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Summary of Hearings on Pharmaceutical Supply Chain Security and Biomedical Innovation

On July 15, 2026, the House Select Committee on China, the House Energy and Commerce Health Subcommittee, and the Senate Aging Committee held hearings on the Federal Research Security Enterprise, the role of the Food and Drug Administration (FDA) in biomedical innovation, and foreign control of America’s drug supply. The hearings provided useful context on how members of these committees view the issues surrounding drug development and the threats posed by overreliance on foreign countries for the nation’s pharmaceutical supply chain.

HOUSE SELECT COMMITTEE ON CHINA HEARING ON THE FEDERAL RESEARCH SECURITY ENTERPRISE

Opening Statements

Witness Testimony

Member Discussion

Throughout the hearing, members from both parties expressed concerns that the Chinese Communist Party is exploiting American taxpayer-funded research by leveraging universities, labs, and researchers to accelerate their own developments. Questions centered around research security protocols and the impact of funding and workforce cuts.

Research Security Protocols

Republicans focused on how the Department of Energy (DOE), National Institutes of Health (NIH), and National Science Foundation (NSF) utilize the Restricted Entity List to protect American advancements from foreign entities. Chairman John Moolenar (R-MI-2) opened by asking the witnesses about the current policies at their respective agencies for ensuring federal funding does not fund research involving entities on the list. Dr. Keiser described NSF’s Dear Colleague Letter from July 8 notifying the research community of a forthcoming policy to prohibit entities from using NSF funds to collaborate with entities on the restricted parties lists. However, Dr. Keiser said they are waiting on the comment period to finalize before moving forward. Dr. Valdez and Mr. Ison explained that NIH and DOE do not have their own policy, but they are actively reviewing NSF’s and have a series of risk mitigations in place. Rep. Darin LaHood (R-IL-16) and Rep. Ashley Hinson (R-IA-2) asked Mr. Ison to go into more detail about the current DOE guidance in place. He explained that they use physical and cyber security, counterintelligence, and a layered approach to assess conflict of interest and prior commitments. Mr. Ison further stated that they have an escalation clause to bring any findings to the correct federal office should they find high-risk influence.

Funding and Workforce

Democrats largely used their time to highlight funding and workforce cuts at NSF, DOE, and NIH. Ranking Member Ro Khanna (D-CA-17) and Rep. Tom Suozzi (D-NY-3) asked whether the witnesses were concerned about workforce and funding cuts affecting their agencies. Dr. Keiser explained that NSF has had 5 employees choose to leave since 2024, and they are currently working on rebuilding and ensuring all the research community takes responsibility for safe research practices. Dr. Valdez stated that NIH security team has not experienced any cuts, but she understands there have been cuts elsewhere. Mr. Ison explained DOE is executing the President’s budget and is adequately addressing security concerns.

HOUSE ENERGY AND COMMERCE HEALTH SUBCOMMITTEE HEARING ON FDA’S ROLE IN BIOMEDICAL INNOVATION

Opening Statements

Witness Testimony

Member Discussion

There was bipartisan support for increasing patient access to clinical trials as well as concerns about the impacts of drug research and development overseas. There was also bipartisan concern raised about uncertainty at the FDA and how it may be hurting pharmaceutical innovation.

Risks of Reduced US Innovation

There were bipartisan concerns raised about the impacts of drug research and development moving overseas, specifically to China. Full Committee Chairman Brett Guthrie (R-KY-2) asked what was risky about the US failing to remain competitive in clinical trials. Dr. Verst highlighted that while clinical trials are needed, the US also needs to encourage translational science and collaboration with biotech companies to ensure research and development remains domestic. Full Committee Ranking Member Frank Pallone (D-NJ-6) asked how important it was for the US to support biomedical innovation. Dr. Hwang highlighted that almost every new drug application includes research supported by the NIH and that increased Chinese investment will shift clinical trials overseas. Rep. Buddy Carter (R-GA-1) wanted to know which policies can ensure the US holds on to its competitive edge. Dr. Verst highlighted Operation TrialBlazer, a plan from the Department of Health and Human Services (HHS) to maintain U.S. leadership in early clinical research and development, and the importance of ensuring cooperative work across federal agencies.

Health Subcommittee Vice Chair Diana Harshbarger (R-TN-1) and Rep. Kim Schrier (D-WA-8) were especially worried about the effects of foreign-generated clinical data on drug safety and development. Dr. Hwang noted that foreign governments often have different data standards and that the FDA should be empowered to inspect foreign clinical sites to ensure US data standards are upheld. Ms. Winckler highlighted that when data is collected domestically, local researchers have a much better understanding of the product and better control of data procedures. Mr. Bollyky shared that foreign data needs to be scrutinized and held to high standards.

Clinical Trials

There was bipartisan support for increasing patient access to clinical trials, especially for those from rural areas and underrepresented populations. Subcommittee Chairman Morgan Griffith (R-VA-9) asked how to get more rural care sites involved in clinical trials. Ms. Winckler emphasized the positive impacts of hub-and-spoke models in allowing rural providers to engage their patients in clinical trials without many of the administrative burdens that follow trial design, as well as the potential positive impacts of remote patient monitoring technologies.

