Health Care Watch: April 12, 2026
The following Federal Health Policy (FHP) Strategies Weekly Health Care Watch provides a summary of legislative and regulatory health care activities from April 6 – April 11 Where available, hyperlinks are included to the relevant documents. Please let us know if you have any questions or would like additional information on the items below.
LEGISLATIVE UPDATE
House
On April 7, Ways & Means Health Subcommittee Chairman Vern Buchanan (R-FL) and Ranking Member Lloyd Doggett (D-TX) sent a bipartisan letter to U.S. Department of Health & Human Services (HHS) Secretary Robert F. Kennedy, Jr. requesting the establishment of an Officer of Kidney Health and Transplantation within HHS, consistent with a recommendation from witness testimony during a Committee hearing last month on “Improving Kidney Health Through Better Prevention and Innovative Treatment.”
On April 8, Education & Workforce Committee Ranking Member Bobby Scott (D-VA), released a report titled “Denied: How the Health Care Industry Stacks the Deck Against Working Families.” The report examines health insurance claim denials in employer-sponsored coverage and highlights issues related to transparency, oversight, and enforcement affecting workers and their families.
The House will return to session on April 14.
Senate
The Senate will return to session on April 13.
REGULATORY UPDATE
On April 3, HHS released updated guidance for the Title X Family Planning Program outlining new priorities for participating clinics. The guidance emphasizes natural family planning methods and includes additional program requirements related to funding eligibility and clinic operations, while existing statutory requirements regarding the provision of a broad range of contraceptive services approved by the Food & Drug Administration (FDA) remain in effect.
On April 6, CMS released the Calendar Year (CY) 2027 Medicare Advantage (MA) and Part D Rate Announcement. CMS finalized policies that are projected to result in a net average year-over-year payment increase of 2.48% (higher than the proposed 0.09% increase from the Advance Notice). CMS did not finalize its proposal to adopt the 2027 MA risk adjustment model, instead retaining the 2024 model, and finalized the proposal to exclude diagnoses from unlinked chart review records from risk adjustment, adding an exception for beneficiaries who switch MA organizations. CMS did not finalize the continuation or parameters of the voluntary Part D Premium Stabilization Demonstration for CY 2027 but indicated they would provide an update no later than in summer 2026. CMS also finalized updates to the risk adjustment model to improve payment accuracy and account for Inflation Reduction Act (IRA) provisions. A fact sheet can be found here.
On April 6, Melanie Keller took over the role of FDA Chief Operating Officer and Deputy Commissioner for Operations, succeeding Barclay Butler. She previously served as Deputy Associate Commissioner for Operations and Deputy Chief Operating Officer, as well as Chief Talent Officer at FDA.
On April 7, FDA approved the first generic versions of FARXIGA (dapagliflozin) tablets for use in adults with type 2 diabetes mellitus to improve glycemic control and reduce the risk of hospitalization for heart failure among certain patients with cardiovascular disease or risk factors. The approval applies to multiple generic drug applicants, with labeling that includes the same contraindications, warnings, and precautions as the brand-name product.
On April 7, the Health Resources & Services Administration (HRSA) announced more than $135 million in funding opportunities to expand nutrition services and strengthen the rural health workforce. The funding includes $125 million to support expanded nutrition services at HRSA-funded health centers and $11.25 million for the Rural Residency Planning and Development Program to establish new rural residency programs in high-need specialties.
On April 8, HHS published a new charter for the CDC’s Advisory Committee on Immunization Practices (ACIP) that broadens the panel’s mandate to include investigating vaccine injuries and evaluating gaps in vaccine safety research. The revision expands the criteria for voting members to include experts in fields such as toxicology and recovery from vaccine injuries, while adding several groups that have expressed skepticism of mainstream vaccine policy as official liaison organizations.
On April 8, HHS Secretary Kennedy announced he will launch a new podcast titled “The Secretary Kennedy Podcast.” The podcast is expected to feature discussions with agency staff, scientists, and health experts, and is described by HHS as part of an effort to increase transparency in government.
On April 8, HHS announced that the Interagency Autism Coordinating Committee (IACC) will hold a public meeting on April 28 to discuss committee business, agency updates, and issues related to autism research and services activities. The meeting will be held in a hybrid format at the National Institutes of Health (NIH) campus in Bethesda, Maryland, with virtual access available via NIH webcast.
