Insights^

In April 2026, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. appeared before the House Ways and Means Committee, the House Appropriations Labor-HHS Subcommittee, the House Education and Workforce Committee, and the House Energy and Commerce Health Subcommittee to discuss the Fiscal Year 2027 (FY 27) presidential budget request for HHS. Sec. Kennedy used these hearings to share how the budget proposal is designed to align with the administration’s plans to reorganize the department to reduce duplication and focus on addressing the chronic health crisis. He also used the hearings to highlight what he saw as the administration’s wins in areas related to improving nutrition and reducing health care costs. Notably, he did not highlight his actions related to vaccine policy in any hearing. However, Democratic members in each hearing expressed concerns about this topic. The four hearings featured member questions on rural health care, nutrition, prescription drugs, the management of various HHS agencies, and efforts to eliminate fraud, waste, and abuse within the department.

OPENING STATEMENTS

• House Ways and Means Committee Chairman Jason Smith (R-MO-8)
• House Ways and Means Committee Ranking Member Richard Neal (D-MA-1)
• House Appropriations Labor-HHS Subcommittee Chairman Robert Aderholt (R-AL-4)
• House Appropriations Full Committee and Labor-HHS Subcommittee Ranking Member Rosa DeLauro (D-CT-3)
• House Education and Workforce Committee Chairman Tim Walberg (R-MI-5)
• House Education and Workforce Committee Ranking Member Bobby Scott (D-VA-3)
• House Energy and Commerce Full Committee Chairman Brett Guthrie (R-KY-2)
• House Energy and Commerce Health Subcommittee Vice Chair Diana Harshbarger (R-TN-1)
• House Energy and Commerce Full Committee Ranking Member Frank Pallone (D-NJ-11)
• House Energy and Commerce Health Subcommittee Ranking Member Diana DeGette (D-CO-1)

WITNESS TESTIMONY

• Robert F. Kennedy, Jr., Secretary of Health and Human Services – Testimony

MEMBER DISCUSSION

Rural Health

During the Committee hearings, Republican representatives focused on rural health care and the need for continued investments in this area. During the Ways and Means Committee hearing, Chairman Jason Smith (R-MO-8) requested Sec. Kennedy’s commitment to ensuring Rural Health Transformation Program (RHTP) funds are distributed to rural communities, improving the Rural Emergency Hospital designation approval process, and working to equalize payments between rural and urban hospitals. Sec. Kennedy reaffirmed his commitment to work on these issues. Reps. Adrian Smith (R-NE-3), Michelle Fischbach (R-MN-7), and Randy Feenstra (R-IA-4) asked what additional actions could further improve access to rural health care. Sec. Kennedy highlighted recent investments in community health centers and the RHTP, as well as previous and ongoing efforts to move toward site-neutral payments. During the Appropriations Labor-HHS Subcommittee hearing, Subcommittee Chair Aderholt (R-AL-4) asked how the Centers for Medicare and Medicaid Services (CMS) is evaluating whether the hospital wage index accurately reflects true labor costs. Sec. Kennedy explained that changing the wage index is extremely complex because the program must remain budget-neutral, so Congress needs to intervene to affect changes. During the Energy and Commerce Health Subcommittee hearing, Full Committee Chairman Guthrie (R-KY-2) asked the secretary about his experience administering RHTP and what he is most excited about. Sec. Kennedy explained that he is most excited about how RHTP dollars will help address what he described as a crisis in rural health and an epidemic of hospital closures, Reps. Troy Balderson (R-OH-12) and Mariannette Miller-Meeks (R-IA-1) asked how the funds can be used for recruitment to address staffing shortages. Sec. Kennedy shared that RHTP funds can be used to expand residency programs in rural areas, but he is unsure if they can be put towards recruitment bonuses.

Nutrition

There was bipartisan support for the nutrition initiatives that Sec. Kennedy has been championing across the hearings, although Democratic members questioned cutting funds for programs they argued are vital to supporting Americans’ nutrition. During the Ways and Means Committee hearing, Health Subcommittee Chair Vern Buchanan (R-FL-16), as well as Reps. Lloyd Smucker (R-PA-11) and Brian Fitzpatrick (R-PA-1) asked what future actions HHS plans to take to improve nutrition. Sec. Kennedy responded that he was interested in reviewing the list of substances generally recognized as safe (GRAS) and in driving cultural changes in diet and exercise. Rep. Gwen Moore (D-WI-4) expressed her disappointment with the proposed budget cuts to Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP), arguing that these cuts hamper efforts to improve nutrition. Sec. Kennedy acknowledged her disappointment, sharing that he was not happy with the funding changes, but with the large federal debt, cuts had to happen. During the Education and Workforce Committee hearing, Rep. Alma Adams (D-NC-12) questioned the budget cuts to programs that she argued promote nutrition, such as the Farm-to-School Program and school lunch grants. Sec. Kennedy shared that President Trump did not discuss the proposed cuts with him, but that he preserved Head Start and is focused on expanding access to whole foods. Rep. Kevin Kiley (I-CA-6) asked Sec. Kennedy to expand on the link between our food supply and chronic health issues. In response, the secretary reiterated his view that the lack of regulation of GRAS substances is a major problem. Rep. Glenn Thompson (R-PA-15) then asked about efforts to improve access to nutritional foods in schools. Sec. Kennedy explained that schools have abandoned their kitchens, that we need to help them rebuild to make good food, and that they need to continue encouraging the provision of whole milk during meals.

