What the AMA's House of Delegates Decided in Orlando, From AI Licensure to Downcoded Claims
By our count the AMA adopted 15 policies at its Nov. 6-9 meeting, including a bar on licensing AI as a physician and EHR alerts for downcoded claims.
Section
Policy
Reimbursement, regulation, and the rules being written about your work.
Year Two of the Rural Health Fund Shifts $68 Million Among States, Less Than 1 Percent of the Total
This Year's 5,182 Measles Cases Exceed 2018 Through 2025 Combined. The Elimination Review Is Due This Month.
CMS Proposes Dropping the Obstetric Training and Quality Rules Hospitals Must Meet on Jan. 1
Medicare's Final 2027 Fee Schedule Cuts the Conversion Factor 2.31 Percent. Our Math Shows Visits That Billed G2211 Lose More.
More in Policy
Seven of the Eight Health Measures on the Ballot Are Decided. Colorado's Is Still Too Close to Call.
Missouri kept its abortion-rights amendment, Idaho its ban, and South Dakota rejected a Medicaid trigger. Colorado's Proposition 135 led but was uncalled.
Medicare Will Pay ASP Minus 28 Percent for 340B Drugs in 2027 and Add 619 Procedures to the Surgery Center List
CMS's final 2027 outpatient rule cuts 340B drug payment, moves 637 services off the inpatient-only list and adds 619 procedures to the ASC list.
Health Is on the Ballot in Seven States Today. Here Is What Each Measure Would Change for Physicians.
Seven states vote Nov. 3 on eight health measures: abortion, Medicaid expansion, minors' gender care, clinic spending and research bonds.
South Dakota Votes on Tying Medicaid Expansion to a 90 Percent Federal Match. Its Sponsors and Its Ballot Language Disagree on the Effect.
Amendment I would end South Dakota's duty to cover 31,000-plus expansion adults if the federal match drops below 90 percent. Sponsors dispute the wording.
Stand-Alone Part D Premiums Could Rise to $51 a Month in 2027. Expect Plan Switches Before Dec. 7.
KFF finds 10.4 million stand-alone Part D enrollees face higher 2027 premiums if they stay put, and no zero-premium plans remain. CMS projected $36.
CMS Finalizes Its Organ Procurement Rule. The Declaration of Death Stays With the Hospital Physician.
The Oct. 30 rule defines the unsound practices that let CMS decertify an organ procurement organization at once and stops counting research pancreata.
HHS Finalizes Section 504 Rule Excluding Gender Dysphoria From Disability Protections. It Takes Effect in January.
The rule, effective Jan. 2, writes the exclusion into disability rules for HHS-funded programs. A 2022 appeals ruling points the other way in five states.
ACA Open Enrollment Starts Nov. 1 With Benchmark Premiums Up 13 Percent. Expect Your Patients' Coverage to Shift in January.
HealthCare.gov opens Nov. 1 after a 26 percent benchmark jump this year. Insurer exits and lost subsidies mean more patients will switch or drop plans.
A Judge Blocked CMS's Narrower Medically Frail Test for Medicaid's Work Rule. The 12-Month Lookback Stands.
A judge ruled Oct. 29 that CMS cannot make frail Medicaid patients prove their illness impairs work. Records over 12 months old can still be rejected.
The CDC Is Taking Nominations for Its Vaccine Advisory Committee. Applications Are Due Dec. 31.
An Oct. 30 notice seeks nominees for ACIP, which has up to 19 seats and has not met in 2026. Thirteen appointees remain blocked by a court order on appeal.
HHS Lets Pharmacies Compound BPC-157 and Five Other Peptides. None Is FDA-Approved.
An HHS policy filed Oct. 28 shields 503A compounding of six unapproved peptides if sourcing, labeling and reporting rules are met. Comments close Nov. 13.
Medicare's 2027 Dialysis Rule Sets the Base Rate at $297.52 and Folds In Phosphate Binders
CMS's Oct. 28 final rule raises dialysis payments 2.7 percent, adds $12.85 for phosphate binders and extends low-volume payments to 1,489 facilities.
