Health Policy Report – July 28, 2026

CMS Releases MPFS Proposed Rule

On July 14, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the Medicare Physician Fee Schedule (MPFS) for Calendar Year (CY) 2027. The proposed rule once again included a cut to the conversion factor, this time by 1.18% for qualifying alternative payment model (APM) participants and by 1.58% for non-qualifying APM participants.  

Following significant advocacy efforts by The Network and other stakeholders following last year’s proposed rule, CMS is proposing to revise payment relativity among radiation treatment delivery codes. As a result, the agency estimates an overall impact of +3% for radiation oncology and radiation therapy centers, with a projected non-facility impact of +5%.

CMS proposes to sunset traditional MIPS reporting at the end of 2029 in favor of “more clinically meaningful specialty-focused MIPS Value Pathways,” or MVPs. It also outlines a plan to create incentives for more physicians to participate in the Medicare Shared Savings Program (MSSP), the largest value-based payment program in the country.

The agency also proposes to add five new telehealth services and establish two new billing modifiers to implement recently extended Medicare telehealth flexibilities authorized by Congress.

Beginning January 1, 2027, CMS proposes to require 340B covered entities to report specific information on Medicare Part D claims for covered drugs dispensed through the eligible entity or its contract pharmacies. Under the proposed rule, CMS also outlines several technical updates to how inflation rebates are calculated under the Inflation Reduction Act when Medicare Part B or Part D drugs rise faster than inflation.

CMS is seeking stakeholder feedback on ways to reduce unnecessary duplicate laboratory and imaging tests for Medicare beneficiaries and improve the exchange of diagnostic information across healthcare settings.

The agency also proposes updates to implement the 2026 Consolidated Appropriations Act, including revised laboratory data reporting requirements and continued limits on payment reductions through 2029. Consistent with legislation enacted earlier this year, no CLFS payment reductions would apply in 2026, helping preserve access to laboratory services in community-based settings.

The Network will continue to review this proposed rule and will provide feedback to the agency in forthcoming comments due on September 15, 2026.

To read a fact sheet, CLICK HERE.

To read the proposed rule, CLICK HERE.

Dr. Nathan Shumway Pens LTE in the Pleasanton Express

In a letter to the editor recently (LTE) published in the Pleasanton Express, Dr. Nathan Shumway thanks Representative Henry Cuellar, Ph.D. (D-TX) for cosponsoring the Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299).

In his LTE, Dr. Shumway advocates for access to affordable, convenient cancer care from independent oncologists for rural Texans. He explains that H.R. 4299 is crucial to maintain payments to community-based oncologists, allowing practices to stay afloat and continue to provide complex cancer treatments.

“When community cancer care goes away, patients don’t stop needing treatment. They’re instead forced to seek care farther from home or in a hospital that usually costs more,” he writes.

To read his full LTE, CLICK HERE.

Virginia Cancer Specialists Hosts State Senator Kannan Srinivasan for Site Visit

On July 15, Virginia Cancer Specialists hosted State Senator Kannan Srinivasan for a site visit at its Fairfax clinic. The tour, led by Dr. Anne Favret, VCS Medical Director, and Dr. Jey Maran, VCS Practice President, offered State Senator Kannan Srinivasan an opportunity to learn more about the role community oncology plays across Northern Virginia.

During the tour, State Senator Srinivasan learned more about how VCS is working to ensure access to clinical trials, including phase 1 trials, and the importance of affordable, community-based cancer care. Ann Miner, the new Executive Director of VCS, Eired Eddy, Government Relations with The US Oncology Network, and Joel Andrus from Kemper Consulting were also in attendance for the tour and discussion.

FCS and The Network appreciate the Senator’s time and willingness to meet with physicians and tour the VCS Fairfax site to hear about how community oncology provides personalized and high-quality care to patients in Virginia.

If your practice is interested in hosting a site visit, please contact Angela Storseth at angela.storseth@usoncology.com.