Vaccines

Many Democrats during all hearings expressed concerns about Sec. Kennedy’s views on vaccines and recent changes to vaccine recommendations. During the Ways and Means Committee hearing, Rep. Judy Chu (D-CA-28) questioned the removal of the universal Hepatitis B vaccination recommendation. Sec. Kennedy defended the change in recommendation, saying that infants are not generally at risk, vaccination is still recommended when the mother is positive for Hepatitis B, and that insurance companies can still cover the vaccination. Rep. Madeliene Dean (D-PA-4) asked how many members of the Advisory Committee on Immunization Practices (ACIP) he replaced. The secretary responded that he fired all 17 members because he didn’t like the work they were doing. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Lois Frankel (D-FL-22) shared her concern about the lack of funding released to GAVI, the Vaccine Alliance that produces vaccines for underdeveloped countries, which was appropriated in both FY 25 and FY 26. Sec. Kennedy did not have a response. Reps. Mike Thompson (D-CA-4) and Linda Sanchez (D-CA-38) on Ways and Means, and Rep. Dean (D-PA-4) on the Appropriations Labor-HHS Subcommittee, focused on the rise in measles cases and the decline in measles vaccination rates. When asked by Reps. Sanchez (D-CA-38) and Dean (D-PA-4), if the vaccine was safe and effective, especially compared with contracting the disease, Sec. Kennedy agreed that it was. During the Education and Workforce Committee hearing, Rep. Suzanne Bonamici (D-OR-1) and Rep. Haley Stevens (D-MI-11) asked why Sec. Kennedy does not approve of the measles vaccine. The secretary stated that he has never been anti-vaccine, but that the combined measles vaccine for those under two was dangerous. He also cited a new cancer vaccine that HHS approved to show his support for vaccines. House Education and Workforce Committee Chair Tim Walberg (R-MI-5) provided the secretary with an opportunity to defend his actions by asking Sec. Kennedy to address allegations that he was responsible for the measles outbreak. Sec. Kennedy responded that the accusation is not science-based because the outbreak began before he took office. Sec. Kennedy also shared that if the 2 children who died in Texas had been given proper treatment when they went to the hospital, they could have been saved. During the Energy and Commerce Health Subcommittee hearing, Reps. Kim Schrier (D-WA-8) and Marc Veasey (D-TX-33) pressed the secretary on his rhetoric surrounding vaccines and the impact of said rhetoric. Sec. Kennedy reiterated that he has never been anti-vaccination and never removed measles from the list of recommendations. Rep. Schrier (D-WA-8) specifically focused on what she called the “RFK Jr. Spillover Effect,” which she “RFK Jr. Spillover Effect,” which she characterized as leading to overall distrust of doctors and negatively Vitamin K injections for newborns. Sec. Kennedy again emphasized that anybody could get vaccines covered by insurance and noted that he has never said anything about Vitamin K.

Fraud, Waste, and Abuse

Addressing fraud, waste, and abuse was a major topic in all hearings. During the Ways and Means hearing, Full Committee Ranking Member Richard Neal (D-MA-1) and Health Subcommittee Ranking Member Lloyd Doggett (D-TX-37) questioned the Trump administration’s pardoning and reinstatement of those who were charged with Medicare and Medicaid fraud to be brokers. Sec. Kennedy did not have an answer to these questions. Reps. Beth Van Duyne (R-TX-24) and Rudy Yakym (R-IN-2) asked what steps HHS has taken to reduce fraud, waste, and abuse. Sec. Kennedy pointed to investigations into durable medical equipment, hospice, and home health, as well as ensuring proper Medicaid enrollment. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Andy Harris (R-MD-1) asked broadly what the secretary is doing to crack down on fraud, waste, and abuse. Sec. Kennedy said that HHS is ending the pay-and-chase system and auditing state Medicaid claims. During the Education and Workforce Committee hearing, Rep. Burgess Owens (R-UT-4) raised concerns about fraud, waste, and abuse and asked what specific deficiencies were being addressed. Sec. Kennedy stated that there is fraud in both red and blue states, but he argued that Florida cooperated in their investigation while Minnesota did not. During the Energy and Commerce Health Subcommittee hearing, Chair Guthrie (R-KY-2) asked if the secretary was surprised by the amount of fraud, waste, and abuse he has found. Sec. Kennedy explained that the Biden administration opened the door with the pay-and-chase model and by only evaluating reimbursement validations once a year. Rep. Miller-Meeks (R-IA-1) requested Sec. Kennedy’s support for her legislation aimed at investigating programs with significant increases in billing over a 6-month period to prevent fraud, which the secretary described as a great idea but something that he would need to look into further.

Affordability

During the hearings, there was bipartisan interest in health care affordability. At the Ways and Means hearing, Rep. Steven Horsford (D-NV-4) was specifically interested in knowing what steps HHS was taking to lower premiums and increase insurance coverage. Sec. Kennedy emphasized HHS’s actions to negotiate lower drug prices. Reps. Jodey Arrington (R-TX-19) and Max Miller (R-OH-7) asked what steps Congress and HHS can take to support affordability in the future. Sec. Kennedy shared that he would like to address perverse incentives that lead to higher costs, address concerns about certain pharmacy benefit manager (PBM) practices, increase direct primary care, and promote individual choice in health. Rep. Miller (R-OH-7) requested a framework for the future. During the Energy and Commerce Health Subcommittee hearing, Reps. Cliff Bentz (R-OR-2) and Nick Langworthy (R-NY-23) asked what steps HHS is taking to drive down prices. Sec. Kennedy shared that they have dozens of initiatives, including the most favored nation deals, cost-sharing, and “cleaning up the coverage pool.”

Members from both parties also raised questions about efforts to lower prescription drug prices. Education and Workforce Committee Ranking Member Scott (D-VA-3) asked if the secretary could commit to releasing the information on the deals from the most-favored-nation deals, to which he responded that most of the information is public, and he said that all that hasn’t been shared is proprietary. Rep. Rick Allen (R-GA-12) and Rep. James Comer (R-KY-1) turned the focus to PBMs and vertical integration. Sec. Kennedy explained that they are driving up costs everywhere and steering patients towards more expensive medications to receive higher compensation. The secretary also stated that vertical integration is a major safety issue and has led to people without medical degrees making decisions about which medications patients have access to. During the Energy and Commerce Health Subcommittee hearing, Rep. Buddy Carter (R-GA-1) raised concerns about the 340B program and its shift away from its intended goals. Sec. Kennedy shared his concerns and stated that any change to the program would need to be statutory, but he would be happy to work with Congress on any solutions.

Sec. Kennedy also faced questions from Democrats regarding Medicaid and Medicare. At the Ways and Means hearing, Rep. Joe Courtney (D-CT-2) and Rep. Greg Casar (D-TX-5) raised concerns about cuts to Medicaid and Medicare in H.R.1 and argued that these cuts have resulted in a high number of Americans losing their health insurance. Sec. Kennedy emphasized his belief that both Medicare and Medicaid are critical programs that need to be saved and stated that the cuts to Medicaid are solely the result of ending coverage for illegal immigrants. During the Energy and Commerce Health subcommittee, Sec. Kennedy was repeatedly questioned about Medicaid cuts, which he adamantly denied occurred, based on a recent Congressional Budget Office (CBO) report. Rep. Alexandria Ocasio-Cortez (D-NY-14) specifically focused on Medicare Advantage (MA) reimbursement rates and the increase in reimbursement for MA plans that the administration provided for 2027. Sec. Kennedy agreed that insurance companies are fleecing Americans, but said HHS was facing huge blowback from the insurance industry, which was threatening to abandon patients, so the department did what they thought was best.

