Weekly Health Care Policy Update – October 24, 2025

October 31, 2025

In this update:  

  • Federal Funding
    • Government Shutdown Continues, ACA Talks Grow
    • CMS Calls Back Furloughed Workers to Staff Open Enrollment
  • Trump Administration
    • Trump Administration Announces Actions on IVF
  • Federal Agencies
    • CMS Updates Rural Health Transformation Program FAQs
    • Trump Names Alicia Jackson to Lead ARPA-H
  • Other Updates
    • IHI Publishes New Framework for Advancing Health Equity
    • Chamber of Commerce Challenges H1-B Visa Fee; NY Hospitals Estimate $112M Impact
    • KFF Publishes 2025 Employer Health Benefits Survey
  • New York State Updates
    • OMH and OASAS Issue Proposed Regulations for Certification of CCBHCs
    • DOH Adopts Final Regulations on EMS Equipment and Waivers
    • OMH to Host Webinar on Telehealth Regulatory Guidance for Providers

Federal Funding

Government Shutdown Continues, ACA Talks Grow 
As the federal government enters the fourth week of its shutdown, signs of bipartisan cooperation remain sparse. On October 23rd, the Senate failed to move a bill to provide pay to “excepted” federal workers, who are required to work during a shutdown without pay. Republicans are also considering standalone votes to fund the Supplemental Nutrition Assistance Program (SNAP) through the shutdown, and to pay air traffic controllers, but all votes are expected to fail as Democrats have said they will not support funding bills before addressing enhanced subsidies for Affordable Care Act premium tax credits.

On October 21st, thirteen politically vulnerable, moderate House Republicans wrote to Speaker Mike Johnson (R-LA) urging him to “immediately turn our focus” to the expiration of the premium credits as soon as the government is reopened.  While the public letter highlights rising anxiety among Republicans about the premium increases their constituents will see when enrollment opens on November 1st, the letter continues to support the Speaker in his stance that the shutdown should not be used as leverage.

Reports suggest ongoing, high-level conversations regarding the details of potential Republican reforms to the enhanced premium tax credits: reinstating an income cap, reducing availability of zero premium plans, grandfathering in current enrollees but reducing subsidies for new enrollees, and other provisions. Republican leaders are also reportedly discussing the legislative mechanism by which the ACA subsidy issue could move through the House and Senate.

The letter to Speaker Johnson is available here.

CMS Temporarily Calls Back Furloughed Workers to Staff Open Enrollment 
On October 23rd, CMS announced in an email that it will be bringing back 3,000 previously furloughed workers to temporarily staff open enrollment beginning October 27th. The agency will repurpose funding to ensure employees are paid on time for open enrollment work, receiving a partial paycheck on November 7th. Medicare’s open enrollment period began on October 15th and will run through December 7th; open enrollment for the ACA’s marketplace begins on November 1st and runs through January 15th in most states (January 31st in NY).

Trump Administration

Trump Administration Announces Actions on IVF, Deal with EMDSerono
On October 16th, the Trump Administration made several announcements aimed at lowering costs and increasing access to IVF:

  • The FDA will include a lower-cost fertility drug, currently only approved in Europe, in the Commissioner’s National Priority Review Voucher program.
  • The Departments of Labor, HHS, and the Treasury announced that employers can now offer a standalone IVF benefit package to employees, similar to packages for dental, vision, and life insurance. This will not include any employer subsidies or mandates.
  • EMD Serono will offer the its fertility drugs, including Gonal-F, Cetrotide and Ovidrel, directly to self-pay patients on TrumpRx.gov, at a discount. They are the third pharmaceutical company, after Pfizer and AstraZeneca, to make a drug pricing deal with the administration.

It is still unclear how much the new policies will affect the price of IVF, which typically costs around $15,000 to $20,000 for a single cycle. The announcement from the White House is available here. The announcement from EMD Serono is available here.

Federal Agencies

CMS Updates Rural Health Transformation Program FAQs
On October 17th, CMS updated the Rural Health Transformation Program’s FAQ document. The document adds additional details on the $50 billion program’s scoring methodology including factor weights, percentile ranking for facility/population metrics, and the Full Score Potential; allowable uses of funds including compliance expectations for unexpended and unobligated funds, administrative cost limits, and caps; details on quarterly reporting; instructions for application preparation and submission; and additional information on the Rural Tech Catalyst Fund. The updated version also specifies that the program will proceed regardless of the government shutdown, and the November 5th submission date for states remains in effect.
 
The updated document is available here.
 
Trump Names Alicia Jackson to Lead ARPA-H
On October 20th, Alicia Jackson was sworn in as the new director of the Advanced Research Projects Agency for Health (ARPA-H). Jackson is the founder and chief executive officer of Evernow, a telehealth company for menopause care. She previously worked at the Defense Advanced Research Projects Agency (DARPA) under the Obama administration, as both a program manager and deputy director of the biology programs office.

Other Updates

IHI Publishes New Framework for Advancing Health Equity
On October 14th, the Institute for Healthcare Improvement (IHI) released a new evidence-based framework for measuring health equity. The framework was created by the IHI’s Health Equity Accelerator, a collaboration of 19 health care organizations and 35 subject-matter experts. Perspectives came from those in a variety of settings, including clinical, quality, payor, academia, and administration.

The proposed four-step approach includes: (1) identify and prioritize a health equity focus area, population of focus, and metrics, (2) determine stratification attributes and calculate metrics for all attribute values, (3) choose reference points, and (4) quantify and characterize health disparities. The goal of the framework is to become a U.S. industry standard for measuring health equity.

The framework is available here.