Reps. Raul Ruiz (D-CA-25) and Robin Kelly (D-IL-2) wanted to highlight the importance of diverse patient populations in clinical trials and how to best ensure minority communities are represented. Ms. Winckler shared that often the challenge is that community providers are not aware of what clinical trials their patients are eligible to participate in. Dr. Verst emphasized that diversity in clinical trials is critical for good science and results in increased success for drugs and that community physicians need increased support for improving the process of referring their patients to potential clinical trial investigators. Dr. Kowalski highlighted that Breakthrough T1D mandates representative trials with clear methods to ensure representation as part of its grant-agreement process. Rep. Kat Cammack (R-Fl-3) questioned how to improve the underrepresentation of women in clinical trials. Ms. Winckler suggested that clinical trial designs should be clear about how sponsors plan to address potential sex-based differences in their participant mix. Rep. Troy Balderson (D-LA-2) asked the panel what actions they would like to see Congress take to improve enrolling patients in clinical trials. Dr. Verst emphasized that guidance on patients’ access and standard of care for clinical trials, as well as the need for simple trial designs, are the most critical steps that Congress could take.

Federal Rulemaking

Multiple Democratic members took the opportunity to express concerns about the potential impacts of a rule proposed by the Office of Management and Budget (OMB) that expands agencies’ authority to suspend or terminate discretionary grant awards if it is determined that the grant no longer aligns with agency priorities or national interest. Subcommittee Ranking Member Diana DeGette (D-CO-1), as well as Reps. Lori Trahan (D-MA-3) and Troy Carter (D-LA-2) all asked witnesses to explain how this proposed rule could affect the grantmaking and peer review process. Dr. Kowalski highlighted that merit-based peer review is imperative for science and drives clinical benefits. Dr. Hwang shared that the proposed rule could potentially disrupt current clinical trials and could make it much harder for international collaboration and argued the proposed rule should be withdrawn.

FDA Uncertainty and the Impact on Drug Development

Members highlighted the ongoing uncertainty at the FDA. Rep. Debbie Dingell (D-MI-6) asked Dr. Kowalski if companies shared concerns about getting new therapies approved by the FDA. Dr. Kowalski shared that he is aware of multiple companies making contingency plans to get therapies approved in other countries if they cannot reach agreements with FDA regulators.

Reps. Tom Kean (R-NJ-7), Jake Auchincloss (D-MA-4), and Kevin Mullin (D-CA-15) asked for witness input on how to improve the FDA and modernize FDA processes. Ms. Winckler said we should encourage use of and conversations with patients about clinical trial endpoints as well as clarifications from the FDA on how to operationalize hub and spoke models. Ms. Winckler also emphasized the need for consistent messaging across the FDA, Congress, and stakeholders about what is expected during the drug development process. Dr. Verst shared that biotech companies are looking for greater certainty, clarity, and guidance on FDA processes.

Other Topics
  • Rep. John Joyce (R-PA-13) discussed H.R. 9000, the SCREEN for Type 1 Diabetes Act, which would help ensure patients are properly screened for Type 1 diabetes. Dr. Kowalski voiced his support for the bill.
  • Rep. Nick Langworthy (R-NY-23) asked about opportunities to reduce the use of animal models and encourage the adoption of new approach methodologies (NAMs). Dr. Verst shared that NAMs can speed drug development and that the FDA should provide guidance on their use.

SENATE AGING COMMITTEE HEARING ON FOREIGN CONTROL OF AMERICA’S DRUG SUPPLY CHAIN

Opening Statements

Witness Testimony

Member Discussion

Throughout the hearing, members from both parties expressed alarm that foreign ownership and investment, particularly from China, have created hidden vulnerabilities across the pharmaceutical and biotechnology supply chain, extending beyond visible drug ingredients to clinical trial data, corporate ownership structures, and biomanufacturing capacity. Committee Chairman Rick Scott (R-FL) and Committee Ranking Member Kirsten Gillibrand (D-NY) both emphasized that current law is not sufficient to identify these risks, and members discussed the newly introduced Pharmaceutical Investment Oversight and Accountability Act as a first step toward addressing the gap.

Foreign Investment and CFIUS Oversight Gaps

Chairman Scott, Ranking Member Gillibrand, and Sen. Elizabeth Warren (D-MA) announced the Pharmaceutical Investment Oversight and Accountability Act, which would require the Federal Trade Commission (FTC) and the Committee on Foreign Investment in the United States (CFIUS) to report annually to Congress on foreign investment in pharmaceutical manufacturing and related technologies. Ms. Nikakhtar testified that CFIUS jurisdiction does not extend to most greenfield investments and joint ventures, board seats obtained without an equity stake, or licensing and data-access deals that involve no investment, and that many qualifying transactions are simply never filed for review. She recommended a presumption of denial for Chinese biotech transactions that do fall under CFIUS jurisdiction and urged Congress to pass legislation to close the greenfield and joint-venture gap. Senator Warren pressed Ms. Nikakhtar on why biotech acquisitions continue to escape review despite 2018 reforms expanding CFIUS’s scope; Ms. Nikakhtar attributed the gap to voluntary filing, executive branch self-limiting of its own authority, and China’s use of legal counsel to structure deals around CFIUS jurisdiction.

Supply Chain Dependency and Weaponization Risk

Chairman Scott and Mr. Ezell highlighted that China controls 94% of the key starting materials (KSMs) for amoxicillin, 74% of heparin, and effectively all of the KSMs for common blood pressure medications, and that nearly 700 medicines approved for use in the United States depend on at least one upstream input produced solely in China. Dr. Doshi warned that “Made in America” labeling can mask upstream dependency on Chinese-sourced KSMs and active pharmaceutical ingredients (APIs). Mr. Ezell, Ms. Nikakhtar, and Mr. You each warned that China is positioning these chokepoints as leverage over the United States, comparable to its dominance in rare earths and critical minerals, and could restrict supply at a time of its choosing.