Agency Management

Hearings also featured bipartisan interest in the management of HHS agencies. During the Ways and Means Committee hearing, Reps. Darin LaHood (R-IL-16) and Blake Moore (R-UT-1) expressed interest in updates about the Food and Drug Administration (FDA). Rep. LaHood (R-IL-16) raised the possibility of mismanagement at the FDA. Sec. Kennedy responded that the FDA has set records for the number of approvals of new drugs, generics, and medical devices, and has improved efficiency through the use of artificial intelligence. Rep. Moore (R-UT-1) asked about coordination between the FDA and CMS to provide temporary coverage of breakthrough medical devices. Sec. Kennedy shared that an announcement would be coming soon. During the Energy and Commerce Health Subcommittee hearing, Reps. Kat Cammack (R-FL-3) and Erin Houchin (R-IN-9) asked what specifically the FDA and HHS were doing to accelerate domestic manufacturing in hopes of maintaining U.S. leadership in pharmaceutical production. Sec. Kennedy described a pre-check program that will fast-track proposals to expand domestic plants and stated that 90% of the FDA is now using AI, which he stated has condensed the time taken to review applications for drugs.

Funding Reductions to Agencies

During all hearings, members of both parties also raised questions about funding reductions for certain agencies. At the Ways and Means hearing, Reps. Brendan Boyle (D-PA-2) and Brad Schneider (D-IL-10) expressed concerns about the proposed funding changes to the National Institutes of Health (NIH), with Rep. Schneider (D-IL-10) saying that it would likely lead to fewer drugs coming to market in the next 5 years. Rep. Boyle (D-PA-2) was specifically concerned about the impact on pediatric cancer research funding. Sec. Kennedy shared that the only Institute within the NIH to see an increase in funding was the National Cancer Institute and emphasized that duplicative programs were reallocated. When asked during the Appropriations Labor-HHS Subcommittee hearing by Rep. Bice (R-OK-5) about the primary areas that would see reductions under the budget, Sec. Kennedy stated that they must make cuts to the NIH to recalibrate funding toward chronic health rather than spending all the agency’s time on genetic testing. During the Education and Workforce Committee hearing, Rep. Donald Norcross (D-NJ-1), Rep. Adelita Grijalva (D-AZ-7), and Rep. Mark DeSaulnier (D-CA-10) voiced concerns with the cuts to research programs within the NIH, the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Sec. Kennedy cited the Great American Recovery Initiative and the increase in funding for the National Cancer Institute as examples of not cutting funding but rather shifting focus. Rep. Grijalva (D-AZ-7) asked which areas he believes deserve less medical research. The secretary stated that diversity, equity, and inclusion (DEI) has never cured any diseases or created new drugs. Rep. Summer Lee (D-PA-12) questioned cuts to research surrounding black maternal mortality rates. Sec. Kennedy explained that maternal mortality impacts everyone, and the perinatal pilot project he has implemented in various hospitals has reduced mortalities by 42% across the board.

Hearings also featured Democratic concerns about staffing changes at agencies. During the Ways and Means Committee hearing, Rep. Don Beyer (D-VA-8) questioned the changes in funding and staffing at the Agency for Healthcare Research and Quality (AHRQ) and SAMHSA, requesting briefings on the agencies. Sec. Kennedy shared that AHRQ has appropriate staffing levels and that the SAMHSA grant termination letters were a mistake. He also agreed to meet about the agencies in the future. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Steny Hoyer (D-MD-5) asked about the changes made to the HHS workforce. Sec. Kennedy explained that there are currently 72,000 employees and that they plan to hire another 12,000 employees who will focus on chronic health. He explained that those who lost their jobs were not bad actors and were doing their jobs, but they had to be fired to change the culture.

Hearings also featured discussions about high-profile vacancies at roles within agencies. For example, during the Ways and Means Committee hearing on April 16th, Rep. Jimmy Panetta (D-CA-19) expressed concerns about vacancies in multiple roles at the Centers for Disease Control and Prevention (CDC) and at the US Surgeon General’s office. This hearing took place before Dr. Erica Schwartz was nominated to be the CDC Director. At the Energy and Commerce Health Subcommittee hearing, Rep. Raul Ruiz (D-CA-25) asked the secretary for his opinion on Dr. Schwartz and why the previous CDC Director, Dr. Monarez, was fired. Sec. Kennedy shared that he was consulted on the nomination and helped vet Dr. Schwartz. He also stated that Dr. Monarez was fired because she said he could not trust her, not because of her differing views on vaccines. During the Appropriations Labor-HHS Subcommittee hearing, Vice Chair Julia Letlow (R-LA-5) gave Sec. Kennedy space to promote Surgeon General nominee Casey Means. The secretary emphasized her importance in upholding the work of MAHA and educating people on metabolic health. He described Means as an effective evangelist for MAHA.

Women’s Health

Both Republicans and Democrats spent time questioning and clarifying various issues related to women’s health. During the Ways and Means Committee hearing, Rep. Nicole Malliotakis (R-NY-11) questioned how HHS plans to advance women’s health. Sec. Kennedy pointed to the RHTP to address issues related to maternal mortality. Rep. Malliotakis (R-NY-11) shared that she would like attention for safety net facilities, especially for those in urban areas that will not benefit from RHTP. During the Appropriations Labor-HHS Subcommittee hearing, Subcommittee Chair Robert Aderholt (R-AL-4) asked how the FDA could appropriately address the risk of chemical abortion drugs, specifically Mifepristone, without the reporting in place on the serious adverse events. Sec. Kennedy stated he couldn’t speak on Mifepristone because of the ongoing litigation in Louisiana. Full Committee and Labor-HHS Subcommittee Ranking Member Rosa DeLauro (D-CT-3) then questioned if Sec. Kennedy plans to reinstate the maternal health experts who were let go, to which he responded that it would be up to the new CDC leadership. Vice Chair Letlow praised the secretary for his work on women’s health and asked about the actions being taken after the national conference. Sec. Kennedy detailed the initiatives in the proposed budget, specifically to address maternal health and disparities among minorities. Rep. Andrew Clyde (R-GA-9) and Rep. Blake Moore (R-UT-1) asked about the use of Title X funding going towards abortion and research using fetal tissue. Sec. Kennedy explained that new rules and regulations are coming soon to address this, and it is illegal to use fetal tissue in NIH-funded research. During the Energy and Commerce Health Subcommittee hearing, Subcommittee Ranking Member Diana DeGette (D-CO-1) and Reps. Robin Kelly (D-IL-2) and Nanette Barragan (D-CA-44) questioned cuts to maternal mortality programs. Sec. Kennedy stated his support for access to birth control but defended the cuts saying there were 27 maternal mortality programs and he is consolidating them.

