Weekly Health Care Policy Updates – June 27, 2025

July 4, 2025

In this update: 

  • Legislative Updates
    • House Republicans Send Warning on Senate Medicaid Changes
    • Senate Parliamentarian Issues Rulings on Health Care Provisions
    • CBO Estimates OBBBA Will Lower Provider Payments, Require Benefit and Enrollment Cuts
  • Federal Agencies
    • CMS Finalizes 2025 Marketplace Integrity and Affordability Final Rule
    • New ACIP Panel Convenes; Senator Cassidy Expresses Disapproval
    • Insurers Release Prior Authorization Pledge
    • HRSA Requires Health Insurers to Provide Certain Drugs at 340B Prices or Lower
  • Other Updates
    • Medicare Trustees Release Annual Report
    • SCOTUS Allows States to Exclude Planned Parenthood from Medicaid
  • New York State Updates
    • DOH Issues Proposed Regulations on EMS Equipment and Waivers
    • CMS Approves New York SPA to Reimburse for Multidimensional Family Therapy Services within CFTSS Program
    • SED Adopts Final Regulations Expanding Scope of Practice for RNs

Legislative Updates

House Republicans Send Warning on Senate Medicaid Changes
On June 24th, a group of moderate House Republicans penned a letter to Senate Majority Leader John Thune and House Speaker Mike Johnson warning that they “cannot support” a final reconciliation bill with the Senate’s Medicaid provisions and cuts, which are deeper than the House-passed text. Favoring the “more pragmatic and compassionate standard” for reform, the Representatives take particular issue with the provider tax and state-directed payment (SDPs) policies outlined in the Senate text. The authors echoed the concerns of many providers who have warned of service line or facility closures, particularly in rural areas. The 16 representatives represent a mix of districts and are vital for the passage of the package once it returns to the House for consideration.

The letter is available here, and the announcement is available here.

Senate Parliamentarian Issues Rulings on Health Care Provisions
On June 26th, the Senate Parliamentarian, Elizabeth MacDonough, issued a slate of rulings on health care provisions within the Senate Finance Committee’s  portion of the One Big Beautiful Bill Act (OBBBA). The rulings continued MacDonough’s review of draft language Republicans intend to include in the Chamber’s budget reconciliation bill, to ensure compliance with the Senate’s Byrd Rule. The rule – officially Section 313 of the Congressional Budget Act of 1974 – restricts the content of reconciliation legislation to provisions directly related to spending or revenue, preventing the passage of unrelated policy changes.

MacDonough advised that of the provisions included in current text, the following would be subject to a 60-vote threshold if they remain in the bill, rather than to a simple majority vote: 

  • Prohibiting federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality or satisfactory immigration status;
  • Denying federal funding to states for Medicaid coverage for certain immigrants who are not citizens;
  • Lowering the Medicaid expansion federal medical assistance percentage from 90 percent to 80 percent for states that choose to provide coverage to people who are undocumented using the state’s own funds;
  • Requiring Medicaid managed care contracts with pharmacy benefit managers (PBMs) to adopt state reimbursement methodologies for reimbursement;
  • Prohibiting federal Medicaid and Children’s Health Insurance Program (CHIP) funding for gender affirming care;
  • Prohibiting non-expansion states from increasing current provider taxes;
  • Revoking Medicare eligibility from certain immigrants without citizenship status such as refugees and asylum seekers; and
  • Limiting immigrants without citizenship status from qualifying for premium tax credits or cost-sharing reductions.

Several key provisions remain under review by the Parliamentarian:

  • Repealing the “Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment” final rule;
  • Repealing the “Medicaid Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Process” final rule;
  • Repealing the “Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting” final rule; and 
  • Prohibiting Planned Parenthood from receiving federal Medicaid funds.

Majority Leader John Thune (R-SD) has indicated that he will not move to overrule the Parliamentarian, instead expressing  his intent to release revised portions of the bill based on the rulings, and keep the Senate in session until the bill passes. House Republican leadership has asked members to keep their schedules flexible, suggesting the House may take up the measure immediately if the Senate is able to pass the legislation.

