THIS WEEK’S DOSE

• Congress Debates Government Funding. A continuing resolution (CR) to fund the government through September passed the House and will very likely pass the Senate today.
• Senate HELP Committee Advances NIH, FDA Nominations, Meanwhile White House Pulls CDC Director Nomination. National Institutes of Health (NIH) director nominee Jay Bhattacharya and US Food and Drug Administration (FDA) commissioner nominee Martin Makary are expected to be confirmed by the full Senate. The White House abruptly withdrew Dave Weldon’s nomination for Centers for Disease Control and Prevention (CDC) director just prior to his Senate confirmation hearing and has not yet announced a new nominee.
• Senate Finance Committee Holds CMS Administrator Nomination Hearing. The committee held its nomination hearing for Mehmet Oz, MD, to be administrator of the Centers for Medicare and Medicaid Services (CMS) as this Check-Up went to press.
• House Oversight Committee Holds Hearing on Preventing Improper Payments and Fraud. The hearing continued previous committee work broadly focused on improper payments and fraud, including in Medicare and Medicaid.
• House Ways and Means Committee Examines Access to Medicare Post-Acute Care. Members discussed barriers to accessing quality post-acute care and highlighted potential solutions.
• Senate Aging Committee Discusses Solutions to Senior Loneliness. There was bipartisan concern about the burden of senior loneliness.
• CMS Issues Marketplace Integrity and Affordability Proposed Rule. The agency’s first proposed rule in the Trump administration aims to reduce improper enrollments in the Marketplace.
• CMMI Releases Statement on Strategic Direction. The Center for Medicare and Medicaid Innovation (CMMI) announced actions to cancel certain models and transition participants to other models.
• OCR Announces Investigations into Four Medical Schools and Hospitals. The schools and hospitals being investigated were not officially identified.
• Federal Judges Rule Agencies Must Reinstate Fired Probationary Employees. One of the rulings applies to the US Department of Health and Human Services (HHS).

CONGRESS

Congress Debates Government Funding. In advance of the March 14, 2025, government funding deadline, House Republicans on March 8 released a 99-page CR to fund the government through September 30, 2025, the end of the fiscal year (FY). The CR includes short-term extensions of healthcare programs and provisions, including Medicare telehealth flexibilities and community health center funding, through September 30. The legislation includes increases in defense spending and cuts to nondefense spending, including a 50% cut to the Congressionally Directed Medical Research Programs (CDMRP) within the US Department of Defense. CDMRP funds biomedical research on conditions such as cancer, Alzheimer’s disease, and autism.

The CR does not include a Medicare physician payment fix or additional bipartisan health provisions, such as pharmacy benefit manager reform, from the December 2024 bipartisan healthcare package, which has been reintroduced by Sens. Wyden (D-OR) and Sanders (I-VT). Rep. Murphy (R-NC), Co-Chair of the GOP Doctors Caucus, originally said he would oppose the CR if it did not include the so-called doc fix. However, the caucus received a commitment from Republican leadership to include a doc fix in the upcoming budget reconciliation bill, so Rep. Murphy supported the CR.

On March 11, 2025, the House passed the CR mostly along party lines in a 217 – 213 vote. Rep. Golden (D-ME) joined Republicans in voting yes, and Rep. Massie (R-KY) joined Democrats in voting no. In the Senate, the bill needs 60 votes to overcome a procedural hurdle, known as cloture, before final passage, necessitating support from Democrats. Senate Minority Leader Schumer (D-NY) initially pushed back and said Democrats would seek a separate vote on a clean, shorter-term CR that would allow appropriators to finish the full slate of FY 2025 bills. Schumer later reversed and stated he and other Senate Democrats would vote yes on the cloture vote to avoid a government shutdown. The final cloture vote was xx – xx. XX Democrats voted with all but one Republican, Sen. Paul (KY), to achieve the 60 votes necessary to clear the procedural hurdle. As of the time of this publication, a vote on final passage is expected today to avert a government shutdown and complete the FY 2025 appropriations process.