Other Topics

During the Ways and Means Committee hearing:

• Rep. Carol Miller (R-WV-1) expressed concern about how the bundled payment rate for chronic kidney disease could decrease innovation incentives. Sec. Kennedy expressed that he would be happy to work with her on increasing innovation.
• Rep. David Schweikert (R-AZ-1) requested to work with Sec. Kennedy on ways to improve MA, as the Medicare Payment Advisory Commission (MedPAC) has issued reports about the misalignment of incentives and costs.

During the Appropriations Labor-HHS Subcommittee:

• Reps. Jake Ellzey (R-TX-6) and John Moolenaar (R-MI-4) raised concerns about health care cybersecurity, particularly risks tied to the strategic national stockpile and emerging technologies, with secretary Kennedy responding that HHS is coordinating with the Administration for Strategic Preparedness and Response (ASPR) and CMS, reducing reliance on Chinese products, and emphasizing stronger protections as investments in AI and telehealth expand.
• Rep. Bice (R-OK-5) and Rep. Moolenaar (R-MI-4) asked what HHS is doing to reverse the trend of China conducting more Phase 1 trials than the U.S. Sec. Kennedy explained that they are working to accelerate approvals and shorten time to patients, as well as planning to invest $325 million into reshoring pharmaceuticals that puts drugs researched in the U.S. first in line for approvals. He also stated that there is money coming in from Trump’s tariffs, which are also helping the pharmaceutical companies build more plants in the U.S.

During the Education and Workforce Committee hearing:

• Chair Walberg (R-MI-5) and Rep. Mark Harris (R-NC-8) asked about moving certain programs, such as the Foreign Medical Accreditation, from the Department of Education to HHS. Sec. Kennedy explained that those programs align better with HHS priorities, and they are talking with other agencies to see what can be shifted. He also shared that he believes medical school accreditation should fall under HHS’s purview because of its focus on health education.
• Reps. Glenn Grothman (R-WI-6) and Harris (R-NC-8) shared their disapproval of sex change operations and the promotion of them by mental health professionals. Sec. Kennedy explained that it is a multi-billion-dollar industry that is very corrupt, and the administration has ended all federal funding for puberty blockers and gender surgeries. He also confirmed that they are seeing hospitals rolling back on transgender surgeries and treatments since Trump’s Executive Order to suspend Medicare and Medicaid reimbursements if they perform the procedures.

During the Energy and Commerce Health Subcommittee hearing:

• Rep. Gus Bilirakis (R-FL-12) asked if Sec. Kennedy saw any opportunity to engage further on potential links between environmental toxins and neurodegenerative diseases. The secretary shared that he believes it’s regulatory malpractice that we don’t know the full extent of impacts, and he committed to working on getting answers.
• Rep. John Joyce (R-PA-13) asked what HHS is doing to ensure standards under the Stark Law are enforced. Sec. Kennedy explained that they are reforming the site neutrality rule so rural hospitals don’t get paid less to disincentivize families from moving their relatives.
• Rep. Balderson (R-OH-12) asked for HHS’s view on wearable technology, specifically in early detection. Sec. Kennedy stated that he believes they are critical and can revolutionize chronic disease prevention. He specifically mentioned glucose models and their dramatic impact.
• Rep. Debbie Dingell (D-MI-6) asked if Sec. Kennedy planned on addressing the staffing crisis following the CMS decision to repeal the 2024 nursing home staffing requirements. The secretary explained that the requirements were closing rural facilities that couldn’t withstand the staffing numbers, so repealing it helped.

On April 21, the House Ways and Means Committee held a hearing to examine fraud in Medicare. There was strong bipartisan support for ending and preventing fraud in Medicare. Democratic members raised strong objections to actions taken by the Trump administration related to the prosecution of Medicare fraud. Republican members, in contrast, praised the administration’s efforts to combat Medicare fraud, highlighting harm to beneficiaries.

OPENING STATEMENTS

• Chairman Jason Smith (R-MO-8)
• Ranking Member Richard Neal (D-MA-1)

WITNESS TESTIMONY

• Dr. Lynn Ianni, Ph.D., Medicare beneficiary and Medicare fraud victim – Testimony
• Ms. Shelia Clark, President and CEO, California Hospice and Palliative Care Association – Testimony
• Mr. David Klebonis, Chief Operating Officer, Palm Beach ACO – Testimony
• Mr. Christopher Deery, Director of Corporate and Financial Investigations, Independent Blue Cross – Testimony
• Ms. Kristi Martin, Principal, Highway 136 Consulting – Testimony

MEMBER DISCUSSION

Fraud Prevention

There was bipartisan support for preventing fraud in Medicare. Health Subcommittee Chair Vern Buchanan (R-FL-16), and Reps. Danny Davis (D-IL-7), Ron Estes (R-KS-4), Carol Miller (R-WV-1), and Nicole Malliotakis (R-NY-11) asked for input on how to best prevent fraud in Medicare. Mr. Klebonis shared that patient satisfaction surveys and site visits are critical for ensuring proper validation of providers. Ms. Clark repeatedly emphasized the need for better validation during program entry, education for beneficiaries, and looking at data from the beneficiary level to better understand if various claims data make sense. Rep. Davis requested more information on what education could be helpful to beneficiaries. Ms. Martin shared that campaigns on protecting their beneficiaries’ information have been successful. Ms. Clark shared that information about how to identify and report fraud to the senior Medicare Patrol has been important with beneficiaries she has worked with.

Rep. Greg Steube (R-FL-17) suggested that requiring a Certificate of Need can be effective in preventing new fraudulent hospice openings, a view Ms. Clark agreed with. Health Subcommittee Ranking Member Lloyd Doggett (D-TX-37) suggested that the Centers for Medicare and Medicaid Services (CMS) should deactivate the national provider identifier number for those known to be committing fraud. All witnesses supported this suggestion.

Rep. Steven Horsford (D-NV-4) shared that he would like to reduce fraud but that new measures cannot be put into place at the expense of patient care and asked for options on how to strike a balance. Ms. Martin agreed with the statement and highlighted that any new regulations should not delay care.

