Weekly Health Care Policy Update – July 3, 2025

July 10, 2025

In this update:

  • Legislative Updates
    • Senate and House Pass OBBBA
    • CBO Reports OBBBA Projected to Cut 11.8 Million from Insurance
  • Federal Agencies
    • CMS Reports Health Spending to Hit $8.6 Trillion by 2033
    • CMS Innovation Center Introduces WISeR Model
    • CMS Issues CY2026 Home Health PPS Proposed Rule
    • HRSA Releases 2025 UDS Manual
    • CMMI Publishes ACO REACH 2023 Performance Evaluation
  • Other Updates
    • SCOTUS Limits Nationwide Injunctions
    • SCOTUS Upholds ACA’s Free Preventive Services
    • Joint Commission Removes 700 Requirements from Hospital Accreditation
  • New York State Updates
    • Governor Hochul Announces Master Plan for Aging Initiative Final Report
    • NYS Medicaid Adds RPM CPT Code to the APG Fee Schedule for Outpatient Clinic Settings
    • NYS Intends to Phase-In Quality Requirements for the PCMH SCN Participation Enhancement
    • DOH to Host Webinar for Health, Behavioral, and Social Care Providers on 1115 Waiver SCN Participation
    • DOH Announces Proposed Amendments to Children’s Services Waivers

Legislative Updates

Senate and House Pass OBBBA
By a vote of 218-214, the House passed the Senate’s amendments to the One Big Beautiful Bill Act (OBBBA) today, July 3rd. The budget reconciliation bill has been sent to the President, who is expected to sign it into law on July 4th. Reps. Brian Fitzpatrick (R-PA) and Thomas Massie (R-KY) joined Democrats in voting no.

​​On July 1st, the Senate passed their version of the One Big Beautiful Bill Act (OBBBA). Republican Senators Susan Collins (R-ME), Tom Tillis (R-NC), and Rand Paul (R-KY) joined all Democrats in opposing the bill, requiring a tie-breaking vote from Vice PresidentJ.D. Vance.

The Senate version included significant changes from the original House bill, and even from the chamber’s original drafts. It contains over $1 trillion in health care spending cuts, mostly from Medicaid. Key health care provisions (and changes) include: 

  • Provider Taxes: Retaining a freeze on all current provider taxes, and deepening the state provider tax cut by gradually reducing the cap by 0.5% per year, to a 3.5% final cap (the House bill had a 6% cap);
  • State Directed Payments: Retaining a cap on new State Directed Payments (SDPs) at 100% of the Medicare rate for Medicaid expansion states and 110% of the Medicare rate for non-expansion states, and gradually dropping the allowed amount for existing SDPs (the House bill grandfathered existing SDPs at the average commercial rate);
  • Eligibility: Retaining a limitation on ACA premium tax credit eligibility for only lawful, permanent residents;
  • Eligibility Checks: Retaining a requirement that Medicaid expansion beneficiaries recertify their eligibility every six months;
  • Medicare Physician Payments: Narrowing a Medicare physician payment increase of 2.5% to apply only for 2026 (the House bill included a longer-term increase);
  • Work Requirements: Expanding the work requirements in Medicaid to include parents of children 14 and older (the House bill excluded parents longer);
  • Planned Parenthood: Retaining a prohibition on Medicaid funding for Planned Parenthood for one year;
  • Rural Hospitals: Expanding a rural hospital fund to $50 billion and beginning disbursements two years earlier, in 2026;
  • Gender-Affirming Care: Dropping a ban on gender-affirming care in Medicaid and the Children’s Health Insurance Program (CHIP);
  • Undocumented Immigrants: Dropping a Federal Medical Assistance Percentage (FMAP) penalty for states using state-only funds to cover non-qualified immigrants; and
  • Cost Sharing Reduction: Dropping a provision to resume Cost Sharing Reduction (CSR) funding, which would have eliminated the incentive for “silver loading”.

Earlier estimates of the bill language projected a $3.3 trillion increase in the national debt over the next decade. Republicans avoided facing the full impact of this number by altering their standard accounting rules to count the extension of the existing tax breaks at $0.

CBO Reports Senate Reconciliation Bill Will Cut 11.8 Million from Insurance
On June 27th, the Congressional Budget Office (CBO) released estimates on the Senate version of the One Big Beautiful Bill Act (OBBBA). CBO found that 11.8 million people will become uninsured due to Medicaid and Affordable Care Act (ACA) cuts in the Senate bill. This figure includes 1.4 million people without verified citizenship. CBO also found that the Senate text would cut Medicaid spending by more than $1 trillion, more than the House bill’s $800 billion cut, either of which would be the largest cut in the program’s history.

The estimates are available here.