Chamber of Commerce Challenges Trump’s $100K H-1B Visa Fee; Hospitals Project $112M Impact, Current Workers Grandfathered
On October 16th, the U.S. Chamber of Commerce sued the Trump administration over their proposed $100,000 fee for new H1-B work visa applicants. The lawsuit claims that President Trump exceeded his authority in altering the visa program and that Congress “struck an intricate, thoughtful balance” in originally determining fees for the visa program. The Chamber also argues that the fee increase would impact small businesses, increase labor costs, and reduce the number of hired foreign workers.

In New York, for example, the Greater New York Hospital Association anticipates that member hospitals will incur at least $112 million in new costs to replace their 1,222 medical residents who are currently working under an H1-B visa. Ten percent of all residents in primary care specialties among GNYHA’s member hospitals train under an H-1B visa.

On October 20th, the administration clarified that the new fee does not impact current visa holders or their ability to travel to and from the U.S. The fee also does not apply to “change of status” cases where people change from one category to another without leaving the country, such as moving from F-1 student status to H-1B status.

The Chamber of Commerce complaint is available here. The most recent guidance from USCIS is available here.

KFF Publishes 2025 Employer Health Benefits Survey
On October 22nd, KFF published the results of their 27th annual Employer Health Benefits Survey. The Survey examines trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. Employer-sponsored insurance covers 154 million people in the U.S. under the age of 65.

Through 1,862 interviews with non-federal public and private firms, KFF found that:

  • In 2025, the average annual premium for family health coverage reached $26,993 (an increase of $1,408, or 6%, from the previous year). This is similar to the 7% increase KFF reported for 2024 and 2023.
  • Among workers with a general annual deductible for single coverage, the average deductible was $1,886.
  • Covered workers contributed an average of 16% ($1,440) toward premiums to enroll in single coverage and 26% ($6,850) for family coverage.
  • 19% of large firms offering health benefits covered GLP-1 agonists when used primarily for weight loss.
  • 45% of firms offering health benefits indicated that their employees had a “high” or “moderate” level of concern about the affordability of cost sharing.
  • 36% of large firms offering health benefits reported that prescription drug prices contributed “a great deal” toward premium increases.

The full results of the survey are available here.

New York State Updates

OMH and OASAS Issue Proposed Regulations for State-Level Certification of CCBHCs
On October 22nd, The New York State (NYS) Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS) released proposed regulations for state-level certification of Certified Community Behavioral Health Clinics (CCBHCs). CCBHCs are the behavioral health analogue to the Federally Qualified Health Center (FQHC) model, offering integrated behavioral health care to all individuals regardless of ability to pay. New York was selected as one of eight CCBHC demonstration sites in 2016, and the program has since been renewed and extended periodically by Congress. As the federal CCBHC demonstration expired on September 30th, New York has announced its intention to submit a State Plan Amendment (SPA) to CMS to ensure continuation of the CCBHC model and full Medicaid coverage of its services.

The proposed regulations establish new standards for the certification, operation, and reimbursement of CCBHCs under the NYS Medicaid benefit. CCBHCs will be jointly certified by OMH and OASAS under Article 36 of the Mental Hygiene Law, and all providers seeking to continue operating a CCBHC or to obtain CCBHC certification must be licensed, certified, or otherwise authorized by both OMH and OASAS. CCBHCs will be certified for up to three years before re-certification is required. Reimbursement for CCBHC services will be based on provider-specific cost-based rates with a bundled daily rate for all CCBHC services provided on a single day. CCBHCs will also be eligible to participate in a Quality Bonus Payment program based on achievement of certain performance measures.

Until the regulations are adopted, CCBHCs are expected to continue operation pursuant to their Article 31 or Article 32 license and SAMHSA criteria. To ensure continuity of care, once the regulation has been adopted as a final rule, existing CCBHC demonstration sites will receive immediate provisional designation to continue operations and receive reimbursement until they are approved under NYS regulations. Once the rule is adopted, providers who apply for certification within 90 days may have their provisional designation extended as necessary until their application is acted upon.

OMH and OASAS are jointly developing an application and guidance document that will be forthcoming for providers.

The proposed regulations are available here. Public comments may be emailed to Kelly Grace at kelly.grace@oasas.ny.gov by December 21st. Questions may be emailed to CCBHC@omh.ny.gov.

DOH Adopts Final Regulations on EMS Equipment and Waivers
On October 22nd, the NYS Department of Health (DOH) adopted final amendments to Part 800 of Title 10 of the New York Codes, Rules, and Regulations (NYCRR), the State’s Emergency Medical Services (EMS) regulation. The update streamlines vehicle equipment requirements and sets 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 the second round of public comments, the revised and adopted regulations include updates and clarifications on the equipment requirements (e.g., infant swaddler made optional) and provide additional details on the waiver submission process. Waiver requests will be submitted to the relevant Regional Emergency Medical Services Council (REMSCO) for comment; in the proposed regulations, REMSCO input was discretionary.

The final approved regulations are available here.

OMH to Host Webinar on Telehealth Regulatory Guidance for Providers
On December 4th, NYS OMH and the Managed Care Technical Assistance Center (MCTAC) will host a webinar aimed at clarifying current telehealth standards, provider responsibilities, and documentation practices. The session will provide an overview of OMH’s approach to telehealth and guidance on how it can be effectively and appropriately integrated into programs. Participants will gain a better understanding of how telehealth fits within OMH’s expectations for care and where flexibility exists for providers. The session will also include time for questions and feedback.

The webinar will be held from 12pm-1:30pm on December 4th and all OMH providers are invited to attend.

Registration for the webinar is available here. Questions may be submitted in advance here. Additional questions about the webinar may be emailed to mctac.info@nyu.edu with the subject line “Telehealth Regulatory Webinar”.