Biotech Innovation and Clinical Trial Data

Mr. You testified that clinical trial data generated by American patients in FDA-authorized trials can legally flow to Chinese-linked companies with no federal agency able to stop it, citing FDA-cleared Chinese CAR-T cell therapy startups whose U.S. trial data feeds back into Chinese drug development while U.S. companies license and Medicare reimburses the resulting products. Dr. Doshi added that China’s looser regulatory requirements for first-in-human trials let American pharmaceutical companies obtain de-risked clinical data faster from Chinese assets than from domestic ones, a dynamic that has driven $53 billion in U.S. licensing deals with Chinese biotech over the past five years that now account for one-third of new drug pipelines. Mr. Ezell and Mr. You both flagged Chinese “brand obfuscation,” citing BGI’s Complete Genomics and WuXi AppTec as companies with undisclosed ties to the Chinese Communist Party (CCP) and the People’s Liberation Army (PLA) that operate within the U.S. pharmaceutical supply chain.

Legislative and Policy Responses

Senator Warren discussed her broader Pharmaceutical Supply Chain Defense and Enhancement Act, which would pair the Pharmaceutical Investment Oversight and Accountability Act’s investment transparency requirements with greater use of federal procurement power to build sustained domestic demand for allied-sourced medicines. Witnesses recommended complementary measures, including passage of the Biotech Investment National Security Act (BINSA), expanded export controls on biological materials and data, “clear labels” legislation to expose upstream KSM and API dependencies, tariff and reimbursement incentives favoring allied inputs, and a Manufacturing USA institute for critical minerals and APIs. Several witnesses urged deeper coordination with allies, including South Korea, Mexico, and India, to diversify away from Chinese-controlled inputs.

Other Topics
  • Senator Warren asked how two recent Chinese decrees, 834 and 835, could affect U.S. regulators’ ability to inspect Chinese API facilities. Mr. Ezell warned the decrees create legal risk for any U.S. company operating in China and urged Congress to insist on continued inspection access and to properly resource the FDA’s foreign inspection program.
  • Senator Warren also asked which federal agency should be accountable for mapping foreign ownership across the drug supply chain. Dr. Doshi called for a White House-level coordinating body to combine FDA, Commerce, and Customs data, while Ms. Nikakhtar argued that any new designation authority should be structured, like CFIUS determinations, to be non-litigable.
  • Senator Jon Husted (R-OH) asked what the offshoring of pharmaceutical manufacturing has cost the United States in engineering and manufacturing talent, drawing a parallel to the semiconductor industry. Mr. Ezell and Ms. Nikakhtar agreed that the U.S. lost significant manufacturing talent and investor expertise in other sectors, but noted that biotech talent can still be rebuilt if reinvestment continues.
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Calendar Year 2027 Medicare Physician Fee Schedule Proposed Rule

On July 14, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS) Proposed Rule. The CMS press release can be found here. A fact sheet from CMS is available here. A separate fact sheet on the Medicare Shared Savings Program (MSSP) proposals can be found here. The 60-day comment period under the Administrative Procedure Act (APA) for the CY27 PFS proposed rule ends on September 14, 2026.

CONVERSION FACTOR

As part of the rule, CMS proposes a CY27 conversion factor (CF) of $33.17 for Alternative Payment Model (APM) participants, known as Qualifying Participants (QPs), a -1.19% decrease ($0.40) from the CY26 QP CF of $33.57. For non-qualifying participants (non-QPs), the aggregate proposed CF is $32.84, reflecting a -1.68% decrease ($0.56) from the CY26 non-QP CF of $33.40. A summary of the components of those aggregate payment updates is below.

  • Under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, the statutory update for CY27 is 0.75% for QPs and 0.25% for non-QPs. These are the same bifurcated statutory updates that first took effect in CY26 and that are intended to incentivize clinician participation in Advanced APMs.
  • The one-year 2.50% CF increase provided by the One Big Beautiful Bill Act (OBBBA), which CMS refers to in the rule as the Working Families Tax Cut (WFTC) legislation, applies only to CY26 and expires at the end of this year. The expiration of that adjustment functionally imposes a 2.50% payment reduction under the PFS relative to CY26, absent further congressional action.
  • The proposed CFs also include an estimated positive 0.53% adjustment to account for proposed changes in the work relative value units (RVUs) for certain services. The combination of the statutory updates, the expiration of the WFTC increase, and the work RVU adjustment produces the net negative CF updates described above.

E/M VISITS FURNISHED DURING GLOBAL SURGICAL PERIODS

CMS proposes reducing payment when a separately identifiable office/outpatient evaluation and management (E/M) visit is furnished by the same physician (or a physician in the same group practice) on the same day as a procedure with a 0-, 10-, or 90-day global period. Under the proposal, the most expensive service (whether the surgical procedure or the E/M visit) would be paid at 100% of its rate, and all other surgical procedures or E/M visits furnished that day would be paid at 50%. CMS advanced a similar proposal in the CY19 PFS proposed rule but did not finalize it at that time. In the CY27 rule, the agency reiterates its view that efficiencies exist when the same physician or group furnishes an E/M service in conjunction with a global procedure and that the current methodology therefore duplicates payment.

E/M VISIT COMPLEXITY ADD-ON (G2211)

In the CY21 PFS final rule, CMS finalized separate payment for the office/outpatient E/M visit complexity add-on code, HCPCS code G2211. Implementation was delayed by statute and took effect for CY25. For CY27, CMS proposes two changes to this policy.

