peer-reviewed report that is critical of pediatric gender-affirming care, highlighting potential risks and long-term health impacts associated with treatments such as puberty blockers, hormones, and surgeries. CDC updates vaccine safety website. On Wednesday (November 19), the Centers for Disease Control and Prevention (CDC) updated its website to state, "The claim 'vaccines do not cause autism' is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism." The website states CDC is conducting a "a comprehensive assessment of the causes of autism." While the website maintains the subhead, "Vaccines do not cause autism," it includes an asterisk that says, "The header 'Vaccines do not cause autism' has not been removed due to an agreement with the chair of the U.S. Senate Health, Education, Labor, and Pensions Committee that it would remain on the CDC website." The CDC's Advisory Committee on Immunization Practices (ACIP) is scheduled to meet next month to discuss the childhood immunization schedule. Several medical organizations, including the American Medical Association, have criticized the new language. HHS unveils AI caregiver competition. On Tuesday (November 18), HHS announced the Caregiver Artificial Intelligence (AI) Prize Competition, which aims to develop AI caregiver tools that support family members, friends, and the direct-care workforce in providing safe, person-centered care at home, as well as AI caregiver workforce tools that help home care organizations improve efficiency, scheduling, and training. The Administration for Community Living (ACL) will award 10 innovators up to $2 million over a three-year period as part of the initiative. CMS publishes Medicare Parts A and B premiums. On Friday (November 14), CMS published 2026 premiums and deductibles for Medicare Part A and Part B. CMS said the Part B standard monthly premium will be $202.90, up 9.7% from 2025. The annual Part B deductible for 2026 will be $283.00, up 10.1% from 2025. CMS said the Part A monthly premium will be $565, up 9.1% from 2025. The Part A inpatient deductible will be $1,736, up 3.6% from 2025, and cost sharing for inpatient stays that exceed 60 days will be $434 per day for days 61 — 90 and $868 per day for lifetime reserve days. In its announcement, CMS noted that the Part B premium increase would have been about $11 more a month should they not have taken action to address "unprecedented spending on skin substitutes," in their final physician payment rule. CMS issues guidance implementing certain OBBBA provisions. On Friday (November 14), CMS issued guidance on implementing certain Medicaid provisions from the One Big Beautiful Bill Act (OBBBA) for both providers and managed care organizations (MCOs), including provider taxes and provider tax waivers. CMS also issued an information bulletin on the entire bill's Medicaid and the Children's Health Insurance Program (CHIP) related provisions, noting that additional guidance and regulation is expected to aid states in implementation. House Ways and Means Health Subcommittee held a hearing on "Modernizing Care Coordination to Prevent and Treat Chronic Disease." On Wednesday (November 19), the Committee held a hearing to discuss innovations in care coordination during which they heard from witnesses representing providers, blood cancer patients, and community pharmacists. During the hearing, there was bipartisan agreement on the need to improve care coordination through value-based models, team-based care that enable providers to practice at the top of license and expand pharmacists' role in care, and telehealth and remote patient monitoring. Several Democrats urged the Republican colleagues to extend the expiring ACA enhanced PTCs and warned against rising Medicare premiums.
House Energy & Commerce Oversight & Investigations Subcommittee held an oversight hearing on "The Safety of Artificial Intelligence (AI) Chatbots." On Tuesday (November 18), the Subcommittee held a hearing during which they heard from a panel of witnesses representing psychiatry, academics, and researchers who spoke about the risks AI may pose to privacy and mental health, particularly the vulnerability of children and teens, as well as the potential benefit of increasing access to mental health services. Lawmakers expressed bipartisan support for certain guardrails and discussed legislation to add new AI regulations, including the Algorithmic Accountability Act, and provide guidance to families on AI chatbot safety, including the AWARE Act.
Senate Finance Committee held a hearing on "The Rising Cost of Health Care: Considering Meaningful Solutions for all Americans." On Wednesday (November 19), the Senate Finance Committee held a hearing on rising health care costs that primarily focused on the ACA's enhanced premium tax credits expiring at the end of the year. During the hearing, all Democrats and Sen. Thom Tillis (R-NC) stated there is no more time to explore alternative solutions, saying they would support at least a short-term extension of the PTCs while lawmakers work on bipartisan reforms. Republicans, meanwhile, voiced their opposition to extending the enhanced PTCs, which they said results in funneling taxpayer money directly to insurers without addressing the underlying problems with costs and the ACA. At the end, there was no clear policy solution advanced. Republicans and witnesses discussed several alternatives, including new tax-preferred accounts, funding the ACA's cost-sharing reduction payments (CSRs), and increasing transparency in health care to give consumers more control over their health care decisions. Sen. Maria Cantwell (D-WA) proposed moving lower income ACA enrollees to the ACA's basic health program (BHP).
Senate Special Committee on Aging held a hearing on "Made in America: Restoring Trust in Our Medicines." On Wednesday (November 19), the Committee held a hearing on the U.S. drug supply chains during which members raised concerns about the country's reliance on foreign nations for drugs and active pharmaceutical ingredients (APIs). During the hearing, members and witnesses discussed ways to shore up the U.S. drug supply chain, address economic pressures facing generics, and reduce regulatory barriers to domestic manufacturing. Policy solutions discussed included financial incentives, such as tax credits or grants, for domestic manufacturing, increased transparency into the API supply chain, and leveraging multi-year purchasing agreements to support generic manufacturing.
Senate Homeland Security and Governmental Affairs Committee held a hearing to consider nominations. On Wednesday (November 19), the Committee considered the nomination of Thomas Bell to be HHS Inspector General. During the hearing, Mr. Bell fielded questions on a range of topics including fraud, waste, and abuse, the right of the executive branch to remove IGs, cybersecurity, and more.
Senate Finance Committee held a hearing to vote on nominations. On Wednesday (November 19), the Committee approved the nomination of Thomas Bell to be Inspector General of HHS.
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