Federal Agencies

CMS Reports Health Spending to Hit $8.6 Trillion by 2033
On June 24th, the Centers for Medicare & Medicaid Services (CMS) released new national health expenditure (NHE) data with projections through 2033. CMS found:

  • NHE is projected to increase 7.1% in 2025 and 5.6% over 2026-2027;
  • For 2024, personal health care spending is projected to increase by 8.7%, hospital spending is projected to increase by 9.2%, and prescription drug spending is expected to slow to 10.1% growth;
  • From 2024 to 2033, NHE (averaging 5.8% growth) will outpace gross domestic product (averaging 4.3%);
  • By 2033, the health share of GDP will reach 20.3%; and
  • Direct purchase enrollment is expected to decline by 4.7 million (-12.3%) in 2026 due to the expiration of Affordable Care Act (ACA) tax credits.

The announcement is available here, and a related Health Affairs article is available here.

CMS Innovation Center Introduces WISeR Model
On June 27th, the Centers for Medicare & Medicaid Services (CMS) announced a new model intended to limit wasteful and inappropriate services in the original Medicare program. The Wasteful and Inappropriate Service Reduction (WISeR) Model will use enhanced technologies, including AI, to test ways to provide “improved and expedited” prior authorization processes for certain services that have been flagged for potentially inappropriate use, including but not limited to, skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. Providers and suppliers caring for Medicare patients will have the option of submitting a prior authorization request or undergo a post-service/pre-payment medical review.

Participants include “companies with expertise managing the prior authorization process for other payers” and will be responsible for a certain geographic region with clinicians on staff to validate coverage determinations. Participants will be paid based on their ability to reduce unnecessary services and spending. The WISeR Model will not change Medicare coverage or payment criteria. The model is voluntary and will run for six performance years from 2026 to 2031. Applications are due July 25th.

The announcement is available here, the fact sheet is available here, and the request for applications is available here.

CMS Issues CY2026 Home Health PPS Proposed Rule
On June 30th, the Centers for Medicare and Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Home Health (HH) Prospective Payment System (PPS) proposed rule. Overall, CMS estimates that the proposed rule will decrease Medicare payments to home health agencies (HHAs) by 6.4%, or $1.135 billion, compared to CY 2025, based on the proposed policies. The decrease is the result of a 2.4% home health payment update, a 3.7% decrease from the permanent behavior adjustment, and a 0.5% decrease that reflects a proposed fixed dollar loss for outlier payments.

Additional key provisions of the proposed rule include:

  • PDGM and Behavior Assumptions: CMS is proposing a permanent prospective adjustment to the CY 2026 HH payment rate of -4.059% to fully account for the impact of implementing the Patient-Driven Groupings Model (PDGM), with a change to a 30-day unit of payment;
  • Temporary Adjustment on Prospective Basis: CMS is proposing a -5.0% temporary adjustment on a prospective basis to the CY 2026 base payment rate to address retrospective overpayments;
  • PDGM Case-Mix Weights: CMS is proposing to recalibrate the case-mix weights — including the functional levels and comorbidity adjustment subgroups — and low utilization payment adjustment (LUPA) thresholds using CY 2024 data, to more accurately pay for the types of patients HHAs are serving;
  • Face-to-Face Encounter Policy: CMS is proposing to change the face-to-face regulation to allow physicians, in addition to other providers, to perform the face-to-face encounter regardless of previous interactions with the patient;
  • Quality Reporting Program (QRP): CMS is proposing to remove a Covid-19 vaccine related measure, collect four items as standardized patient assessment data elements in the social determinants of health (SDOH) category (one living situation item, two food items, and one utilities item), among other changes. CMS is also seeking input on a handful of measures related to health IT;
  • Home Health Value-Based Purchasing (HHVBP) Model: Since CMS is proposing changes to the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey, it is proposing to omit three measures currently used in the model (care of patients, communications between providers and patients, and specific care issues), while adding a handful of measures; and
  • Provider Enrollment: To reduce improper payments and protect the integrity of the provider supply, CMS is proposing to increase the number of grounds for which CMS can revoke a provider retroactively and amend regulations to revoke providers in the first situation and deactivate their Medicare billing privileges in the second.

The proposed rule will be open for comment through September 2nd.  The announcement is available here, and the proposed rule is available here.

HRSA Releases 2025 UDS Manual 
On July 1st, the Health Resources and Services Administration (HRSA) released the 2025 Uniform Data System (UDS) Manual, containing reporting instructions for HRSA-supported health centers. Changes to the UDS largely align with broader Trump Administration priorities, including removing measures related to sexual orientation and gender identity. Additionally, this year, health centers will begin collecting data on tobacco use cessation pharmacotherapies, medications for opioid use disorder (OUD), and Alzheimer’s Disease and related dementias (ADRD) screening.

The manual is available here, and the program assistance letter, with key changes outlined, is available here.