  • CMS proposes converting G2211 from a stand-alone add-on code into a modifier (placeholder modifier MOD1) appended to the associated E/M base code. The modifier would increase payment for the associated E/M code by 16% rather than providing a flat dollar amount, maintaining an equal percentage increase across all E/M levels.
  • CMS also proposes a second modifier (placeholder modifier MOD2) available only to practitioners participating in a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) or serving as Participant Providers in a Long-term Enhanced ACO Design (LEAD) Model ACO. The MOD2 modifier would increase payment for the associated E/M visit by 32% to recognize the additional costs of longitudinal care, including total cost of care accountability and aligned quality reporting. Use of MOD2 would be voluntary and billable for all beneficiaries served by the practitioner, not only ACO-assigned or ACO-aligned beneficiaries. Claims submitted with MOD2 would be included in MSSP beneficiary assignment calculations, historical benchmark expenditures, and performance year expenditures.

PRACTICE EXPENSE

CMS describes a multi-year effort to transition the practice expense (PE) methodology away from reliance on American Medical Association (AMA) survey data and toward more objective, routinely updated, and auditable cost data. The agency states that the surveys underlying current PE values suffer from low response rates and significant discrepancies with alternative empirical data sources. The CY27 rule contains several proposals in furtherance of that transition.

  • CMS proposes phasing out the portion of the PE methodology that anchors aggregate specialty-level PE RVUs to practice expense per hour (PE/HR) survey data from 2007 or earlier, known as the indirect practice cost index (IPCI). The phase-out would occur over a two-year transition, with half of the measured IPCI variation applied in the first year and none in the second year.

  • In place of the stabilizing effect of the old survey data, CMS proposes a new PE stabilization adjustment that would cap year-over-year increases or decreases in a code’s PE RVU at 5%. The cap would not apply to new, revised, or revalued codes, and it would be applied prior to the separate statutory phase-in that limits total RVU reductions to 19% per year.

  • CMS proposes allocating indirect PE using both work RVUs and clinical labor RVUs for all services, except codes with 010- and 090-day global periods. Under current policy, that combined allocation approach applies only to services billable with professional and technical components.

  • CMS proposes equalizing the facility and non-facility PE RVUs for nursing facility E/M visits (CPT codes 99304 through 99310, 99315, and 99316). This change addresses an unintended consequence of the site of service payment differential finalized in the CY26 final rule, under which payment for these visits varied based solely on whether the beneficiary was in a Part A skilled nursing facility stay.

  • CMS is seeking comment on the broader facility versus non-facility site of service differential, including how indirect costs vary for physicians employed by hospitals, health systems, or other entities. The agency specifically asks whether the current 50% indirect PE allocation for facility-based services is accurate for hospital-employed physicians or whether a lower allocation (potentially 0%) would be appropriate, and whether a new HCPCS modifier should be created to identify employed physicians.

REMOTE MONITORING

CMS proposes several changes to payment for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services. The agency proposes requiring that RTM services be furnished only to established patients, requiring practitioners to furnish a separately reportable initiating visit in association with the onset of RPM or RTM services, and allowing payment only when the services are performed by clinical staff employed by the practice rather than by contractors. CMS also proposes updating the valuation of these services to reflect its understanding that monitoring devices may now be available at lower cost than initially estimated. Finally, CMS is seeking comment on bundling the RPM and RTM CPT codes into four new HCPCS G-codes, an approach the agency states would address recommendations from recent HHS Office of Inspector General (OIG) reports.

GLOBAL SURGERY DATA COLLECTION

CMS proposes pausing the global surgery data collection required by section 523 of MACRA. The agency states that several years of collected data show that post-operative visits assumed within 10- and 90- day global surgical packages are frequently not occurring, even though providers continue to be paid for those visits under the current bundled payment policy. CMS also states that the current data collection requirements may impose undue burden on practitioners. CMS is posting a public-use file that displays imputed RVUs for 10- and 90-day post-operative visits using an arithmetic approach. The agency is soliciting comments on expanded data collection, alternative data sources, and revaluation strategies for global surgical services in future rulemaking.

LIMITS ON MEDICARE ELIGIBILITY FOR CERTAIN INDIVIDUALS

CMS proposes regulations implementing section 71201 of the WFTC legislation (OBBBA), which amended the Social Security Act to limit Medicare eligibility to four groups. Those groups are U.S. citizens or nationals, lawful permanent residents, individuals granted Cuban and Haitian entrant status, and individuals lawfully residing in the U.S. under a Compact of Free Association. The proposed regulations would incorporate the newly specified eligibility groups, establish procedures for terminating coverage for individuals found ineligible, provide applicable appeal rights, and set out enrollment options for individuals who later gain or regain eligibility.

MEDICARE PRESCRIPTION DRUG INFLATION REBATE PROGRAM

The rule proposes updates to the Part B and Part D drug inflation rebate programs established under the Inflation Reduction Act of 2022 (IRA). Among other items, CMS proposes clarifying which Consumer Price Index for All Urban Consumers (CPI-U) data are used to determine benchmark values for subsequently approved drugs when CPI-U data for the relevant month are unavailable, clarifying the definition of “first marketed date,” and clarifying that certain skin substitutes would not be excluded from the definition of a Part B rebatable drug. Separately, CMS proposes requiring providers and suppliers that are 340B covered entities to submit specified claim-level data elements to the Medicare Part D Claims Data 340B Repository for covered Part D drugs dispensed with a 340B discount, beginning with claims with dates of service on or after January 1, 2027.

