20 April 2026 This Week in Health Policy for April 20 House Ways and Means Committee will hold a hearing on "Protecting Patients and Taxpayers: Cracking Down on Medicare Fraud."
House Energy and Commerce Health Subcommittee will hold a hearing on "The Fiscal Year 2027 Department of Health and Human Services Budget."
Senate Appropriations Committee will hold a hearing on "the President's Fiscal Year 2027 Budget Request for the Department of Health and Human Services."
Senate Finance Committee will hold a hearing on "The President's Fiscal Year 2027 Department of Health and Human Services Budget."
House Education and Workforce Subcommittee on Health, Employment, Labor, and Pensions will hold a hearing on "Profits Over Patients: The PBM Business Model Under Scrutiny."
Senate HELP Committee will hold a hearing on "Fiscal Year 2027 Department of Health and Human Services Budget."
Sen. Cassidy publishes health care affordability agenda. On Wednesday (April 15), Sen. Bill Cassidy (R-LA), Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, shared his health care, affordability agenda. The Money and Value for Patients (MVP) agenda focuses on giving money directly to individuals to cover out-of-pocket costs, expand TrumpRx and increase transparency into prices, and address chronic disease through improved nutrition. Trump nominates new CDC leadership. On Thursday (April 16), President Trump nominated Erica Schwartz, a former deputy U.S. Surgeon General, to serve as the next CDC Director. Schwartz also has served as a rear admiral in the Public Health Service Commissioned Corps and U.S. Coast Guard Chief Medical Officer. Schwartz's nomination will require Senate confirmation. President Trump also announced the appointment of Sean Slovenski, a former Walmart executive, as CDC deputy director and chief operating officer; Jennifer Shuford, Texas health commissioner, was appointed the CDC's deputy director and chief medical officer; and Sara Brenner, a former FDA administrator, was designated as a senior counselor for public health to HHS Secretary Robert F. Kennedy Jr. CMMI extends ACCESS application deadline. On Monday (April 13), CMMI said it has extended the initial application deadline to apply for the voluntary ACCESS (Advancing Chronic Care with Effective Scalable Solutions) Model to May 15, 2026. The announcement came as the agency announced more than 150 health care organizations had been accepted to participate in the launch of the model, which aims to expand technology-enabled care for chronic conditions among Medicare beneficiaries. President's Budget Request. On April 3, the White House published a FY 2027 budget request that outlines the Administration's plans for the federal budget, including several health care agencies. While the President's budget request details the Administration's funding priorities, ultimately, it is up to Congress to set the federal budget. The budget requests a 12.5%, or $15.8 billion, cut to the US Department of Health and Human Services (HHS) and would reduce funding to several agencies, including the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health. The budget proposal also renews the Administration's request from last year to create a new Administration for a Healthy America (AHA), which would consolidate several existing agencies, and establishes a new National Center for Chemicals and Toxins. The budget also re-establishes the Administration for Strategic Preparedness and Response (ASPR) and the Advanced Research Projects Agency for Health (ARPA-H) as their own divisions. To read more, click here for the WCEY Alert: Health Care Items in President Trump's FY 2027 Budget Request. CMS finalizes MA and Part D 2027 technical rule. On April 2, the Centers for Medicare & Medicaid Services (CMS) issued the Contract Year (CY) 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program final rule. The rule removes 11 measures from the star ratings beginning with the 2027 measurement year and codifies changes to the Part D benefit design, as required by the Inflation Reduction Act. CMS will require plans to publicly post plan-developed Special Supplemental Benefits for the Chronically Ill (SSBCI) eligibility criteria and establish new guardrails for debit card use. CMS did not finalize the proposal to modify the special enrollment period that allows enrollees to change plans when a provider they see leaves the network. CMS will consider the possibility of further action in future rulemaking. Click here for the fact sheet. Click here for the press release. CMS releases MA final rate notice for 2027. On April 6, the CMS issued the Announcement of Calendar Year (CY) 2027 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. In the Rate Announcement, CMS finalized a net average payment increase of 2.48% for MA plans, up from a proposed .09%, along with updates to MA and Part D risk adjustment models, and updates to MA star ratings measures and calculations. Notably, CMS did not finalize a proposal to re-calibrate the risk adjustment model with newer Medicare diagnosis and expenditure data and will instead continue to calculate non-ESRD MA risk scores using the 2024 CMS-HCC model." CMS did, however, finalize a proposal to exclude diagnoses from unlinked chart review records, with an exception for beneficiaries who switch from one MA organization to another, along with a policy to exclude diagnoses identified as resulting from audio-only services. To read more, click here for the WCEY Alert: CMS Issues CY 2027 Medicare Advantage and Part D Rate Announcement.