Beneficiary Harm

Other members of the Committee focused their questioning on the harms to beneficiaries who have experienced fraud. Reps. Miller, Nathaniel Moran (R-TX-1), and Michelle Fischbach (R-MN-7) requested an explanation of the impact of fraud on beneficiaries. Ms. Clark explained that it is a time-intensive process for beneficiaries to get the care they need after experiencing fraud, and that beneficiaries are often expected to pay for medical services received while fraud is being investigated. Dr. Ianni shared that she wished she had received more compassion and communication through the process of working with CMS, as the emotional toll was quite high. Rep. Estes said he believes fraud is a patient safety issue, especially when patients cannot receive the care they need.

Use of Technology

There was interest from Committee members in understanding how technology can be useful for preventing fraud. Chairman Smith (R-MO-8), Reps. Adrian Smith (R-NE-3), David Schweikert (R-AZ-1), Greg Murphy (R-NC-3), and Blake Moore (R-UT-1) all suggested use of artificial intelligence (AI) could be helpful in identifying fraudulent claims. Mr. Deery agreed, but with the caveat that a human is still needed to guide AI use and make the final decision on whether a claim is fraudulent. Mr. Deery also emphasized the importance of data visualization tools to help identify whether a new claim might be part of a pattern of fraud as well as to track where every dollar is being spent.

Administrative Actions

Many Democrats raised concerns about actions taken by President Trump to pardon individuals convicted of Medicare fraud, as well as other actions that impact the prosecution of fraud claims. Reps. Doggett, Mike Thompson (D-CA-4), and Don Beyer (D-VA-8) questioned the firing of HHS Inspector Generals and attorneys at the Department of Justice. Rep. Beyer explained that many fraud cases have been closed without a full investigation due to inadequate staffing across multiple departments.

Other Topics

• Rep. Beyer highlighted how a federal all payer claims database could create a more robust picture of health care data, which would be beneficial in identifying fraud.
• Rep. Brian Fitzpatrick (R-PA-1) raised concerns about fraud in addiction treatment centers, specifically in Pennsylvania. Mr. Deery responded that a significant dent in fraudulent activities has been made, and commercial insurers are now the primary targets.
• Multiple Democratic members expressed support for H.R. 7966, the Hospice CARE Act of 2026, which implements new hospice program integrity measures.

On April 9 and 10, the Medicare Payment Advisory Commission (MedPAC) met for their April meeting, the last meeting in the 2026 Cycle. Commissioners discussed several topics including, how to improve payment incentives, the impact of Medicare Advantage (MA) on hospitals’ and post-acute care (PAC) providers’ finances, and institutional special needs plans (I-SNPs). Commissioners all expressed concerns with the current system and voiced numerous solutions.

IMPROVING PAYMENT INCENTIVES IN MEDICARE

MedPAC staff began this session discussing the drivers of Medicare’s spending growth, payment incentives within fee-for-service (FFS), alternative payment models (APMs) and MA, as well as recommendations to improve Medicare’s incentives. These recommendations can be viewed on slides 29-38 in the Improving Payment Incentives” slideshow found here. MedPAC staff shared that its presentation, along with the Commissioners’ discussion, will be included in the MedPAC June 2026 report to Congress.

Overall, Commissioners agreed on the shortcomings of FFS, APMs, and MA, saying that they each have their strengths and weaknesses when it comes to payment incentives. Commissioners expressed that FFS is foundational, in that it serves as a guardrail to ensure MA provides a variety of services, yet it leads to high inflation. Commissioners shared that APMs are an incentive layered on top of FFS and have tools to avoid unnecessary plan expenses but do not have sufficient funding to support the infrastructure needed. In terms of MA, a few Commissioners said that it is effective at controlling costs, but the incentive is currently centered around coding care rather than quality of care. Commissioners concluded that each of these services play a core role and are vital but agreed that there needs to be stronger tools to provide better incentives to providers.

Additionally, Commissioners emphasized the need to ensure beneficiaries know they are being enrolled in Medicare, MA, or APMs so they can best understand the benefits available to them. There was also concern regarding the rise of costs as people age and are diagnosed with additional chronic illnesses. Commissioners recommended payment mechanisms that encourage specialist-led services with more focus on patients and increased specialist engagement with APMs to combat the rising costs. A few Commissioners mentioned rising drug costs and expressed concern over the focus on price and quantity impacts, rather than innovation impacts. A few Commissioners noted that there are tools in place to manage every cost except for drug costs and recommended the utilization component as an incentive to control when drugs are used in a managed environment.

MA ENROLLMENT AND HOSPITALS’ AND POST-ACUTE CARE (PAC) PROVIDERS’ FINANCES

MedPAC staff began this session giving a brief background on MA enrollment and plan incentives, then discussed how MA enrollment affects hospital finances and PAC providers’ finances. The staff explained the elements of the study they conducted as there was no pre-existing literature that included all of the information they needed. Their research showed that there is no significant association between MA penetration and hospitals’ and PAC providers’ finances, despite complaints that providers are experiencing difficulties navigating the space. This chapter will be included in the June 2026 Report to Congress.

A number of Commissioners voiced concerns on the subjectivity of what is medically necessary, specifically in terms of referrals and denials. One Commissioner detailed that providers have different resources they use to evaluate medical necessity than health plans do, which contributes to different decisions. One Commissioner explained that an MA plan can decide a procedure is not necessary if it’s nonemergent, which leads to increased time-to-placement, which increases costs. While the overturn rate of these denials is very high, providers then lose money and time appealing the decision. Other Commissioners echoed concerns about this. One Commissioner questioned if the reason data is not reflecting the issue is due to the way providers and hospitals have adjusted to MA market penetration in order to combat the rising costs.

Commissioners also spent time discussing heterogeneity between MA plans, and between home health agencies (HHAs), skilled nursing facilities (SNFs), and inpatient rehabilitation facilities (IRFs). Commissioners explored how MA plans vary in how they approach situations depending on the geography and relationships with providers in the areas they are operating in. Commissioners noted that each facility varies in size, coverage, and care level and that these differences impact the solutions they need. For example, one commissioner detailed that smaller SNFs operate better than larger SNFs, while smaller HHAs are not as effective as larger HHAs. Commissioners continuously raised this concern and there was agreement about the need to look into the structural failures currently in place that are either positively or negatively impacting each player.

INSTITUTIONAL SPECIAL NEEDS PLANS (I-SNPS): PROVISION OF SERVICES, NETWORK-ADEQUACY REQUIREMENTS, AND STAR RATINGS

MedPAC staff began this session reviewing their work last year on I-SNPs. Staff also emphasized that this work will not be included in the June 2026 Report to Congress, but if there were commissioner interest, they would conduct additional work in the next cycle and include this as a chapter in the June 2027 Report.