CLINICAL LABORATORY FEE SCHEDULE (CLFS)

CMS proposes conforming regulatory changes to implement CAA, 2026 amendments to the CLFS. The changes would update the data collection and reporting requirements for clinical diagnostic laboratory tests (CDLTs) as well as the phase-in of payment reductions based on private payor rate data. The next data reporting period for CDLTs that are not advanced diagnostic laboratory tests runs from May 1, 2026, through July 31, 2026, based on applicable information collected from January 1, 2025, through June 30, 2025. Beginning in CY27, payment reductions resulting from the private payor rate data would be subject to a phase-in cap of up to 15% per year through CY29.

AMBULATORY SPECIALTY MODEL (ASM)

The CY26 PFS final rule established the ASM, a mandatory alternative payment model administered through the CMS Innovation Center that focuses on specialists treating Medicare beneficiaries with heart failure and low back pain. The model runs from 2027 through 2031, with the first performance year beginning January 1, 2027, and payment adjustments applied two years after each performance year. Participating specialists are assessed individually (at the Taxpayer Identification Number/National Provider Identifier (TIN/NPI) level) across four performance categories, which are quality, cost, improvement activities, and Promoting Interoperability. Performance relative to peers treating the same condition determines two-sided adjustments to Medicare Part B payments ranging from -9% to +9% in the first two payment years (2029 and 2030) and gradually increasing to 12% by the final payment year (2033).

In the CY27 rule, CMS proposes a series of technical refinements to the model that would take effect at its start. Key proposals include adding an administrative claims-based imaging quality measure for low back pain, replacing the low back pain patient-reported outcome measure with a functional status outcome process measure, adjusting quality measure benchmarking and scoring policies, adding a quality scoring incentive for voluntary submission of patient-reported outcome data, incorporating a rural scoring adjustment, and aligning the model’s Promoting Interoperability requirements with proposed MIPS changes. CMS also proposes participant-level flexibilities, including exceptions for participants affected by TIN changes or specialty redesignations, an option to terminate participants under certain circumstances, an option to submit improvement activities data at the individual or group level, and revisions to collaborative care arrangement requirements.

QUALITY PAYMENT PROGRAM (QPP)

The proposed rule includes significant changes to the QPP. Most notably, CMS proposes sunsetting traditional Merit-based Incentive Payment System (MIPS) reporting beginning with the CY29 performance period (2031 payment year). At that point, MIPS Value Pathways (MVPs) would become the only MIPS reporting option for clinicians not reporting through the APM Performance Pathway. Additional QPP proposals include:

  • Adding three new MVPs focused on diabetic disease, hypertension, and hospitalist care, which would bring the MVP inventory to 30 pathways.
  • Establishing a CY27 quality measure inventory of 180 measures, reflecting 20 measure removals, 10 measure additions, and 43 substantive changes. CMS also proposes creating a new “MIPS core measure” designation and requiring clinicians to report at least one core measure in place of the current outcome or high priority measure requirement, with an exemption for small practices.
  • Updating the improvement activities inventory by adding six new activities (including a new Advancing Health and Wellness subcategory aligned with the Make America Healthy Again initiative), modifying five activities, and removing eleven activities.
  • Revising the Promoting Interoperability category, including removing the Security Risk Analysis measure and restructuring the Electronic Prior Authorization measure so that it is optional (and worth bonus points) for CY27 before becoming required in CY28 alongside a new required Electronic Prior Authorization for Prescription Drugs measure.
  • Applying Qualifying Participant (QP) status at the TIN/NPI level under which the clinician achieves that status and modifying the QP thresholds in accordance with the CAA, 2026.

MEDICARE SHARED SAVINGS PROGRAM (MSSP)

The CY27 PFS proposed rule includes numerous updates to the MSSP, including:

  • Rebalancing financial incentives across risk tracks, including raising the shared savings rate for Level E of the BASIC track from 50% to 60%, lowering the maximum weight of the positive regional benchmark adjustment for ENHANCED track ACOs from 50% to 35%, raising the prior savings adjustment scaling factor from 50% to 75%, risk adjusting the 5% cap on upward benchmark adjustments, and adding a new growth adjustment that rewards ACOs for bringing clinicians and beneficiaries new to value-based care into the program.
  • Adding a guardrail to the Accountable Care Prospective Trend (ACPT) component of the benchmark update factor so the ACPT is no more than 1 percentage point below (or 1.5 percentage points above) observed national expenditure growth. The lower guardrail would apply retroactively to ACOs with 2024 through 2026 start dates, and CMS is delaying performance year 2025 financial reconciliation until November 2026 to implement the change if finalized.
  • Allowing ACOs, upon CMS approval of an implementation plan, to reduce or eliminate Part B cost sharing for beneficiaries beginning April 1, 2027 (excluding durable medical equipment, prosthetics, orthotics, supplies, and prescription drugs), while removing the prepaid shared savings payment option due to low uptake.
  • Modifying the beneficiary assignment methodology for performance year 2028 and beyond, including excluding primary care charges billed through non-ACO taxpayer identification numbers from assignment calculations.
  • Streamlining quality and certified electronic health record technology (CEHRT) requirements, including extending the MIPS Clinical Quality Measures collection type and its reporting incentive, creating a new Medicare electronic Clinical Quality Measure (eCQM) collection type, reducing the APP Plus quality measure set to eight measures, and replacing the current Promoting Interoperability reporting requirement with a simplified three-option CEHRT use attestation.