On April 8, CMS issued a State Health Official letter providing guidance to states on implementing Section 71109 of the Working Families Tax Cut legislation, which modifies Medicaid and CHIP eligibility for certain noncitizens. The guidance outlines limitations on federal financial participation for full Medicaid and CHIP benefits, beginning October 1, and describes required updates to state eligibility systems and processes. CMS stated that the policy limits coverage eligibility, with certain exceptions, to specified categories of noncitizens and requires states to ensure compliance with new federal requirements. The press release can be found here.
On April 9, CMS announced the launch of the first wave of HealthTech Ecosystem tools, including a Medicare App Library and patient-facing digital applications. The initiative introduces interoperable tools designed to improve data access, streamline patient check-in, and support personalized health management. CMS stated that the effort aims to modernize health care delivery by expanding digital infrastructure and enhancing patient access to health information.
On April 10, CMS issued the Fiscal Year (FY) 2027 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule. CMS proposed updates to policies and rates that are projected to result in a 2.4% increase in IPPS payment rates, which is expected to increase overall hospital payments by ~$1.4 billion. CMS also estimates additional payments for inpatient cases involving technologies that qualify for new technology add-on payments (NTAPs) will increase by $464 million in FY 2027. CMS is proposing to repeal the “alternative pathway” for NTAP and outpatient device pass-through applications that apply to Breakthrough Devices and other technologies and instead require these technologies to meet the full criteria under the “traditional” pathway. CMS is also proposing to expand the Comprehensive Care for Joint Replacement (CJR) Model into a mandatory nationwide program called CJR-X for lower extremity joint replacements, beginning October 1, 2027. Comments on the rule are due by June 15. A fact sheet can be found here.
On April 10, CMS issued the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule that would extend certain prior authorization requirements impacting non-drug items and services to cover drugs. Specifically, CMS is proposing to require impacted payers to: support electronic prior authorization for drugs, make decisions on requests within shorter timeframes that align CMS programs, increase transparency for the prior authorization of drugs, update health IT standards, and report prior authorization usage metrics to CMS. The rule also includes RFIs on the following: step therapy; electronic event notifications for value-based care and care coordination; increasing health care resiliency; improving implementation of payer application programming interface technology; and prior authorization for laboratory tests and DMEPOS. Comments on the rule are due by June 15. A fact sheet can be found here.
RULES AT THE WHITE HOUSE OFFICE OF MANAGEMENT & BUDGET (OMB)
Pending Review
CMS
Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes (CMS-2452); Proposed Rule, 12/31/2025
Independent Dispute Resolution Operations (CMS-9897); Final Rule; 01/29/2026
Strengthening Oversight of Accrediting Organizations (AO), Burden Reduction, and Related Provisions (CMS-3367); Final Rule; 02/04/2026
Medicare Drug Price Negotiation Program (CMS-4215); Proposed Rule; 02/26/2026
Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments (CMS-2449); Proposed Rule; 02/27/2026
Establishing State Community Engagement Requirements for Certain Individuals Under Section 1902(xx) of the Social Security Act (CMS-2454); Interim Final Rule; 03/31/2026
Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program (CMS-9883); Final Rule; 4/01/2026
FDA
Evaluating the Safety of Antimicrobial New Animal Drugs with Regard to their Microbiological Effects on Bacteria of Human Health Concern; Guidance for Industry; Notice; 7/10/25
Postapproval Pregnancy Safety Studies; Guidance for Industry; Availability; Notice; 8/21/25
Substances Generally Recognized as Safe; Proposed Rule; 12/01/25
Establishment Registration and Product Listing for Tobacco Products; Proposed Rule; 02/19/2026
Drug Establishment Registration and Drug Listing Requirements for Establishments Engaged in Distributed Manufacturing and Certain Foreign Establishments; Rule; 03/04/2026
Cannabidiol (CBD) Products Compliance and Enforcement Policy; Notice; 03/13/2026
Harmful and Potentially Harmful Constituents in Tobacco Products and Tobacco Smoke; Established List Additions and Request for Comments; Notice; 03/19/2026
Compliance Policy Regarding Premarket and Other Requirements for Certain NIOSH Approved Air-Purifying Respirators; Draft Guidance for Industry and Food and Drug Administration Staff; Availability; Notice; 03/23/2026