A number of Commissioners voiced concerns about the interaction between Medicare and Medicaid plans within I-SNPs as it is the only model that can apply to long-stay older adults on Medicaid that are getting care in nursing homes from Medicare. One Commissioner specifically raised the issue of conflicting incentives in terms of nursing homes electing to send patients to the hospital due to higher reimbursement rates from Medicare versus I-SNPs focus on keeping care within the nursing home. Additionally, Commissioners expressed the need to better understand what nurse practitioners are doing and how they interact with the rest of the nursing home staff.

Other Commissioners also asked questions regarding the functionality of I-SNPs and the data collected on them. One Commissioner asked if there was a way to identify incident to billing in nurse practitioner visits, to which the staff explained that they are salaried employees, so it is unclear if they are cataloging every visit. Another Commissioner asked why insurer sponsored I-SNPs are getting higher star ratings over those that are provider sponsored. Staff explained that insurer sponsored I-SNPs are simply larger, so they have more enrollees and therefore get more data. Additionally, one Commissioner proposed having CMS require SNP beneficiaries, or their proxy, be educated about the choice of FFS, MA, or I-SNP coverage within the nursing home.

Today’s sessions concluded with a public comment period. Shannan Wu, the Director of Payment Policy at the American Hospital Association urged MedPAC to continue carefully examining the role MA plays in access to care and spending. Wu explained that the major high-cost drivers in Medicare can be found in MA, despite the greater administrative burdens, and believes the Commission should look towards combatting that.

On April 9 and 10, 2026, the Medicaid and CHIP Payment and Access Commission (MACPAC) met for their April meeting. The Commissioners held sessions on implementing community engagement requirements in Medicaid and on Medicaid program integrity. Commissioners also voted in favor of 2 recommendations related to Medicaid managed care to be included in the June 2026 report to Congress.

IMPLEMENTING COMMUNITY ENGAGEMENT REQUIREMENTS IN MEDICAID

MACPAC staff began the session by providing an overview of the previous research completed on the community engagement requirements, including expert panel and stakeholder interviews that were conducted in the summer of 2025. Staff then presented the draft recommendation that will be voted on during the May 2026 meeting, for inclusion in the June 2026 report to Congress. The draft recommendation reads: “The Secretary of the US Department of Health and Human Services should direct the Centers for Medicare & Medicaid Services (CMS) to develop a transparent plan for monitoring and evaluating community engagement requirements in Medicaid that provides insight into how such policies affect eligibility and enrollment, health status, employment, state and federal administrative spending, and the attainment of other identified policy goals. CMS should identify new metrics for state reporting, as needed, and build upon existing data collection activities to minimize administrative burden. Additionally, CMS should ensure timely publication of monitoring and evaluation results to inform policy and operational decision making.”

Commissioners appreciated the content and tone of the draft chapter, noting that the topic requires considerable detail. In general, the Commissioners indicated support for the draft recommendation but had some concerns about implementation. For example, Commissioners raised concerns about the additional administrative burden that could be placed on states due to monitoring and evaluation requirements. Commissioners commented that state Medicaid agencies lack the ability to track health insurance enrollment and health status once a beneficiary leaves the program. Commissioners did note that it is easier to track the health and insurance status of beneficiaries who continually enter and exit the program because data such as their use of preventive care, emergency department care, and health insurance coverage is often available from the time they were not enrolled in Medicaid. Overall, Commissioners felt it was important for the recommendation to be realistic about what data can be captured and not recommend beyond what is possible.

Many Commissioners also felt it would be important to evaluate the cost-effectiveness of community engagement requirement implementation, specifically understanding how much states are spending versus saving. Commissioners highlighted costs associated with the accelerated implementation timeline and the likely increase in uncompensated care, especially in rural communities that serve a higher percentage of Medicaid beneficiaries.

Commissioners also discussed a few other topics. One Commissioner highlighted the need to track the reason an individual becomes disenrolled after the work requirements are implemented, especially to understand if it is an administrative error and the individual is still eligible. Another Commissioner questioned whether there were platforms that could evaluate participation in nontraditional employment, such as gig work, as Equifax, one of the highlighted platforms, does not have that capability. MACPAC staff shared that beneficiaries could use an income verification service but that they are not currently aware of additional platforms to recommend. Commissioners and MACPAC staff agreed that new platforms may have become available since data was collected, and so additional research would be beneficial. Lastly, a Commissioner requested that staff include more literature on the effects of increased administrative burden on patients, specifically how it leads to higher rates of health insurance disenrollment. MACPAC staff agreed that including literature about the topic could be beneficial and said they would review possible inclusions.

INTRODUCTION TO MEDICAID PROGRAM INTEGRITY

This session began with MACPAC staff providing an overview of program integrity and fraud, waste, and abuse within Medicaid. Staff then discussed the roles and responsibility of federal and state departments in program integrity and outlined the current issues in Medicaid program integrity. Key takeaways from the presentation included:

• Known fraud, waste, and abuse accounts for a small portion of program spending and its scale and impact are difficult to measure.

• Federal government, states, and health plans have a significant number of statutory and regulatory program integrity responsibilities.

• Key issues in program integrity include federal-state collaboration and program integrity in managed care.

Staff requested that the Commissioners provide feedback on the policy scan findings and further areas for exploration during stakeholder interviews.

Commissioners widely praised the material presented and appreciated the clear definitions and examples of fraud, waste, and abuse. Multiple Commissioners expressed the view that often the terms are inaccurately used, pointing out that disagreeing with a policy or statute does not constitute fraudulent or wasteful spending.

Commissioners had a wide variety of topics of interest for further exploration. A few Commissioners were interested in understanding how CMS and states decide where to invest money and time to best prevent program integrity issues and recover improper payments. One Commissioner specifically requested a return on investment analysis to understand where to invest to produce the best results. There was also widespread interest in understanding best practices for preventing fraud, recovering payments, and working with state Medicaid agencies.

Some other areas of interest included measuring the quality of State Medicaid Fraud Control Units, understanding how prior authorization is useful for program integrity, the impact of delays in convictions during fraud investigations for states, and ways to improve collaboration between CMS and states.

VOTE ON RECOMMENDATIONS FOR JUNE REPORT TO CONGRESS

Commissioners voted on 2 recommendations related to ensuring accountability of Medicaid managed care plans for inclusion in the June 2026 report to Congress.