Senate HELP Committee Advances NIH, FDA Nominations, Meanwhile White House Pulls CDC Director Nomination. The Senate Health, Education, Labor, and Pensions (HELP) Committee voted on the nominations of Jay Bhattacharya, MD, for NIH director and Martin Makary, MD, for FDA commissioner. The committee held its nomination hearings last week. Bhattacharya advanced with a vote of 12 – 11 along party lines. Makary advanced with a vote of 14 – 9, with Sens. Hassan (D-NH) and Hickenlooper (D-CO) joining Republicans. Both nominations now move to the full Senate floor, where they are expected to be confirmed. Sen. Hawley (R-MO) expressed concern over Makary’s initial support of Hilary Perkins as FDA chief counsel. Perkins previously worked for the US Department of Justice under President Biden and defended that administration’s abortion and vaccine policies. Sen. Hawley noted that Makary withdrew his support for Perkins, who resigned on March 13, 2025, only two days after becoming FDA chief counsel.

On the morning of Dave Weldon’s scheduled Senate HELP Committee nomination hearing for CDC director, the White House suddenly withdrew his nomination. Weldon was previously a US representative from Florida. He has been subject to significant scrutiny for his views on vaccines, and there have been rumors for some time that his nomination could be withdrawn. At the time of publication, President Trump had not yet announced a new CDC director nominee.

Senate Finance Committee Holds CMS Administrator Nomination Hearing. The Senate Finance Committee held its nomination hearing for Mehmet Oz, MD, to be administrator of CMS as this issue went to press.

House Oversight Committee Holds Hearing on Preventing Improper Payments and Fraud. The hearing included three witnesses who discussed the prevalence of fraud broadly across federal spending, including in Social Security and Medicaid. Members of both parties expressed interest in working together to address waste, fraud, and abuse, but Democrats emphasized the importance of Medicaid and ensuring it remains accessible. Republicans highlighted the Department of Government Efficiency’s role in addressing waste, fraud, and abuse.

House Ways and Means Committee Examines Access to Medicare Post-Acute Care. During the hearing, Democrats predominantly focused on the impact that potential cuts to Medicare and Medicaid (under discussion as part of the ongoing budget reconciliation process) would have on long-term care hospitals and skilled nursing facilities. Republicans focused on the burden of prior authorization for beneficiaries and the impact of workforce shortages on access to care. Both members and witnesses discussed the importance of Medicare telehealth flexibilities in home health and hospice care and the proposal to create a single Medicare payment system for all post-acute care providers.

Senate Aging Committee Discusses Solutions to Senior Loneliness. Witnesses for the hearing included individuals from organizations that provide social services to seniors. Members of both parties expressed concern about senior loneliness and its impact on health outcomes. Both members and witnesses expressed support for the Social Engagement and Network Initiatives for Older Relief (SENIOR) Act and the Older Americans Act. There was discussion about the cost burden of senior loneliness on Medicare and Medicaid.

ADMINISTRATION

CMS Issues ACA Marketplace Integrity and Affordability Proposed Rule. CMS issued a proposed rule on March 10, 2025, that would undo Biden-era policies designed to enhance enrollments through the Marketplace. Key proposals include the following:

• CMS proposes to shorten the annual open enrollment period by one month, such that it would run from November 1 to December 15, as under the first Trump administration, instead of November 1 to January 15. CMS also proposes to apply this timeframe to state-based Marketplaces, which were previously permitted flexibility on this front.
• CMS proposes to add sex-trait modifications to the list of items and services that may not be covered as essential health benefits beginning in plan year 2026.
• CMS proposes to amend the definition of “lawfully present” to exclude Deferred Action for Childhood Arrivals recipients for purposes of enrolling in Marketplace coverage.
• CMS proposes to end the availability of the monthly special enrollment period for individuals with household incomes below 150% of the federal poverty level. All Marketplaces would also have to reinstitute pre-enrollment verifications of eligibility for special enrollment periods and conduct further verifications of income when no tax data is available for verification.

The policies would have varying effective dates, some as early as immediately upon implementation, but the proposed rule specifically requests input on implementation timelines. There is a 30-day comment window that ends April 11, 2025. Click here for the press release, and here for the fact sheet.

CMMI Releases Statement on Strategic Direction. On March 12, 2025, CMMI stated that it plans to announce a new strategy focused on choice, competition, consumer empowerment, and evidence-based practices. CMMI will also work to streamline payment models, and some models will end early on December 31, 2025, with participants transitioning to other models. CMMI subsequently announced that the Maryland Total Cost of Care, Primary Care First, ESRD Treatment Choices, and Making Care Primary models will end early. CMMI is considering options to reduce the size of the Integrated Care for Kids model, and the Medicare $2 Drug List and Accelerating Clinical Evidence models will not be implemented. CMMI estimates that ending these models will save taxpayers approximately $750 million but doesn’t spell out how those savings will be realized. Read more about what’s next for value-based care under the Trump administration here.