CMMI Publishes ACO REACH 2023 Performance Evaluation 
On June 30th, the CMS Innovation Center released its June 2025 Evaluation Digest, which included a report on the ACO REACH program for Performance Year 2023. Overall, the model has shown “incremental improvements” in quality and spending reduction. In particular, Standard and New Entrant ACOs showed statistically significant reductions in gross spending and meaningful improvement in quality measures. High Needs ACOs, while showing statistically significant improvement in quality, had non-significant reductions in gross spending, but this may be the result of an overrepresentation of a new cohort of participants. After accounting for shared savings/losses and performance bonuses, all ACO types increased net spending, though savings, quality, and utilization “show signs oftrending in a positive direction.”

The full report is available here. 

Other Updates

SCOTUS Limits Nationwide Injunctions 
On June 27th, the Supreme Court of the United States (SCOTUS) issued a 6-3 decision in Trump v. CASA, Inc, which pertained to lower courts’ abilities to block executive branch policies nationwide. The ruling directed lower courts to tailor nationwide injunctions – which prohibit the government from enforcing a law against anyone (not just plaintiffs) – as narrowly as possible. In this case, SCOTUS directed the courts to provide relief to the 22 states and immigration groups suing the Trump Administration over its executive order barring birthright citizenship, rather than providing nationwide relief. Now, the executive order will take effect in the 28 states that did not join the suit. The ruling does not end nationwide injunctions, rather it only allows them in cases where injunctions are the only way to provide plaintiffs “complete relief.” SCOTUS did not rule on the merits or constitutionality of the order, though it will likely in the future.
 
Nationwide injunctions have been a frequent tool for lower court judges to suspend the implementation of Trump Administration policies they determine are likely unlawful. The ruling will have a considerable impact on how health policy is litigated moving forward,potentially creating a patchwork in which executive actions take effect in some states but not others.
 
SCOTUS Upholds ACA’s Free Preventive Services 
On June 27th, the U.S. Supreme Court issued a 6-3 decision in Kennedy v. Braidwood Management, Inc., which challenged the Constitutionality of requiring health insurance issuers to cover items and services recommended by the U.S. Preventive Services Task Force (USPSTF) without cost sharing. The challengers stated that the Task Force members were not principal or inferior officers of the executive branch who have Constitutional authority under the Appointments Clause to make decisions such as those requiringinsurance coverage. The Court sided with the government, agreeing that Task Force members are appointed by the Secretary of Health and Human Services, making them inferior officers and affirming that the Secretary also has the power to veto Task Force recommendations.
 
The decision gives Secretary Kennedy, and future Secretaries, broad power to reject recommendations he disagrees with and to potentially appoint new Task Force members who reject previously issued recommendations. Therefore, while insurance coverage of preventive items and services remains intact in the short-term, the long-term implications are unclear and likely more politically influenced than they have been in the past.
 
The Supreme Court decision is available here.
 
22 State AGs Send Letter to Hospitals on Abortion and EMTALA
On June 24th, attorneys general from 22 states sent a letter to the American Hospital Association (AHA) regarding hospitals’ obligations under the Emergency Medical Treatment and Labor Act (EMTALA). The letter comes weeks after the Centers for Medicare & Medicaid Services (CMS) rescinded guidance that included stabilizing abortion care as a requirement under EMTALA, preempting any state law to the contrary. The authors reiterated that the lack of guidance did not change hospitals’ statutory obligations under the law and that “EMTALA’s requirement to provide stabilizing care is based on the medical condition of the pregnant patient, not the fetus.”
 
The letter is available here.
 
Joint Commission Removes 700 Requirements from Hospital Accreditation 
On June 30th, the Joint Commission announced a new, streamlined process for accrediting hospitals, dropping over 700 requirements. The Joint Commission’s new program, Accreditation 360, is the most significant update to its accreditation process since 1965.The program includes clearer identification of Centers for Medicare & Medicaid Services-directed Conditions of Participation, a new, continuous engagement model, streamlined patient safety requirements under the Commission’s National Performance Goals, and a Survey Analysis For Evaluating STrengths (SAFEST) Program for outstanding safety and quality achievement. The Commission’s affiliate, the National Quality Forum, is also launching a new certification program.
 
The announcement is available here.

New York State Updates

Governor Hochul Announces Master Plan for Aging Initiative Final Report
On June 30th, Governor Hochul announced the release of the State’s Master Plan for Aging (MPA) final report. Governor Hochul issued Executive Order 23 in November 2022, establishing a task force to create a Master Plan for Aging whose mandate is “to put forward a comprehensive set of recommended policies and programs that will ensure all New Yorkers can age with dignity and independence.”

The MPA process, led by the New York State (NYS) Department of Health (DOH) and Office for the Aging, included a series of workgroups and subcommittees that were responsible for identifying and developing proposals to address the most urgent needs of New York’s older adults and people with disabilities. The proposals were informed by public input obtained from town halls, listening sessions, roundtables, and a public survey.