The first recommendation reads, “The Secretary of the US Department of Health and Human Services should direct the Centers for Medicare and Medicaid Services to provide guidance on the types of accountability actions, such as liquidated damages, informal interventions, and other accountability actions, taken in response to plan noncompliance, in the sanctions section of the Managed Care Program Annual Report pursuant to 42 CFR 438.66(e)(2)(viii).” This recommendation passed by a vote of 17 to 0.

The second recommendation reads, “The Secretary of the US Department of Health and Human Services should direct the Centers for Medicare and Medicaid Services to develop a publicly available database on managed care plan performance that links federally mandated reported data together to facilitate analysis. CMS should also issue guidance and toolkits to help states effectively use these data to assess past performance, improve beneficiary experience, and oversee managed care plans.” This recommendation passed by a vote of 17 to 0.

There was no discussion about either of the recommendations.

On April 10, 2026, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year 2027 Medicare Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule. A fact sheet from CMS is available here. Complete text of the proposal is available here. Comments on the rule are due June 9, 2026.

UPDATES TO IPPS PAYMENT RATES

As part of the proposed rule, CMS would increase payment rates by 2.4% for general acute care hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful users of electronic health records (EHRs) under the Medicare Promoting Interoperability Program. This proposed update reflects a projected FY 2027 hospital market basket increase of 3.2%, reduced by a 0.8% productivity adjustment. Overall, CMS estimates that the proposed changes in IPPS payment rates, together with other policy changes, would increase hospital payments by approximately $1.4 billion in FY 2027.

CMS also proposes setting the FY 2027 outlier fixed-loss threshold at $51,704, which would target outlier payments at approximately 5.14% of total operating DRG payments and capital payments, after incorporating an estimate of outlier reconciliation. In its impact analysis, CMS estimates that overall IPPS payments would increase by 1.2% relative to FY 2026, reflecting the combined effects of the proposed update, outlier policies, uncompensated care payments, and wage index changes.

MEDICARE-DEPENDENT HOSPITALS (MDHS) AND LOW-VOLUME HOSPITALS

The MDH program provides enhanced payments to small rural hospitals (≤100 beds, not Sole Community Hospitals) where at least 60% of inpatient days or discharges are attributable to Medicare patients, using a blended rate that includes 75% of the federal rate plus 25% of the hospital-specific rate based on historical costs. The low-volume hospital adjustment offers percentage add-ons to IPPS payments for rural hospitals with low annual discharges to offset higher per-case costs, currently on a sliding scale up to 25% for facilities with fewer than 3,800 discharges and more than 15 road miles from another subsection (d) hospital.

In the FY 2027 proposed rule, CMS does not propose substantive policy changes to either the MDH program or the low-volume hospital adjustment. Rather, the agency proposes conforming regulatory changes to reflect current law, under which both policies have been extended through December 31, 2026. As a result, absent further congressional action, the MDH program would expire, and the temporary low-volume hospital policy would revert to permanent law beginning January 1, 2027.

Accordingly, the central issue is less the substance of CMS’s proposal than the current appropriations and extender status of these programs. Congress first provided a short-term extension in the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026, and subsequently extended both policies through December 31, 2026, in the Consolidated Appropriations Act, 2026. CMS states that it will revise the regulatory language in the final rule if Congress again extends the programs before the rule is finalized. In practical terms, unless lawmakers enact another extender later this year, both policies will lapse beginning January 1, 2027.

CMS estimates that, if Congress were to extend the MDH and low-volume hospital policies through the end of FY 2027, affected hospitals would receive approximately $0.4 billion in additional payments. Conversely, under current law, CMS estimates that expiration of the MDH status would reduce payments by approximately $110 million for roughly 80 affected hospitals, while expiration of the temporary low-volume policy would reduce aggregate payments by approximately $258 million in FY 2027, with approximately 589 hospitals expected to lose qualification under the stricter post-January 1 criteria.

DISCONTINUATION OF THE LOW-WAGE INDEX HOSPITAL POLICY

The low-wage index hospital policy was established in the FY2020 IPPS final rule as a temporary, budget-neutral initiative to address wage index disparities, benefiting rural hospitals by raising their wage indices to mitigate the impacts of lower payments. This policy adjusted the wage index for hospitals in the bottom quartile, setting a floor at the 25th percentile value, which was offset by a corresponding reduction for higher-wage hospitals. However, in July 2024, the U.S. Court of Appeals for the D.C. Circuit in Bridgeport Hosp. v. Becerra ruled that CMS lacked the statutory authority under sections 1886(d)(3)(E) or 1886(d)(5)(I) of the Social Security Act (SSA) to implement this policy, vacating both the policy and its budget neutrality adjustment.

In the FY 2026 final rule, CMS formally discontinued the low-wage index hospital policy and its associated budget-neutrality adjustment for FY 2026 and subsequent fiscal years. At the same time, CMS finalized a narrow, budget-neutral transitional payment exception for FY 2026 for certain hospitals experiencing significant decreases in their wage index resulting from the policy’s discontinuation. Under that transition, eligible hospitals could receive additional FY 2026 payments if their wage index otherwise would have fallen by more than 9.75% from their FY 2024 wage index, with payments calculated as if the hospital’s FY 2026 wage index were equal to 90.25% of its FY 2024 wage index.

For FY 2027, CMS does not propose to reinstate the low-wage index hospital policy. Instead, it proposes continuing the same transition approach for hospitals that are still significantly affected by the policy’s discontinuation. Specifically, CMS proposes a narrow transitional payment exception for hospitals whose FY 2027 wage index would be more than 14.2625% below their FY 2024 wage index, with those hospitals receiving FY 2027 payments as if their wage index were equal to 85.7375% of their FY 2024 wage index. CMS proposes implementing this transition in a budget-neutral manner after applying the 5% cap on wage index decreases.

HOSPITAL INPATIENT QUALITY REPORTING (IQR) PROGRAM

In the FY 2027 proposed rule, CMS proposes a fairly broad set of updates to the Hospital IQR Program. Most notably, CMS would adopt three new measures: the Excess Days in Acute Care After Hospitalization for Diabetes measure beginning with the FY 2029 payment determination, and the Hospital Harm–Postoperative Venous Thromboembolism eCQM and Advance Care Planning eCQM beginning with the FY 2030 payment determination. CMS also proposes to adopt modified versions of five mortality measures beginning with the FY 2028 payment determination – acute myocardial infarction, heart failure, pneumonia, COPD, and CABG mortality – by adding Medicare Advantage patients and shortening the applicable performance period from three years to two years. In addition, CMS proposes similar modifications to three Excess Days in Acute Care measures (for AMI, heart failure, and pneumonia), also beginning with the FY 2028 payment determination.