REQUESTS FOR INFORMATION (RFIS) AND COMMENT SOLICITATIONS

As part of the proposed rule, CMS issued several RFIs and comment solicitations, seeking stakeholder feedback on issues including:

  • How CMS might redesign primary care valuation to support a shift toward preventive medicine, covering three topics, which are reconsidering relative primary care payment under the PFS, understanding the payment implications of incorporating technology into primary care, and establishing prospective primary care payment within the MSSP and potentially Original Medicare more broadly.
  • How to address duplicate laboratory testing and imaging resulting from siloed diagnostic results, including potential actions to improve result sharing and interoperability across care settings.
  • Whether and how the facility versus non-facility site of service differential should be refined, including the appropriate indirect PE allocation for hospital-employed physicians.
  • How to improve data collection and valuation accuracy for global surgical packages, including potential revaluation strategies for future rulemaking.
  • Whether the RPM and RTM code families should be restructured into bundled HCPCS G-codes.
  • The anticipated timeline, milestones, and implementation considerations for transitioning to FHIR-based digital quality reporting across the QPP and other CMS quality programs.
  • The influence of the American Medical Association’s (AMA) CPT coding system and RUC valuation process on physician payment policy, including questions about the AMA’s licensing monopoly, conflicts of interest in service valuation, and potential alternatives for data collection and payment recommendations.
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Summary of Health Care Price Transparency and Medicare Advantage Legislation in House Energy and Commerce Health Subcommittee Markup

On June 25, 2026, the House Energy and Commerce Health Subcommittee held a markup to consider 15 bills to increase price transparency across the health care sector, including hospitals and insurers, to address concerns about prior authorization and other practices by Medicare Advantage plans, and to deal with the public health threat posed by illicit drugs. This memo covers the legislation related to price transparency and Medicare Advantage. All bills were advanced to the full committee on voice votes. Full Committee Ranking Member Frank Pallone (D-NJ-6) offered general support for the price transparency legislation but raised concerns about the Prices on the Wall Act, arguing that it could cause more confusion than it would help. Several amendments were offered during the markup but were ultimately withdrawn following a commitment from both Full Committee Chairman Bret Guthrie (R-KY-2) and Health Subcommittee Chair Morgan Griffith (R-VA-9) to work on the bill before it goes to full committee.

OPENING STATEMENTS

PRICE TRANSPARENCY AND MEDICARE ADVANTAGE LEGISLATION MARKED UP

H.R. 9393, the Lower Costs, More Transparency Act of 2026 (Reps. Guthrie (R-KY-2) and Pallone (DNJ-6)), to require hospitals, surgical centers, labs, and imaging providers to post prices and require health plans to disclose negotiated rates, cost-sharing estimates, and pharmacy benefit manager (PBM) spread pricing.

  • Full Committee Chair Guthrie and Ranking Member Pallone spoke in favor of this bill, highlighting the amount of bipartisan work that went into getting to this point.
  • Rep. John James (R-MI-10) stated he would support this bill but believes it does not go far enough in terms of making the prices easy to understand. He shared that he would be putting up his bill, H.R. 5582, the Patients Deserve Price Tags, as an amendment to strengthen the underlying bill.
  • Rep. Greg Landsman (R-OH-1) offered an amendment to tack on language to ensure that the data shared is transparent, accurate, and understandable. This amendment was withdrawn after Rep. Landsman acknowledged it did not have the support.
  • Rep. Buddy Carter (R-GA-1) offered an amendment to include language from the DOC Access Act, which would promote transparency of the vision and dental benefit industry. He argued that vision benefit managers (VBMs) cause harm to patients as they do not have a choice in their eye doctor or treatment. This amendment was withdrawn.
  • Health Subcommittee Ranking Member Diana DeGette (D-CO-1) offered an amendment to include language requiring certain entities to share their ownership structures. This amendment was withdrawn following assurances from Health Subcommittee Chairman Griffith that they could talk about implementing changes.
  • This bill was forwarded to the full committee following a voice vote.

H.R. 9397, the Premium Transparency Act (Reps. August Pfluger (R-TX-11) and Nathanial Moran (R-TX-1)), to ensure health insurer accountability through publishing of overhead costs and claim payments.

  • Health Subcommittee Ranking Member DeGette highlighted that this language was already put into law within the ACA, but would still support the legislation.
  • This bill was forwarded to the full committee following a voice vote.

H.R. 9396, the Prior Authorization Accountability Act (Rep. Craig Goldman (R-TX-12)), to require insurers to display which services were subject to prior authorization, the percentage of requests approved or denied, and the average amount of time between the request submission and determination.

  • Health Subcommittee Chair Griffith, Health Subcommittee Ranking Member DeGette, and Rep. Mariannette Miller-Meeks (R-IA-2) spoke in support of the bill.
  • This bill was forwarded to the full committee following a voice vote.

H.R. 9390, the Prices on the Wall Act (Rep. Mariannette Miller-Meeks (R-IA-2)), to require hospitals, ambulatory surgical centers, and labs to post the discounted cash price in dollar amount on the wall for each service they provide.

  • Rep. Miller-Meeks (R-IA-2) spoke in support of the bill, highlighting the importance of physically seeing the prices.
  • Full Committee Ranking Member Pallone expressed his concern that it will cause more confusion for consumers and could deter them from care. While he acknowledged the good intent behind the bill, he explicitly raised issues with the fact that the posted prices will not be what patients actually pay and that billing codes can be unclear.
  • This bill was forwarded to the full committee following a voice vote.