CBO Estimates OBBBA Will Lower Provider Payments, Require Benefit and Enrollment Cuts
On June 24th, the Congressional Budget Office (CBO) sent a letter to Budget Committee  Chairman Jodey Arrington (R-TX) and Energy and Commerce Committee Chairman Brett Gutherie (R-KY) regarding coverage changes under the House-passed One Big Beautiful Bill Act (OBBBA). In the letter, CBO estimates that the Medicaid provisions included in OBBBA would reduce states’ total share of spending on Medicaid by $13.1 billion, on net, over the 2025–2034 period. The $13.1 billion figure is the balance of a $214.4 billion decline in state spending (due to eligibility, enrollment, and payment changes) and a $201.3 increase in state spending to offset reductions in federal funds.

In order to absorb these cuts, CBO expects that states will have to cut spending “by reducing provider payment rates, reducing the scope or amount of optional services, and reducing Medicaid enrollment.” Restrictions on provider taxes used by states to cover expenses will add additional downward pressure on budgets.

CBO also reaffirms past estimates that the Medicaid provisions of OBBBA would increase the number of uninsured individuals by 7.8 million by 2034. Of the 7.8 million individuals without insurance, 1.6 million would be eligible for other forms of subsidized coverage.

The letter is available here, and the Budget Committee’s announcement is available here.

Federal Agencies

CMS Finalizes 2025 Marketplace Integrity and Affordability Final Rule 
On June 20th, the Centers for Medicare & Medicaid Services (CMS) finalized the Marketplace Integrity and Affordability rule, originally proposed on March 10th. CMS finalized most provisions as proposed, but some will take effect only for the 2026 plan year. Many of the policies in the final rule also appear in the House-passed budget reconciliation bill (and some appear in the draft Senate bill), and therefore could be codified on a more permanent basis, depending on whether they are included in the final reconciliation bill. Key provisions include:

  • Past-Due Premium Payments: CMS finalized repeal of the rule restricting issuers from attributing premium payment for new coverage to past-due premiums from prior coverage;
  • Exclusion of Deferred Action for Childhood Arrivals (DACA) Recipients: CMS finalized the removal of DACA recipients from the definition of “lawfully present,” thus excluding them from eligibility for enrollment in a qualified health plan (QHP) and eligibility for premium tax credits (PTCs), cost-sharing reductions (CSRs), or to enroll in a Basic Health Plan (BHP);
  • Failure to File and Reconcile (FTR): CMS finalized a temporary return to a one-year FTR process, rather than a two consecutive-year process;
  • Income Inconsistency and Validation: CMS finalized the removal of the 60-day extension of the statutorily required 90-day period for resolving income inconsistencies. CMS also finalized new requirements for validating incomes for individuals for whom data sources indicate an income of less than 100% of the Federal Poverty Level (FPL). For premium tax credit and cost-sharing reduction income verification, CMS will no longer accept an applicant’s self-attestation when the IRS confirms there is no tax return available;
  • Annual Eligibility Redetermination: CMS finalized its proposal to prevent enrollees from being automatically re-enrolled in coverage with APTC that fully covers the premium without taking action to confirm their eligibility information;
  • Premium Payment Threshold: CMS finalized the elimination of the option for issuers to establish a fixed-dollar or gross percentage-based premium payment threshold, which were established in the 2026 payment notice;
  • Annual Open Enrollment Period: CMS finalized, with modification, changes to the annual open enrollment period (OEP). Changes apply to on- and off-Marketplace individual coverage. The OEP must start no later than November 1, end no later than December 31, and last no longer than nine weeks. Coverage for all OEP enrollments must begin January 1;
  • Special Enrollment Periods: CMS proposes to repeal the monthly special enrollment period (SEP) for APTC-eligible individuals with a projected annual household income at or below 150% of the FPL;
  • Premium Adjustment Percentage Methodology: CMS will return to the methodology for calculating the premium adjustment percentage methodology established in the 2020 Payment Notice; and
  • Sex Trait Modification: CMS finalized a prohibition on issuers of coverage subject to essential health benefit (EHB) requirements from providing coverage for sex-trait modification as an EHB.

