Health Policy Report – January 27, 2026

CMS Publishes HPMS Complaints Form
The Centers for Medicare & Medicaid Services (CMS) released a letter that includes instructions about a revised process for providers to report complaints about a Medicare Advantage (MA) plan. The process includes submitting a complaint online at cms.gov.

The online form collects basic information about the complainant, beneficiary, provider, and plan, along with a summary of the complaint. Submitted complaints will be routed to CMS’s Health Plan Management System (HPMS) Complaints Tracking Module (CTM), where they will be queued and reviewed by CMS.

This is a welcome development for providers, which marks a major step forward in ensuring that providers can issue timely complaints.

To read the form, CLICK HERE.

House Passes Health Package Including PBM, Site Neutral Payment Reforms

On January 22, the House of Representatives passed the Consolidated Appropriations Act of 2026, a minibus funding package that includes appropriations for the Department of Health and Human Services (HHS). The package includes a variety of health provisions and extenders, including pharmacy benefit manager (PBM) reform, site neutral policies, and an extension of telehealth flexibilities that were set to expire at the end of January.

The package includes meaningful PBM reforms that represent a major federal step toward reshaping Medicare Part D and pharmacy contracting practices. The bill includes several provisions seeking to rein in PBM practices such as spread pricing and bona fide service fees. PBMs now have mandatory transparency reports, and pharmacies have strengthened contract standards to ensure they are protected from unreasonable reimbursement practices. These provisions are intended to increase accountability and reduce opaque revenue streams, which often negatively impact pharmacy viability and beneficiary out-of-pocket costs.

The bill also includes a two-year extension of Medicare telehealth flexibilities and creates new Medicare coverage for Multi Cancer Early Detection (MCED) blood tests that can screen for multiple types of cancer at once. The coverage would begin on January 1, 2029 and the tests would need to be authorized by the Food and Drug Administration (FDA) and use advanced genomic or sequencing technology.

The legislation also revises Medicare’s clinical laboratory payment timeline by extending the phase-in period for laboratory test payment changes by an additional year, moving the end date from 2028 to 2029.

Finally, the package revives elements of the Lower Costs, More Transparency Act, namely the requirement that providers on separate hospital campuses bill with separate National Provider Identifier (NPI) numbers. The move is intended to keep hospitals, which are typically paid more, from charging more for services at affiliated locations.

To support this transition, CMS will set up a verification process that may include site visits, virtual reviews, and checks of supporting documents. The bill provides $20 million for CMS to implement and oversee these requirements and directs the HHS Office of Inspector General to issue a report by January 1, 2030, evaluating how well CMS is carrying out this work and recommending improvements.

The bill now advances to the Senate, where action is needed before the January 30 deadline to prevent a full or partial government shutdown.

To read more, CLICK HERE.

Trump Administration Releases the Great American Healthcare Plan

The Trump Administration recently announced the Great American Healthcare Plan, which calls on Congress to lower drug prices and insurance premiums, hold big insurance companies accountable, and maximize price transparency.

The plan was light on specific details but called for sending billions in subsidies directly to consumers so they can buy health insurance, rather than sending it to the companies to lower premiums. The White House plan also aims to increase transparency in healthcare by requiring all providers who accept Medicare or Medicaid and insurers to present clearer pricing information and increase penalties to encourage compliance.

The plan also targets PBMs, noting it will “end the kickbacks” paid to “to the large brokerage middlemen that deceptively raise the cost of health insurance.”

The White House further calls on Congress to codify recent “most-favored nation” agreements with pharmaceutical companies that have agreed to offer their products in the United States at prices in line with other countries. The plan also aims to expand the availability of prescription drugs for over-the-counter purchase.

Congressional Republicans, including Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee Bill Cassidy, MD (R-LA) and House Ways & Means Chair Jason Smith (R-MO), applauded the proposal’s broad goals. However, lawmakers face an uphill battle in advancing the plan, particularly given its lack of specificity and ongoing partisan division. Dr. Mehmet Oz, CMS Administrator, is set to meet with Senate Republicans on Wednesday, January 28, to discuss the plan and possible paths forward.

To read the plan, CLICK HERE.

MedPAC to Vote on New Medicare Payment Recommendations

On January 15, the Medicare Payment Advisory Commission (MedPAC) recommended a modest .5% update to Medicare physician payments for 2027. However, MedPAC retreated from its previous position that annual payment updates should be linked to inflation — a reform long sought by doctors.

In response, the American Medical Association (AMA) praised MedPAC’s recommended physician pay adjustment, saying it underscores “a longstanding policy failure that is widely recognized but remains unresolved.” However, AMA highlighted that MedPAC’s recommendation doesn’t address concerns that Medicare payments aren’t keeping pace with rising practice costs.

The commission also voted to recommend that Congress update the 2027 Medicare base payments for hospitals in line with the current law and implement the Medicare Safety-Net Index with an additional $1 billion in funding.

MedPAC will forward its 2027 Medicare pay recommendations to Congress via the commission’s March report.

To read more, CLICK HERE.

Think Tank Warns Against Government Interference in Pharmacy Industry

The Competitive Enterprise Institute (CEI), a think tank that advocates for regulatory reform, recently published a report warning against government interference in the pharmacy industry.

As new drug delivery models are embraced by policymakers and the wider industry, the report argues that efforts to prevent pharmacy benefit managers from owning pharmacies would be detrimental. Bans on PBM-owned pharmacies, which have been sought by federal and state lawmakers, would reduce the number of options patients have to acquire their prescriptions, according to CEI.

“Policymakers should tread extremely lightly to avoid harming consumers with misguided and harmful regulations and prohibitions on a market they are unqualified to manage,” the report read.

As of 2025, at least 18 states have enacted laws barring PBMs from steering patients to acquire their medications from PBM-affiliated pharmacies over other independent pharmacy options, while Arkansas is the only state to pass a law that explicitly prohibits PBMs from owning pharmacy businesses within the state.

To read the full report, CLICK HERE.