H.R. 3514, Improving Seniors’ Timely Access to Care Act of 2025 (Reps. Mike Kelly (R-PA-16) and Suzan DelBene (D-WA-1)), to require plans to establish, and evaluate the implementation of, an electronic prior authorization.

  • Reps. John Joyce (R-PA-13), Kim Schrier (D-WA-1), Miller-Meeks, Lizzie
  • Fletcher (D-TX-7), and Troy Carter (D-LA-2) spoke in support.
  • This bill was forwarded to the full committee following a voice vote.

H.R. 9392, the Medicare Advantage Cost Transparency Act (Reps. Diana DeGette (D-CO-1) and John Joyce (R-PA-13)), to require the inclusion of certain information in Medicare Advantage encounter data.

  • Rep. Joyce spoke in support of the bill and emphasized the importance of including value- based contracting in this list of information to capture the full picture. He also shared the need for a uniform reporting standard so the data is comparable across plan types.
  • This bill was forwarded to the full committee following a voice vote.

H.R. 5243, to require each Medicare Advantage plan to submit eligibility for supplemental benefits, types of benefit categories offered, and data on utilization of and payments for such benefits (Rep. Jennifer McClellan (D-VA-4)).

  • This bill as amended was forwarded to the full committee following a voice vote.

H.R. 9395, the Transparency in Medicare Advantage Steering Act (Rep. Alexandria Ocasio-Cortez (D-NY14)), to require Medicare Advantage organizations to share the amount and form of compensation paid to an agent or broker, along with the total amount of compensation paid to agents and brokers.

  • This bill was forwarded to the full committee following a voice vote.
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Joint Economic Committee Hearing on Combating Health Care Fraud and Leakage

On June 24, 2026, the Joint Economic Committee held a hearing to examine ways to prevent health care fraud and instances where health care programs are not being used as intended. Chairman David Schweikert (R-AZ-1) encouraged Committee members and witnesses to focus on tangible solutions to the issue. Members discussed ways to reduce health sector consolidation, prevent fraudulent actions from health plan brokers, and leverage technology to reduce fraud in federal health programs.

OPENING STATEMENTS

WITNESS TESTIMONY

  • Dr. Brian Blase, Founder and President, Paragon Health Institute – Testimony
  • Dr. David Meyers, Associate Professor of Health Services, Policy, and Practice, Associate Director of the Center for Advancing Health Policy Through Research, Vice Department Chair, Brown University – Testimony
  • Dr. Chris Pope, Senior Fellow, Manhattan Institute – Testimony
  • Jessica Tillipman, J.D., Associate Dean for Governmental Procurement Law Studies, Government Contracts Advisory Council Distinguished Professorial Lecturer in Law, George Washington University Law School – Testimony

MEMBER DISCUSSION

Consolidation

Multiple members expressed concerns about the level of consolidation and vertical integration in the health system. Reps. Don Beyer (D-VA-8) and Victoria Spartz (R-IN-5) asked for solutions to prevent consolidation as well as to unwind some of the current consolidation. Dr. Meyers expressed that it would be extremely challenging to unwind current consolidation but gave recommendations to prevent further consolidation. These recommendations include structural separation, preventing health plans from acquiring more providers, and changing incentives, such as site neutral payment reforms, risk adjustment, and the medical loss ratio, to prevent encouraging more consolidation.

Brokers

Democrats on the Committee raised concerns about health insurance brokers. Ranking Member Maggie Hassan (D-NH) and Rep. Beyer wanted to understand how to prevent brokers from acting fraudulently. Dr. Meyers highlighted registering brokers, requiring stricter beneficiary understanding and consent for their plan of choice, and changing incentives for brokers to enroll a beneficiary in a specific plan by standardizing plan payments to brokers and making brokers a fiduciary of the beneficiary. Ms. Tillipman was supportive of reevaluating the specific incentives that create issues with brokers, but she cautioned the committee to not create broad disruptions.

Medicare and Medicaid

Chairman Schweikert suggested that a universal solution to fraud in Medicare Advantage would be to move to a capitated payment model, with a longer enrollment period. Dr. Meyers shared that a capitated model could be beneficial for improving plan incentives to support beneficiaries but cautioned that there would need to be a way for beneficiaries to leave the plan before their enrollment was over.

Rep. Spartz raised concerns about the high levels of automatic funding for federal health programs and questioned if Congress should provide more regular oversight. Dr. Blase agreed, sharing that the Medicare Part B trust fund will soon reach insolvency which will force Congress to address spending.

Sen. Amy Klobuchar (D-MN) asked each witness to share the top bipartisan reform Congress should focus on. Dr. Blase highlighted the need for the federal government to recoup funds states have spent on improper Medicaid payments. Dr. Pope shared that there needs to be increased documentation of services received by enrollees in Medicaid managed care plans.

Technology

Chairman Schweikert was curious if there was a universal data solution to reduce fraud. Dr. Blase shared that while artificial intelligence may play a role, he would recommend Congress focus on reducing the distortions that occur due to government payment policies. Dr. Meyer suggested that developing a better plan finder tool could be beneficial, as well as overlaying technology on top of other larger reforms to increase their impact. Sen. Klobuchar was interested in technological improvements but highlighted that many government computer systems need system wide upgrades to bring them into the modern age. Ms. Tillipman agreed, sharing that public systems need widespread upgrades to allow them to share information broadly, which can reduce duplicate work and decrease fraud.