The final rule is available here, and a fact sheet is available here.

New ACIP Panel Convenes; Senator Cassidy Expresses Disapproval 
On June 25th, the Advisory Committee on Immunization Practices (ACIP) held its first two-day meeting with new members, though the panel is not yet fully staffed. Chaired by Dr. Martin Kulldorff, a former epidemiologist at Harvard Medical School, the Committee reiterated many of Secretary Kennedy’s main talking points regarding vaccine safety for children. Dr. Kulldorff announced the formation of two new working groups: one to study the interaction of vaccines and the cumulative childhood vaccine schedule, and another to reevaluate vaccines that have not been reviewed in more than seven years, with opportunities to change recommendations for long-accepted vaccines. Experts raised concerns over the lack of conflict of interest disclosures made public thus far; a handful of members have served as expert witnesses in litigation against vaccine manufacturers.

On June 26th, ACIP voted to recommend that Americans not receive flu vaccines containing thimerosal, a vaccine preservative. Roughly 4% of flu doses in the U.S. contain thimerosal because they are packed in multi-dose vials. The preservative reduces the chance of contamination in the process of withdrawing multiple doses, and has been proven safe in multiple studies.

Prior to the meeting, Senator Bill Cassidy, M.D. (R-LA), a crucial vote in Secretary Kennedy’s confirmation, took to X to express his disapproval with the Committee’s trajectory. Senator Cassidy noted that many of the members “do not have significant experience studying microbiology, epidemiology, or immunology.” Senator Cassidy advised that the panel should not engage in official activity “until the panel is fully staffed with more robust and balanced representation.”

Insurers Release Prior Authorization Pledge
On June 23rd, the Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced, with dozens of insurance companies, a new pledge to improve prior authorization across commercial plans, Medicare Advantage, and Medicaid managed care. Together, the insurance companies have pledged to:

  • Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR)-based applications;
  • Reduce the volume of medical services subject to prior authorization by January 1st;
  • Honor existing authorizations during insurance transitions:
    • Insurers have agreed to allow patients that switch plans to continue receiving treatment for 90 days before facing new prior authorization requirements;
  • Enhance transparency and communication around authorization decisions and appeals, including expanding real-time responses with real-time approvals for most requests by 2027; and
  • Ensure medical professionals review all clinical denials.

Critically, CMS Administrator Dr. Mehmet Oz affirmed that “the pledge is not a mandate,” though companies may see this pledge as a way to avoid more regulations. CMS leadership has floated the idea of eliminating prior authorization for vaginal deliveries, colonoscopies, and cataract surgeries, among other procedures. In the news conference, Dr. Oz discussed complementary actions with few details including a public dashboard where insurers post prior authorization data and potential “performance targets.” 

The pledge is available here, and announcement is available here.

HRSA Requires Health Centers  to Provide Certain Drugs at 340B Prices or Lower 
On June 24th, Health Resources and Services Administration (HRSA) announced an update to award terms that requires health centers to provide insulin and injectable epinephrine be made available to low-income patients at or below the price paid by the center through the 340B Drug Pricing Program. Per the ongoing reorganization at the Department of Health and Human Services (HHS), the 340B program is in the process of migrating from HRSA to the Centers for Medicare & Medicaid Services (CMS). The move is intended to improve “access and affordability”; no details on implementation are provided in the announcement.

The announcement is available here.