Bipartisan House Lawmakers Introduce the Patients First Act

On July 15, Representatives John Joyce, M.D. (R-PA), Greg Murphy, M.D. (R-NC), and Kim Schrier, M.D. (D-WA) – chairs of the GOP and Democratic Doctors Caucuses – introduced the Patients First Act (H.R. 9693).

This bipartisan legislation would make significant reforms to the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). The legislation would tie annual updates under the Medicare Physician Fee Schedule (MPFS) to the Medicare Economic Index (MEI), ensuring that payments more closely align with the costs of running a practice. The bill would also increase the budget neutrality threshold from $20 million to $54.3 million.    

In addition, the bill proposes to phase out MIPS in favor of the Patient Outcome Improvement National Tabulation System (POINTS) program, which would create a physician and clinician-led task force within CMS that will develop streamlined quality metrics. The bill would also freeze Alternative Payment Model (APM) participation thresholds for three years and create notice and comment periods for CMS Innovation Center models.

“As a practicing urologist for more than 30 years, I’ve seen firsthand the challenges physicians face in keeping their doors open while providing the highest quality care for their patients,” said Congressman Greg Murphy, M.D. (R-NC), in a press release. “Our current Medicare physician payment system is unsustainable. It has fueled consolidation, increased administrative burdens, and made it harder for independent physicians in rural communities to continue serving the patients who rely on them. The bipartisan Patients First Act delivers long-overdue reforms that strengthen independent practices, invest in primary care, and ensure physicians can spend more time caring for patients instead of navigating bureaucracy. When physicians succeed, patients receive better care, and that’s exactly what this legislation is designed to achieve.”

To read more, CLICK HERE.

To read a press release, CLICK HERE.

Senators Smith and Moran Introduce the Cancer Drug Parity Act

On July 20, Senators Tina Smith (D-MN) and Jerry Moran (R-KS) reintroduced the Cancer Drug Parity Act, which would lower out-of-pocket costs for patients receiving oral chemotherapy medication. Specifically, the bill would require health insurers to cover oral cancer medications at the same cost-sharing level as intravenous treatments.

In a press release, the lawmakers noted that despite the benefits of oral cancer medications, this treatment option remains inaccessible to many due to unaffordable copays.

“Oral treatments for cancer are often less invasive than traditional IV medications and can be taken at home, reducing logistical and occupational barriers to treatment,” said Senator Smith. “However, unlike IV treatments, which are covered by a health plan’s medical benefits with moderate to minimal copays, oral medications often have high, unaffordable copays.  It can add up to thousands of dollars in costs for patients each year and can cause many to delay or forego necessary care to treat their cancer.  Our bill brings parity to these two kinds of treatments and lowers costs for those taking oral cancer drugs.”

To read the press release, CLICK HERE.

House Energy & Commerce Committee Holds Markup on Prior Auth, Price Transparency Legislation

On July 20, the House Energy & Commerce Committee advanced several key healthcare bills during a markup. The committee combined eight bills into one package under the Lower Costs, More Transparency Act of 2026 (H.R. 9393). The package passed unanimously.

The package now includes provisions to strengthen price transparency requirements, modernize prior authorization under Medicare Advantage (MA), and strengthen prior authorization reporting requirements for commercial insurers.

To watch the markup, CLICK HERE.  

House Ways & Means Committee Advances Hospital Price Transparency Legislation

In a markup held on July 15, the House Committee on Ways and Means advanced legislation that would reform hospital and insurance price transparency standards.

In a party line vote of 25-15, the committee advanced the Health Care Price Certainty for All Americans Act, which would mandate that hospitals, imaging providers, ambulatory surgical centers, and labs provide pricing information for employers and patients. The bill would also require insurers to post their negotiated prices.

This latest action comes amid a broader push from lawmakers to increase healthcare price transparency and give patients and employers greater insight into the cost of care.

To watch the markup, CLICK HERE.

To read the committee press release, CLICK HERE.