Dec. 5, 2025: National Advocacy Update

Recommendations to minimize Medicaid coverage losses

The AMA sent a letter (PDF) to Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet C. Oz, MD, MBA, offering recommendations regarding forthcoming CMS guidance on the new requirement for states to redetermine the eligibility of certain Medicaid beneficiaries more frequently—on a six-month basis as opposed to annually. 

The letter identifies strategies, such as the use of ex parte or automatic renewal processes that do not require eligible beneficiaries to take any action to maintain their Medicaid coverage, that the AMA believes are essential to minimizing procedural disenrollments and loss of health coverage for eligible individuals. 

The letter is part of the AMA's ongoing campaign to influence the implementation of Public Law 119-21 (also known as the "One Big Beautiful Bill Act" or "OB3"). The AMA is committed to working with policymakers at the state and federal levels to minimize disruption and maintain access to affordable health coverage for eligible individuals and to ensure the best outcomes possible for physicians, medical students, and patients. 

Medicare telehealth update

In response to AMA advocacy, CMS issued important new guidance clarifying that physicians who have a practice location other than their home can continue to use that location as their Medicare enrollment address even if they provide some telehealth services from their home. The AMA had asked CMS to clarify the policy after the 2026 final rule stated only that the previous flexibility allowing physicians providing telehealth services from their homes to use their currently enrolled practice location instead of listing their home address in the Medicare enrollment database was not being extended. 

New FAQs (PDF) make it clear that the only physicians who need to report their home address to Medicare are those whose practice involves provision of telehealth services from their home and who do not have another practice location. The FAQs also reinforce that physicians who report their home address to the Medicare enrollment database can easily suppress their street address details so that their address is not accessible to patients or the public. 

CMS has also issued new guidance responding to questions from the AMA and others about the status of telehealth claims now that the government shutdown has ended. Telehealth claims that had been held by CMS and returned to physicians unpaid can now be resubmitted, and telehealth claims that physicians may have been holding can be submitted. Claims for Acute Hospital Care at Home services are also now payable. 

House of Representatives passes Hospital-at-Home waiver extension

An overwhelming majority of the U.S. House of Representatives voted in favor of a long-term extension of the Acute Hospital Care at Home program on Dec. 1. More specifically, the House passed H.R. 4313, the Hospital Inpatient Services Modernization Act, by a voice vote. While Congress temporarily extended the Hospital-at-Home program through Jan. 30, 2026, as part of a broader bill to reopen the federal government following a lapse in appropriations, the House of Representatives hopes passing a separate, stand-alone piece of legislation puts additional pressure on the Senate to enact a long-term extension of this crucial policy.  

H.R. 4313 extends the Acute Hospital Care at Home program for an additional five years, as well as mandates that the Department of Health and Human Services (HHS) conduct a study and final report on the effectiveness of the Hospital-at-Home program. This analysis will help HHS better understand patient eligibility criteria established by different hospitals. The study and report seek to compare and contrast a multitude of metrics among both participating and non-participating hospitals including: 

• Quality of care furnished to patients with similar conditions (e.g., outcomes, length of stay, mortality and infection rates, nursing staff ratios, transfers to and from the home to the hospital and vice versa)
• Types of clinical conditions treated
• Costs
• Quantity, mix and intensity of services provided
• Patient socioeconomic information 

The study and final report are required to be delivered to the House Committee on Ways and Means and Senate Committee on Finance no later than Sept. 30, 2028.   

AMA sent a letter of support (PDF) to the chief sponsors of this bipartisan legislation, specifically Ways and Means Health Subcommittee Chairman Vern Buchanan (R-FL), Representative Lloyd Smucker (R-PA) and Representative Dwight Evans (D-PA) in Aug. 2025. A Senate companion bill, S. 2237, that is led by Senators Tim Scott (R-SC) and Raphael Warnock (D-GA), is also supported (PDF) by the AMA. 

CMS finalizes 2026 Medicare hospital outpatient, ASC payment policies for 2026

On Nov. 21, 2025, CMS released the 2026 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System final rule (PDF). The AMA supported CMS’s continued use of the hospital market basket to update ASC rates, which resulted in a 2.6% update for ASCs based on a hospital market basket percentage increase of 3.3% minus a 0.7 percentage point productivity adjustment. CMS also finalized several site-of-service policy changes including: 

• Cutting OPPS payment by 60% for drug administration services provided in off-campus hospital outpatient departments.
• Eliminating the Inpatient Only (IPO) List over three years, beginning with the removal of 285 mostly musculoskeletal procedures for 2026.
• Adding over 500 procedures to the ASC Covered Procedures List. 