The proposed rule also would expand the Comprehensive Care for Joint Replacement (CJR) Model. The expanded model, called CJR-X, would aim to improve care coordination for Medicare patients undergoing hip, knee and ankle replacements in both inpatient and outpatient hospital settings. CJR-X would be mandatory nationwide and begin on October 1, 2027. In addition, the proposed rule makes several updates to hospital quality and pay-for-performance programs. The proposed rule is open for public comment through June 9, 2026. Click here for the fact sheet. Click here for the press release.
CMS, ONC issue Interoperability Standards and Prior Authorization for Drugs proposed rule. On April 10, CMS and ONC issued a proposed rule to apply interoperability standards and electronic prior authorization requirements to drugs. The rule would apply to Medicare Advantage (MA) organizations, Medicaid and Children's Health Insurance Program (CHIP) programs, and qualified health plan (QHP) issuers on the federally-facilitated exchanges (FFEs). The rule would establish new timeframes for prior authorization decisions for drugs and would require impacted payers beginning October 1, 2027, to implement and maintain a prior authorization API to facilitate electronic prior authorization for drugs covered under a medical benefit. This change would align Prior Authorization API standards for drugs with those for non-drug items and services. The rule also proposes to adopt HL7 FHIR standards and implementation guides (IGs) for referral certification/authorization and eligibility transactions, and the Da Vinci Clinical Data Exchange (CDex) IG for attachments. The rule also includes five standalone RFIs. The rule is open for public comments through June 15, 2026. Click here for the fact sheet. Click here for the press release. ACIP publishes new charter. On April 8, the Advisory Committee on Immunization Practices (ACIP) published a new charter that places an increased focus on potential vaccine harms and seeks to expand the Committee's membership to include areas outside of immunization expertise, including toxicology, pediatric neurodevelopment, and on "recovery from serious vaccine injuries." CMS issues guidance on OBBBA federal matching fund changes. On April 8, the Centers for Medicare and Medicaid Services (CMS) published initial guidance on how states should implement a provision in the One Big Beautiful Bill Act (OBBBA) that limits federal matching funds to U.S. citizens and nationals; legal permanent residents, or "green card holders," Cuban/Haitian entrants, and migrants eligible under the Compact of Free Association (COFA). The provision takes effect October 1. The guidance details steps states must take to determine and verify an individual's immigration status and clarifies that federal matching dollars are still available for treatment of emergency conditions. HRSA unveils new funding for nutrition and rural workforce. On April 7, the Health Resources and Services Administration announced $125 million in funding opportunities to expand access to nutrition services at more than 350 HRSA-funded health centers. HRSA also announced $11.25 million to support new rural residency programs in high-need specialties, including family medicine, internal medicine, psychiatry, OB-GYN, general surgery, and preventive medicine. CMS reminds hospitals of nutrition requirements. On March 30, CMS issued a memo to hospitals reminding them of federal Medicare requirements to ensure hospital menus and diets meet individual patient nutritional needs in accordance with recognized dietary practices. CMS directed hospitals to review and revise food and nutrition service policies, standard menus, therapeutic diet protocols, and food procurement practices to align with the 2025 — 2030 Dietary Guidelines for America. House Energy and Commerce Health Subcommittee held a hearing on "Healthier America: Legislative Proposals to Improve Public Health." On Wednesday (April 15), the Subcommittee discussed nine health care bills, including those related to early detection of dementia and Alzheimer's, support nutrition education and chronic disease prevention services in community health centers, require community health centers to provide behavioral and mental health and substance use disorder services, and codify FDA guidelines that exclude low-risk products, such as wearable devices, from regulation as medical devices. Other bills discussed would reauthorize programs related to tick-borne diseases, breast cancer awareness, school-based health centers, cord blood and stem cell research, and research into ALS treatments.