HEARINGS
House
Ways & Means Health Subcommittee
Field Hearing on Modernized Health Care in Practice: Empowering Americans to Live Healthier Lives
April 14, 9:00 AM; Bradenton, Florida
Witnesses: TBA
Full Committee
Hearing on President Trump’s FY27 Budget Proposal
April 16; 9:00 AM; 1100 Longworth
Witness: HHS Secretary Kennedy
Full Committee
April 28; Time TBD; 1100 Longworth
Hearing on Health Care Affordability with Hospital CEOs
Witnesses: TBA
Energy & Commerce Health Subcommittee
Healthier America: Legislative Proposals to Improve Public Health
April 15; 10:15 AM; 2123 Rayburn
Appropriations Labor, HHS, Education, and Related Agencies Subcommittee
Hearing on President Trump's FY27 Budget Proposal
April 16; 2:00PM; 2358-C Rayburn
Witness: HHS Secretary Kennedy
Senate
Health, Education, Labor & Pensions Committee
Making Medicines More Affordable: How Competition Can Lower Drug Prices
April 16; 10:00 AM; 430 Dirksen
Witnesses: TBA
Budget Committee
Hearing on President Trump's Fiscal Year 2027 Budget Proposal
April 16; 10:00 AM; 608 Dirksen
Witness: HHS Secretary Kennedy
Finance Committee
The President’s Fiscal Year 2027 Budget Proposal
April 22; Time TBD
Witness: HHS Secretary Kennedy
ADDITIONAL POLICY NEWS
On April 3, the New York State Department of Health (DOH) submitted a response to CMS regarding a request for information on Medicaid program integrity and oversight. The response outlined the state’s efforts to prevent, detect, and address fraud, waste, and abuse, including the use of audits, data analytics, and interagency coordination with the Office of the Medicaid Inspector General (OMIG) and the Medicaid Fraud Control Unit (MFCU).
On April 7, a federal district court in Louisiana granted a stay in litigation challenging FDA’s policies on mifepristone that would allow current access to the drug, including telehealth prescribing, to remain in place while FDA conducts a safety review. The court directed the FDA to provide an update on its review within six months.
On April 7, the Center for American Progress (CAP) released a report titled “A Patients’ Bill of Rights to Lower Health Care Costs” outlining policy proposals to reduce premiums, deductibles, and administrative barriers in health care. The report proposed measures including limits on premium increases, caps on hospital prices, and reforms to prior authorization (PA) processes. CAP stated that the recommendations aim to address rising health care costs and improve affordability for patients and employers.
On April 7, Virginia Gov. Abigail Spanberger (D) signed legislation requiring PA for prescription drugs to remain valid for at least six months for initial approvals and 12 months for continued authorizations. The law limits insurers’ ability to revoke approvals except under specified circumstances, such as fraud or updated drug safety information from FDA.
On April 8, the Pharmaceutical Research and Manufacturers of America (PhRMA) announced that President and CEO Steve Ubl will be stepping down from his position at the end of the year and that the Board of Directors will begin a search for his successor.
On April 9, the Washington Post reported that publication of a CDC report on the effectiveness of this season’s COVID-19 vaccines was delayed due to additional review by agency leadership. The study concluded that the COVID-19 vaccine reduced the likelihood of emergency department visits and hospitalizations among vaccinated individuals and was slated for publication in the Morbidity and Mortality Weekly Report on March 19.
On April 9, the Blue Cross Blue Shield (BCBS) Association and America’s Health Insurance Plans (AHIP) announced that major health insurers have reduced PA requirements across certain medical services. The groups reported an 11% reduction overall, including a 15% reduction in MA plans, representing approximately 6.5 million fewer PAs. The announcement states that insurers are working to streamline care delivery processes, including increasing use of real-time electronic data sharing to reduce administrative burden.
On April 9, the Medical Group Management Association (MGMA) released its 2026 Regulatory Burden Report examining the impact of regulatory requirements and reimbursement challenges on medical practices. The report identified PA, MA requirements, and quality reporting as key drivers of administrative burden, based on survey responses from more than 230 group practice executives.
On April 8 and 9, the Medicare Payment Advisory Commission (MedPAC) discussed various topics including payment incentives in Medicare, the association between MA enrollment and hospitals’ and post-acute care providers’ finances, and Institutional special-needs plans. Please contact FHP Strategies for a summary of these sessions.