CMS also finalized several changes to the hospital quality programs, including: 

• Removing several measures from the Hospital Outpatient Quality Reporting Program (HOQRP), including the Median Time from Emergency Department (ED) Arrival to ED Departure for Discharged ED Patients (Median Time for Discharged ED Patients) measure and Left Without Being Seen measure, beginning with the CY 2028 reporting period/CY 2030 payment determination. These measures will be replaced by the Emergency Care Access & Timeliness eCQM, which is an improved measure and better addresses issues related to hospital boarding.  The AMA was supportive of these proposals.
• Despite AMA objections, finalizing its proposal to add the Emergency Care Access & Timeliness measure to the Rural Emergency Hospital Quality Reporting (REHQR) Program.
• Removing several measures from the ASC Quality Reporting Program (ASCQR), which the AMA supported. Due to AMA advocacy, CMS did not finalize its proposal to adopt an information transfer patient-reported outcome measure in the ASCQR and did not finalize a proposed requirement that ASCs use the Hospital Quality Reporting system for data submission of patient-reported outcomes in general. 

For more information, please review the fact sheet. 

Preventive Health Savings Act introduced in the Senate

On Nov. 21, Senator Angus King (I-ME), along with original cosponsors Sens. Mike Crapo (R-ID), Chris Van Hollen (D-MD) and Kevin Cramer (R-ND), introduced the Preventive Health Savings Act (S. 3204), legislation to better measure the cost savings that come with improved investments in preventive health care.   

This critically important legislation would allow the Congressional Budget Office (CBO) to look beyond the current law’s 10-year budget window to a longer 30-year window to assess savings associated with preventive health care legislation. CBO analysis provides an important benchmark by which Congress determines the cost of legislation to the American taxpayer. The Preventive Health Savings Act will allow Congress to have a more accurate picture of how preventive legislation can help patients stay healthier and reduce costs to the health care system.  

The AMA endorsed the legislation, with President Bobby Mukkamala, MD, quoted in the press release as saying, “This bipartisan legislation brings together budget policy and health policy to reflect the benefits of tackling chronic disease. Not only will our patients live longer and healthier because of federally funded health initiatives, but taxpayers will benefit from savings resulting from treating chronic diseases. Allowing CBO to assess long-term savings from prevention legislation is a prescription for bending the health care cost curve.”  

The AMA will continue to work with the bipartisan bill sponsors to advance this legislation in Congress. A House companion bill (H.R. 4464) is also supported (PDF) by the AMA.

AMA joins coalition urging CMS to hold physicians, ACOs harmless from skin substitute spending

On Nov. 25, the AMA joined (PDF) 12 national medical societies and other health care organizations urging CMS and the Center for Medicare and Medicaid Innovation (CMMI) to use their existing authority to ensure that accountable care organizations (ACOs) and Merit-based Incentive Payment System (MIPS) eligible clinicians are held harmless from increased skin substitute spending, which often constitutes egregious examples of waste, fraud, or abuse. Medicare spending on skin substitutes has experienced unprecedented growth, increasing from $256 million in 2019 to more than $10 billion in 2024, with CMS leadership projecting expenditures could exceed $20 billion by 2026. Such spending poses increasing problems for ACOs, as it causes their overall spending to exceed benchmarks and impairs their ability to meet targets for gross and shared savings. Ultimately, this situation leaves the clinicians in these models financially accountable for improper billing. Similarly, physicians participating in MIPS will be penalized on the MIPS cost measures due to aberrant and potentially wasteful, fraudulent, or abusive spending on skin substitutes. Our organizations reiterated that physicians should not be held accountable for spending that is outside of their control and highlighted our partnership with CMS to identify and resolve future instances of fraud, waste, and abuse to protect the interests of the Medicare Trust Fund.

New Annenberg report shows AMA impact as trusted voice on vaccine safety

According to a new report from the Annenberg Public Policy Center at the University of Pennsylvania, Americans are more likely to accept guidance from the American Medical Association than the Centers for Disease Control (CDC) on vaccine safety.

This report comes at a pivotal moment. In recent weeks, several senior CDC officials have departed over disagreements about vaccine policy, and the CDC’s website update suggesting a link between vaccines and autism created confusion. Such changes run counter to decades of scientific evidence, and they raised significant concern among physicians and health experts about public trust and the clarity of our nation’s vaccine guidance. 

The Annenberg survey found: 

• By a 2-1 margin, the public would be more likely to accept the AMA’s recommendation (35%) on vaccine safety than the CDC’s (16%) if the two bodies issue conflicting recommendations.
• Regardless of political party, Americans would accept the AMA’s recommendations on vaccine safety over the CDC’s.
• Half of older Americans age 65+ (50%) would be more likely to accept the AMA’s recommendations on vaccine safety over the CDC’s (13%); the only age group more likely to accept the CDC over the AMA are 18- to 29-year-olds, by 24% to 19%. 

More articles in this issue

• Dec. 5, 2025: State Advocacy Update