Welcome to another round of PYA Washington Updates. It’s been another quiet week in the world of health policy. Seems a good time to celebrate National Relaxation Day!
Happy Birthday, Social Security!
On August 14, 1935, President Franklin D. Roosevelt signed into law the federal Social Security Act. In celebration of the SSA’s 90th birthday, the Administration promised yesterday to “aggressively [root] out all fraud, waste, and abuse that rob our Federal programs of resources….”
Older and WISeR?
On Tuesday, the CMS Innovation Center released updated FAQs on the Wasteful and Inappropriate Service Reduction (WISeR) Model. Under WISeR, providers in seven states will have to obtain prior authorization for certain services furnished to traditional Medicare beneficiaries. The Innovation Center will contract with third parties to review these requests, paying them a portion of the savings generated by denials. (We previously took a deep dive into WISeR.) Last week, congressional Democrats sent a letter to CMS Administrator Mehmet Oz criticizing WISeR as creating unnecessary obstacles to beneficiaries receiving needed care. The new FAQs are a response to such concerns, addressing how WISeR combats fraud and abuse and protects beneficiaries.
Delay in Release of MAHA Report
On February 13, the Trump Administration released an Executive Order creating the Make America Healthy Again Commission. The order directed the MAHA Commission to publish a Make Our Children Healthy Again Assessment within 100 days and a Make Our Children Healthy Again Strategy within 180 days. The commission unveiled its assessment on May 22, identifying poor diet, accumulation of environmental toxins, insufficient physical activity, chronic stress, and overmedicalization as driving higher rates of chronic disease in children. The due date for the strategy was Tuesday, August 12. Administration officials announced this week that the strategy would be delivered to the president by the deadline, but the public release was being delayed due to scheduling issues. Yesterday, the New York Times reported that it had obtained a copy of the strategy, which apparently relies on carrots rather than sticks to address the problems identified in the assessment. Stay tuned.
Strategic Active Pharmaceutical Ingredients Reserve
On Wednesday, President Trump issued an executive order directing the Assistant Secretary for Preparedness and Response at HHS to identify 26 drugs that are essential for public health and to stockpile a six-month supply of active pharmaceutical ingredients (APIs) needed to manufacture these drugs. The order is part of the administration’s broader effort to increase domestic drug production, as only about 10% of APIs are manufactured domestically. Last week, the Food and Drug Administration unveiled its new PreCheck program to streamline U.S. drug plant build-outs. And President Trump has threatened to impose high tariffs on pharmaceuticals.
Q2 Blues
Publicly-traded health insurance companies reported less than stellar financial results for Q2 2025. To turn things around, insurers are promising to raise premiums, to deploy artificial intelligence to control utilization, and to exit unprofitable markets. But they face numerous challenges, from risk pool disruptions due to stricter eligibility requirements for Medicaid and ACA exchange premium tax credits to increasing federal oversight of Medicare Advantage plans. A little bit of good news for plans (but not providers): federal agencies have again extended the deadline for plans’ compliance with stricter criteria for calculating the qualifying payment amount (QPA) under the No Surprises Act.
PYA Webinars – 2026 Medicare Hospital Inpatient Prospective Payment System Final Rule
On August 27, PYA will present a webinar on the 2026 IPPS final rule, addressing updated payment rates, changes to the inpatient quality reporting program and hospital value-based purchasing programs, and details relating to the Transforming Episode Accountability Model, the mandatory alternative payment model set to launch on January 1, 2026. You can register for this webinar here.
Please do not hesitate to contact us if you have any questions regarding these latest developments, and please continue to check PYA’s website for updates.