House Ways and Means Health Subcommittee held a field hearing on "Modernized Health Care in Practice: Empowering Americans to Live Healthier Lives." On Tuesday (April 14), the Subcommittee held a field hearing at Lake Erie College of Osteopathic Medicine (LECOM) in Bradenton, Florida. During the hearing, discussion primarily focused on preventive care, such as increasing access to preventive testing and diagnostics and ways providers can use nutrition, sleep, and wellness to improve patient health. Committee Chairman Jason Smith (R-MO) also asked about rural workforce and training programs and responses were focused on increasing residency programs in rural areas.
Senate HELP Committee held a hearing on "Making Medicines More Affordable: How Competition Can Lower Drug Prices." On Thursday (April 16), Committee held a hearing during which members heard from a panel of policy experts and consumer advocates on ways to lower drug costs. During the hearing, senators expressed concern at continued high drug costs in the U.S and the negative impact on patients. There was considerable discussion on accelerating the approval of biosimilar drugs through FDA reforms such as expedited pathways, calls for greater transparency, discussion of the Administration's Most Favored Nations deals, and debate over the merits of Trump RX.
House Ways and Means Committee held a "Full Committee Hearing with Health and Human Services Secretary Robert F. Kennedy, Jr." On Thursday (April 16), the Committee held a hearing with HHS Secretary Kennedy, Jr. on the FY 2027 HHS budget request. During the hearing, members discussed a range of topics, with Republicans largely focused on market-based solutions to lowering health care costs, improving the implementation of the No Surprises Act, increasing access to care in rural areas, and addressing waste, fraud, and abuse. Democrats, meanwhile, raised concerns about HHS vaccine messaging and policy, proposed cuts to federal health agencies, and leadership vacancies at public health agencies. There was bipartisan support for policies to address chronic disease through preventive care, including nutrition and Food is Medicine
House Appropriations Committee held a budget hearing on the Department of Health and Human Services. On Thursday (April 16), the Committee held a hearing with HHS Secretary Kennedy, Jr. on the FY 2027 HHS budget request. During the hearing, Democrats raised concerns about withheld appropriated funds, HHS vaccine policy, and proposed funding cuts, while Republicans spoke in favor of the Make America Healthy Again agenda and raised concerns about abortion-related funding. Members expressed bipartisan support for maintaining NIH funding. Kennedy during the hearing spoke strongly in favor of Casey Means' nomination for U.S. Surgeon General and said they are bringing in an "extraordinary" team at the CDC.
House Education and Workforce Committee held a hearing on "Examining the Policies and Priorities of the Department of Health and Human Services." On Friday (April 17), the Committee held a hearing with HHS Secretary Kennedy, Jr. on the FY 2027 HHS budget request. During the hearing, Democrats raised concerns about the Secretary's leadership and HHS' approach to autism, vaccines, and medical research, while Republicans spoke in favor of the MAHA agenda to improve nutrition and address chronic disease. There was bipartisan discussion on pharmacy benefit managers, prior authorization denials, and concerns about proposed cuts to NIH.
Senate Committee on Commerce, Science and Transportation held a hearing on "Oversight of the Federal Trade Commission." On Wednesday (April 15), the Committee heard testimony from FTC Chairman Andrew Ferguson and FTC Commissioner Mark Meader who told the Committee about actions the FTC has taken to address anticompetitive practices in health care, including the creation of a Healthcare Task Force. Member questions varied but generally did not include health care topics.
Document ID: 2026-0900 | |||
