Congressional lawmakers have inked a deal to renew several major public health programs and fund bipartisan health reforms and have tacked them into a fiscal year (FY) 2026 spending measure. Among the health measures is a two-year extension of current Medicare telehealth flexibilities that will otherwise expire on Jan. 30, 2026.
Inclusion of the health provisions marks rare bipartisan unity in an otherwise contentious political environment. The House passed the legislative package on January 22. A vote in the Senate is scheduled to take place next week.
The following is a snapshot of some of the bill’s health provisions likely to be of most interest to ASGE members:
- Extends current Medicare telehealth flexibilities through Dec. 31, 2027.
- Prevents pharmacy benefit managers (PBMs) from getting paid based on drug prices or rebates, instead tying compensation to fees they charge to clients that reflects services the PBMs perform.
- Requires PBMs to pass through rebates to commercial plans in an attempt to reduce incentives for PBMs to favor higher-priced drugs that can obtain higher rebates.
- Provides a 3.1 percent alternative payment model incentive payment for eligible clinicians who are determined to be qualified participants for the 2026 performance year / 2028 payment year.
- Beginning in 2028, insurers offering Medicare Advantage plans must verify the accuracy of their provider directories every 90 days. Provides cost-sharing protections to patients who receive care from an out-of-network provider that is listed in the plan’s provider directory.
- Requires health systems to create separate identification numbers for off-campus outpatient departments to enable the Centers for Medicare and Medicaid Services to track pricing in different settings.
- Requires Medicare coverage of multi-cancer early detection screening tests that are approved by the Food and Drug Administration. The national coverage determination process will be used to determine coverage.
- Provides substantial increases to graduate medical education programs through FY 2029.
- Increases funding for implementation of the ‘No Surprises Act.’