CMS also proposes to remove three eCQMs beginning with the FY 2030 payment determination: VTE-1, VTE-2, and STK-02. On reporting requirements, CMS proposes to make reporting of the Malnutrition Care Score eCQM mandatory beginning with the FY 2030 payment determination and to establish a policy under which Hospital Harm eCQMs would become mandatory after two years of self-selected reporting. CMS also proposes to update the Maternal Morbidity Structural Measure, beginning with the FY 2028 payment determination, so that hospitals identify which perinatal quality collaborative program they participate in. The proposed rule explains that these reporting changes are intended to continue CMS’s move toward a more digital measure set and to standardize hospital quality reporting in several areas.

MEDICARE PROMOTING INTEROPERABILITY PROGRAM

In the FY 2027 proposed rule, CMS proposes a series of changes to the Medicare Promoting Interoperability Program, largely focused on streamlining the program’s certification and attestation requirements and shifting hospitals toward newer interoperability functions.

• Most notably, CMS would update the definition of certified electronic health record technology (CEHRT) to align with changes proposed by Office of the National Coordinator for Health Information Technology (ONC), including removing references to several certification criteria from the program’s CEHRT definition.

• CMS also proposes to remove the ONC Direct Review and ONC-Authorized Certification Body surveillance attestations beginning with the CY 2026 EHR reporting period, which the agency describes as a burden-reduction step.

• In addition, CMS proposes to remove the Support Electronic Referral Loops by Sending Health Information and Support Electronic Referral Loops by Receiving and Reconciling Health Information measures beginning with the CY 2028 EHR reporting period, on the view that newer network-based exchange measures better reflect meaningful health information exchange

CMS also proposes several more targeted policy updates.

• The agency would modify the Electronic Prior Authorization measure, including revising the measure language to require that prior authorization be requested electronically using CEHRT and changing the reference from “discharge” to “encounter.”

• CMS further proposes to make that measure optional and worth 10 bonus points for CY 2027, before requiring hospitals to attest “Yes” beginning with the CY 2028 EHR reporting period. CMS indicates the measure would remain unscored in CY 2028 and subsequent years for purposes of point allocation.

• Separately, CMS proposes to add a new Unique Device Identifiers for Implantable Medical Devices measure under the Public Health and Clinical Data Exchange objective beginning with the CY 2027 EHR reporting period.

• Finally, in alignment with the Hospital IQR Program, CMS proposes to adopt two new eCQMs (the Hospital Harm-Postoperative Venous Thromboembolism eCQM and the Advance Care Planning eCQM) beginning with the FY 2030 payment determination, and to remove three eCQMs (VTE-1, VTE-2, and STK-02), also beginning with the FY 2030 payment determination.

HOSPITAL READMISSIONS REDUCTION PROGRAM

In the FY 2027 proposed rule, CMS proposes one substantive change to the Hospital Readmissions Reduction Program (HRRP): adoption of the Hospital 30-Day, All-Cause, Risk-Standardized Readmission Rate Following Sepsis Hospitalization measure. CMS would provide hospitals with an early look at performance for the FY 2028 program year and then begin using the measure for payment adjustment purposes in FY 2029. CMS states that it proposes moving the measure directly into HRRP, rather than phasing it in first through a reporting-only program, because sepsis readmissions are associated with significant morbidity. Under the proposal, the FY 2028 early look would be based on an applicable period of July 1, 2024, through June 30, 2026. The measure would first be used for FY 2029 payment adjustments.

HOSPITAL VALUE-BASED PURCHASING (VBP) PROGRAM

In the FY 2027 proposed rule, CMS does not propose changes to the current Hospital Value-Based Purchasing (VBP) measure set for the FY 2027 program year. CMS instead proposes substantive updates to five existing mortality measures in the Clinical Outcomes domain, beginning with the FY 2032 program year: the Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Acute Myocardial Infarction (AMI) Hospitalization, Heart Failure Hospitalization, Pneumonia Hospitalization, Chronic Obstructive Pulmonary Disease (COPD) Hospitalization, and Coronary Artery Bypass Graft (CABG) Surgery measures.

For these five measures, CMS proposes adding MA beneficiaries to the measure population and shortening the performance period from three years to two years. The proposed rule also includes a related technical update to the risk adjustment methodology for these measures, replacing the current use of hierarchical condition categories with individual ICD-10 codes. CMS states that these VBP changes would be contingent on first adopting the same refined measures in the Hospital Inpatient Quality Reporting (IQR) Program, consistent with the statutory requirement that measures be publicly reported before being used in the VBP Program.

REQUESTS FOR INFORMATION (RFIS)

CMS includes several RFIs aimed at shaping potential future quality program and model design decisions.

• Measuring Emergency Care Access and Timeliness in the Hospital Inpatient Quality Reporting and Hospital Value-Based Purchasing Programs: CMS seeks feedback on whether and how the Emergency Care Access & Timeliness eCQM could be used in the inpatient quality programs, including barriers to improving bed availability and ED boarding, whether the outpatient-developed measure specifications fit the inpatient setting, and whether any numerator, denominator, exclusion, or accountability changes would be needed before future adoption.

• Potential Future Use of the Adult Community-Onset Sepsis Standardized Mortality Ratio Measure in the Hospital Inpatient Quality Reporting Program: CMS seeks comment on the possible future use of this sepsis mortality measure in IQR, including operational feasibility, workflow and data challenges, how claims and EHR/FHIR data would be reconciled, and what implementation issues hospitals (particularly rural hospitals) might face.

• Birthing-Friendly Hospital Designation Modification to Expand Designation Criteria: CMS seeks feedback on expanding the Birthing-Friendly Hospital designation to incorporate the Cesarean Birth eCQM and Severe Obstetric Complications eCQM, as well as on a revised scoring methodology, peer grouping, tiered designation icons, and how the designation should be displayed for consumers.

• Ambulatory Surgical Center (ASC) Episode Request for Information: In the TEAM section, CMS seeks comment on whether and how ASCs could be incorporated into the model in future years, including questions about model structure, participant roles, financial accountability, episode design, target pricing, quality measurement, and whether adding ASCs would require a separate model test.

• Hospital with Physician Ownership Request for Information: Also in the TEAM section, CMS seeks feedback on whether physician-owned hospitals should be allowed to opt into TEAM voluntarily in future years, and, if so, what eligibility criteria, guardrails, and participation requirements should apply to protect model integrity and Medicare savings.