OCR Announces Investigations into Four Medical Schools and Hospitals. The HHS Office for Civil Rights (OCR) stated that four medical schools and hospitals provide medical education and training that discriminates on the basis of race, color, national origin, or sex. OCR alleges that the institutions are in violation of Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act. The announcement states that the action aligns with President Trump’s executive order “Ending Illegal Discrimination and Restoring Merit-Based Opportunity.” The institutions subject to the investigation are not officially identified. For more details, please see this article by our McDermott Will & Emery colleagues.

COURTS

Federal Judges Rule Agencies Must Reinstate Fired Probationary Employees. On March 13, 2025, two federal judges ruled that certain federal agencies must reinstate fired probationary employees. The first judge’s order applied only to six agencies, while the second judge’s order applied to 18 agencies, including HHS. Both judges ruled that the firings by the Office of Personnel Management were unlawful. The Trump administration is likely to appeal the decisions. Other efforts by the Trump administration to shrink the federal workforce, including a reduction in force, will likely continue.

QUICK HITS

• House Democratic Health Leaders Send Letter to CMS on Staff Firings. The ranking members of the full Ways and Means Committee and Energy and Commerce Committee, along with the ranking members of the Health Subcommittees, expressed concern over the impact of the recent firings of Medicare and Medicaid staff. The letter from Reps. Neal (D-MA), Pallone (D-NJ), Doggett (D-TX), and DeGette (D-CO) poses 15 questions to Acting Administrator Stephanie Carlton and asks for responses by March 17, 2025.
• OGC Announces Reorganization Effort. The HHS Office of General Counsel (OGC) will consolidate its regional offices from 10 to four. House Ways and Means Committee Ranking Member Neal and Energy & Commerce Committee Ranking Member Pallone released a statement criticizing the action as inhibiting efforts to reduce waste, fraud, and abuse.
• Senate HELP Chairman Cassidy Announces CDC Working Group. Chairman Cassidy (R-LA) along with Sens. Johnson (R-WI), Lee (R-UT), Marshall (R-KS), Murkowski (R-AK), Paul (R-KY), and Scott (R-SC) announced the working group to examine potential legislative reforms to the CDC. The press release states that the working group aims to restore the public’s trust in the CDC.
• Congressional Democrats File Amicus Brief in Supreme Court Medicaid Case. All Senate Democrats and 191 House Democrats filed the brief in Medina v. Planned Parenthood South Atlantic. At question is whether South Carolina’s exclusion of abortion providers from the Medicaid program violates the “any qualified provider” Medicaid provision.
• MACPAC, MedPAC Release March 2025 Reports to Congress. The Medicaid and CHIP Payment and Access Commission (MACPAC) report includes recommendations to improve the managed care external quality review process, home- and community-based services (HCBS) access, and Medicaid Section 1915 authorities for HCBS. The Medicare Payment Advisory Commission (MedPAC) report includes recommendations for updating 2026 payment rates in traditional Medicare.
• Sen. Jeanne Shaheen (D-NH) Won’t Run for Reelection. Sen. Shaheen has been in office since 2009 and serves on the Senate Appropriations Committee. She is the third Democratic senator, following Sens. Peters (D-MI) and Smith (D-MN), to announce they won’t run for reelection. Her announcement exacerbates Democrats’ challenge to take back the Senate in 2026, as open seats are often more difficult to win than those with incumbents running for reelection.
• CMS Postpones, Renames Annual Conference. CMS postponed its annual Health Equity Conference, originally scheduled for April 23 – 24, 2025 and renamed it the Conference for Building a Healthier America. A new date has not been announced.

BIPARTISAN LEGISLATION SPOTLIGHT

NEXT WEEK’S DIAGNOSIS

The House and Senate are both scheduled to be in recess next week and return March 24, 2025. After the federal government is funded, Republicans will return their attention to the budget reconciliation process. Votes to confirm President Trump’s nominees are also expected to continue in the Senate when members return.