Other Updates

Medicare Trustees Release Annual Report 
On June 18th, Medicare Trustees released their 2025 annual report, finding that the Hospital Insurance Trust Fund will be depleted by 2033, three years earlier than expected, absent congressional action. The Trustees, a panel of senior leadership at the Departments of Health and Human Services (HHS), Treasury, and Labor, caution that Medicare spending continues to outpace the program’s incomes. Costs associated with the Supplemental Medical Insurance Trust Fund (Part B and D) are also climbing. The report estimates that Medicare costs are expected to increase from 3.8% of the gross domestic product in 2024 to 6.2% in 2050. Should the program hit the depletion date, payments would immediately be cut by 11%. Experts say that time is running out to gradually and flexibly implement policies to bolster solvency, given most policies would take a few years to phase in.
 
The report is available here.
 
SCOTUS Allows States to Exclude Planned Parenthood from Medicaid 
On June 26th, the Supreme Court ruled 6-3 against Planned Parenthood and one of its patients in their suit over South Carolina’s effort to deny Medicaid funds to the provider. The central question at issue was whether the party has standing to bring a suit against South Carolina over their exclusion of Planned Parenthood, given Medicaid beneficiaries’ right to access the services of “any qualified provider.” The majority in the decision reasoned that private suits to enforce federal statutes are rare and can require congressional authorization, complicating Medicaid patients’ legal rights to choose their medical providers.  
 
The decision only invokes abortion in passing, though South Carolina’s decision to bar funds to Planned Parenthood was motivated by concerns over potential taxpayer funding of abortion services. The verdict will likely embolden new states to join South Carolina, Texas, Arkansas, and Missouri in removing Planned Parenthood from their Medicaid programs, a trend that could defund the provider and leave its Medicaid patients (half of Planned Parenthood’s total patient base) without reliable access to gynecological services.

New York State Updates

DOH Issues Revised Proposed Regulations on EMS Equipment and Waivers
On June 25th, the New York State (NYS) Department of Health (DOH) issued revised proposed regulations that would update Part 800 of Title 10 of the New York Codes, Rules, and Regulations (NYCRR), which regulates Emergency Medical Services (EMS). The update would streamline vehicle equipment requirements and set up a framework for DOH to grant waivers from the regulations. Specifically, the updated regulations include:  

  • Updated equipment requirements for EMS providers to conform with current industry standards;
  • A list of required equipment for each vehicle/service category:
    • Ambulance;
    • Basic Life Support First Response and Emergency Ambulance Service Vehicles; and
    • Advanced Life Support – First Response Vehicles; and  
  • A framework for “general regulatory waivers” that allows DOH to waive regulatory requirements of Part 800 if compliance is deemed unreasonable, burdensome, or impractical, or would result in impediment of emergency services.

Following an assessment of public comment, the revised proposed regulations include updates and clarifications on the equipment requirements (e.g., required quantities, making certain equipment optional for lower provider levels) and provide additional details on the waiver submission process.

The revised proposed regulations are available here. Public comment may be submitted to regsqna@health.ny.gov through August 11th. Public comment received on the initial proposed regulations is available in the State Register here.

CMS Approves New York SPA to Reimburse for Multidimensional Family Therapy Services within CFTSS Program
On June 17th, CMS approved New York’s State Plan Amendment (SPA) that authorizes payment for evidence-based practices (EBPs) provided within Children and Family Treatment and Support Services (CFTSS) programs. Specifically, the State has identified Multidimensional Family Therapy (MDFT) as a reimbursable EBP under CFTSS. To receive reimbursement, agencies must be designated to provide Community Psychiatric Supports and Treatment (CPST) or Other Licensed Practitioner (OLP) services and have completed the EBP training and certification process.

The SPA is available here. The CMS approval letter is available here.

SED Adopts Final Regulations Expanding Scope of Practice for RNs
On June 25th, the New York State Education Department (SED) adopted final regulations that permit registered professional nurses (RNs) to execute non-patient specific orders written by physician assistants (PAs) for a defined set of services, including but not limited to immunizations, emergency anaphylaxis treatment, pregnancy testing, opioid overdose reversal treatment, and Covid-19/flu testing. This change adds PAs – along with physicians and nurse practitioners (NPs) – to the list of professionals authorized to issue such standing orders.  

Additional details are available in the State Register here.