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House Energy and Commerce Health Subcommittee Hearing on Price Transparency

On June 10, 2026, the House Energy and Commerce Health Subcommittee held a hearing to examine proposals to improve price transparency in the health sector. These proposals included publishing pricing lists for health insurers and hospitals, requiring additional information in Medicare Advantage encounter data, and reporting related to ownership of health care facilities. There was strong bipartisan support for steps to increase price transparency and interest in understanding the impacts of such proposals on patients and employers. Concerns were also raised about the effects of consolidation and private equity involvement in the health care sector.

OPENING STATEMENTS

WITNESS TESTIMONY

  • Carol Skenes, Chief of Staff, Turquoise Health – Testimony
  • Shawn Gremminger, President and Chief Executive Officer, National Alliance of Healthcare Purchaser Coalitions – Testimony
  • Benedic Ippolito, PhD, Senior Fellow, American Enterprise Institute – Testimony
  • Christopher Whaley, PhD, Associate Director of the Center for Advancing Health Policy through Research and Associate Professor of Health Services, Policy and Practice, Brown University School of Public Health – Testimony
  • Sophia Tripoli, MPH, Senior Director of Health Policy, Families USA – Testimony

LEGISLATION BEING CONSIDERED

  • H.R.___, to require hospitals, surgical centers, labs, and imaging providers to post prices and require health plans to disclose negotiated rates, cost-sharing estimates, and PBM spread pricing

  • H.R. ___, to require hospitals post prices on the walls

  • H.R. ___, to require health insurance issuers to publish overhead costs and claim payments

  • H.R. ___, to require displaying of claim denial rates by insurers

  • H.R. 5582, to provide for hospital and insurer price transparency

  • H.R. 9117, to require health plan administrators to disclose pricing and payment data to plans, and to require itemized explanations of benefits and patient bills

  • H.R. ___, to require the inclusion of certain information in Medicare Advantage encounter data

  • H.R. ___, to require mandatory reporting with respect to certain health-related ownership information

  • H.R. ___, to limit the compensation that may be paid to agents and brokers by Medicare Advantage organizations

MEMBER DISCUSSION

Consolidation and Ownership

Concerns were raised about how consolidation and private equity ownership can affect health pricing. Subcommittee Vice Chair Diana Harshbarger (R-TN-1) asked what was driving higher prices, to which Mr. Whaley responded that consolidation was the greatest factor. Full Committee Ranking Member Frank Pallone (D-NJ-6), and Reps. Kim Schrier (D-WA-8) and Marc Veasey (D-TX-33) were curious about why transparency in ownership was important. Mr. Whaley highlighted that when ownership is opaque, it can be extremely difficult for researchers to understand the impacts of consolidation, especially when single transactions are often small but greatly increase market power. Ms. Tripoli also commented that understanding ownership can help researchers and regulators better understand perverse incentives, such as upcoding.

Impacts of Price Transparency

Members showed bipartisan interest in understanding the potential impacts of price transparency legislation. Democratic members, such as Subcommittee Ranking Member Diana DeGette (D-CO-1) and Rep. Raul Ruiz (D-TX-25), commented that price transparency is important but does not directly affect affordability for patients, especially in emergency situations. Ranking Member DeGette and Rep. Ruiz were curious whether the witnesses believed price transparency legislation would reduce patient costs. Ms. Tripoli shared that price transparency would be much more useful for employers and health plan purchasers than individual patients and highlighted reinstating the Advance Premium Tax Credits as more impactful for addressing health care affordability. Subcommittee Chairman Morgan Griffith (R-VA-9) hospitals are sharing their pricing rates, but it is difficult for patients to understand due to the level of complexity.

Multiple Republican members, such as Full Committee Chairman Brett Guthrie (R-KY-2) and Rep. Mariannette Miller Meeks (R-IA-1) were curious about how employers have leveraged price transparency data to lower costs for employees. Mr. Gremminger shared that employers can use the data to engage in innovative plan designs, such as tiered pricing strategies to encourage employees to go to facilities with lower costs. Mr. Whaley shared that employers use claims data to exclude high-priced facilities. Rep. Gus Bilirakis (R-FL-12) asked about the current barriers to employers’ access to their claims data. Mr. Gremminger explained that plans will often only provide high-level data and charge large fees if an employer would like more granular data.

Gaps in Price Transparency Reporting

There was bipartisan interest in understanding how to improve gaps in price transparency requirements currently in place. Rep. Troy Balderson (R-OH-12) asked how to improve the usability of current price data. Ms. Skenes shared that making the data more understandable to patients would be very helpful, as well as addressing the gaps in drug reporting and various ways insurance companies cost-share with patients. Rep. Debbie Dingell (D-MI-6) was focused on understanding the gaps in ownership transparency. Ms. Tripoli stated that many smaller transactions do not meet the threshold for reporting, which makes them difficult to regulate and for intervention, if necessary. Rep. John Joyce (R-PA-13) asked the witnesses if enforcement for current price transparency measures was sufficient, to which both Mr. Whaley and Ms. Tripoli replied that it was not. Reps. Kat Cammack (R-FL-3) and Nick Langworthy (R-NY-23) wanted to understand what additional information could be beneficial to improving price transparency. Ms. Tripoli said that out-of-pocket spending and the quality of care could be beneficial, while Ms. Skene highlighted information on non-hospital entities and negotiated rates of care reimbursement.

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