The final report includes over 100 proposals that are being submitted to the Governor and shared with the public to inform policymaking. The proposals are organized across the following nine pillars:

  • Informal Caregiver and Workforce Support and Modernization of Community-Based Aging Network Service
  • Modernization and Financial Sustainability of Health Care, Residential Facilities and Community-Based Aging Network Service Providers
  • Prevention, Wellness Promotion and Access
  • Housing Access and Community Development
  • Affordability of Basic Necessities
  • Access to Services in and Engagement with Historically Underserved Communities
  • Social Engagement of Older Adults
  • Combatting Elder Abuse, Ageism, Ableism and Stigma
  • Technology Access and Development

The proposals seek to improve New York’s long-term care system through a variety of strategies, including education and training, cross-system coordination, targeted administrative or regulatory changes, and major budget initiatives. Each proposal is classified as a near-term (1-2 years), long-term (3+ years), or infrastructure change and annotated for fiscal or legislative impact by the MPA council.

The Governor’s press release is available here. The final report is available here. The new MPA website, inclusive of the full list of proposals, is available here.

NYS Medicaid Adds RPM CPT Code to the APG Fee Schedule for Outpatient Clinic Settings
Effective July 1st, hospital outpatient departments, freestanding diagnostic and treatment centers (D&TCs), and Federally Qualified Health Centers (FQHCs) that have opted into the Ambulatory Patient Group (APG) reimbursement methodology will be eligible for Medicaid reimbursement for remote patient monitoring (RPM) using Current Procedural Terminology (CPT) code 99457. RPM services may be delivered by clinical staff but must be ordered by a physician or other qualified health care professional. Providers can bill CPT 99457 at a rate of $41.80 once per member every 30 days, provided they deliver at least 20 minutes of RPM management within that month, including one live interaction with the patient/caregiver.

Additional details are available in the Medicaid update here.

NYS Intends to Phase-In Quality Requirements for the PCMH SCN Participation Enhancement
Providers that participate in the State’s Patient-Centered Medical Home (PCMH) program receive a base rate of $6 per-member per-month (PMPM) and are entitled to an additional incentive payment for partnering with 1115 waiver Social Care Networks (SCNs). Tocontinue incentivizing quality improvement within the PCMH program, DOH intends to tie the incentive enhancement payment to quality in upcoming years, with the following program changes forthcoming:

  • SCN referral workflow attestations will transition to the NCQA PCMH application/renewal system, after which attestations will no longer be collected by DOH via survey (additional details on the timeline will be announced at a later date).
  • PCMH practices wishing to continue to earn the incentive payment (additional $2 per month for adults and $4 per month for children) will be required to report on select quality metrics (e.g., childhood immunization status, colorectal cancer screening) starting in 2026, with performance goals incorporated starting in 2028.

Additional details are available in the Medicaid update here. Questions may be submitted to pcmh@health.ny.gov.

DOH to Host Webinar for Health, Behavioral, and Social Care Providers on 1115 Waiver SCN Participation
On July 14th from 11am-12pm, DOH will host a webinar for health, behavioral, and social care providers titled “Social Care Networks: Opportunities for Provider Participation and Impact.” The webinar will include an overview of the SCN program and provide insight on key operational aspects for providers who may be interested in participating, such as onboarding, contracting, and technology requirements.

Registration for the webinar is available here. Feedback and questions may be provided ahead of the webinar by accessing the SCN program survey here.

DOH Announces Proposed Amendments to Children’s Services Waivers 
On July 2nd, DOH issued a public notice the State Register announcing its intent to amend the 1915(c) Children’s Waiver and Children’s Financial Management Services (FMS) 1915(b) Waiver on or after January 1, 2026. Proposed changes include, but are not limited to:

  • Adding the administration of Transitional Services to the FMS contract;
  • Increasing the FMS rate for Environmental Modifications, Vehicle Modifications, and Adaptive and Assistive Technology;
  • Adding two new services, Transitional Care Coordination and Transitional Services, for children who need support transitioning from an inpatient or skilled nursing setting;
  • Eliminating Day Habilitation services and transitioning individuals to Community Habilitation only;
  • Allowing Environmental Modifications, Vehicle Modifications, and Adaptive and Assistive Technology to be purchased up to 180 days prior to discharge from an institutional setting;
  • Eliminating service dogs as a covered benefit under the Waiver;
  • Amending the Community Habilitation provider qualifications to require direct service workers and supervisors to have at least a high school diploma or equivalent; and
  • Clarifying that Community Habilitation staff may teach and assist with health-related tasks, but may not directly perform them.

The notice is available here. Comments may be submitted to BH.Transition@health.ny.govthrough August 14th.