The FDA Lays Out How One Gene-Editing License Could Cover Many Patients' Mutations
An Oct. 27 FDA draft would let one license cover many patient-specific gene-editing variants, adding new ones on lab data. Comments are due Nov. 27.
The CDC's Chief Medical Officer Is Leaving After Less Than Five Months. Satish Pillai Steps In.
Jennifer Shuford, the former Texas health commissioner, leaves the CDC on Nov. 12, the latest senior exit since 2025. Satish Pillai is acting.
Idaho Votes Nov. 3 on Repealing Its Abortion Ban. Here Is What Proposition 1 Would Change for Physicians.
Proposition 1 would create a right to abortion up to fetal viability and in emergencies that threaten a patient's health, and bar discipline or prosecution of clinicians who advise or refer. Idaho lost a net 35 percent of its obstetricians between 2022 and 2024.
HHS's Kidney Care Plan Targets Dialysis Chains and Nephrologist Ties. None of Its 23 Recommendations Has a Deadline.
Released Oct. 20, the plan flags nephrologist directorships and post-contract limits and urges CKD screening. Its 23 recommendations set no dates.
Marketplace Patients Would Have to Re-Verify Each Year to Keep Subsidies Starting in 2028
An Oct. 23 CMS proposed rule would withhold premium tax credits until income, immigration status and other criteria are verified, and re-enroll without subsidies anyone who skips annual re-verification. The first verification window opens Aug. 1, 2027.
FDA Launches a Cross-Center Neuroscience Program. Alzheimer's Prevention Is Its First Project.
The Food and Drug Administration announced the Neuroscience Advancement and Innovation Nexus on Oct. 22, covering neurologic and psychiatric disorders, substance use and pain. Its first initiative targets prevention trial design in Alzheimer's. No budget, guidance or timeline came with it.
CMS Details Nearly $249 Million for Rural Alaska and $219 Million for Georgia. Here Is Where the Money Goes.
Rural Health Transformation Program releases on Oct. 22 and Oct. 23 list 254 Alaska projects, from village telehealth to portable X-ray, and Georgia plans for recruitment, residencies and mobile clinics across 126 counties. Neither gives application terms.
Mississippi Gets $32 Million From the Rural Health Fund to Recruit Physicians and Open Three Psychiatric Emergency Units
CMS announced 60 Rural Health Transformation awards on Oct. 21 for physician recruitment, clinical training and three psychiatric emergency units beside hospital emergency departments. The release does not name recipients, so rural physicians should ask their own hospitals.
A Bipartisan House Bill Would Delay the 340B Rebate Model. The Pilot Is Set to Start Jan. 1, 2027.
H.R. 10770 would keep 340B discounts up front through Dec. 31, 2028, pausing a pilot that makes safety-net providers pay full price and wait for rebates. Hospitals have also sued again. Nothing changes unless Congress or a court acts.
The Patients First Act Would Tie Medicare Physician Pay to Inflation Minus One Point and Replace MIPS
H.R. 9693, now with 65 bipartisan cosponsors, would index annual updates to the Medicare Economic Index minus 1 percentage point and shrink the MIPS adjustment to plus or minus 2 percent for five years. It remains in committee.
HHS Sends a Peptide Compounding Policy to the White House. It Would Be Permission, Not Approval.
The Oct. 14 filing would reportedly let pharmacies temporarily compound BPC-157 and other popular peptides under enforcement discretion. FDA staff scientists have said none has been studied enough to establish safety and effectiveness.
Medicaid's Work Rule Takes Effect by Jan. 1. Here Is What States May Ask Physicians to Document.
CMS's optional three-tier framework for the medically frail exclusion sends unresolved cases to individual review, where states may seek provider records. A federal judge hears the states' challenge on Oct. 22.
CMS Proposes 90-Day Provider Directory Checks for Medicare Advantage. Your Listing Is Part of It.
The Oct. 16 proposed rule would make plans verify every listed physician at least every 90 days, flag listings they cannot confirm and write directory upkeep into provider contracts. Comments are due Dec. 15.
House Members Press CMS to Drop the Employees-Only Rule for Remote Monitoring. Check Your Vendor Contract Before the Final Fee Schedule.
A bipartisan letter from 32 House members opposes the proposal to pay for remote patient monitoring only when the billing practice's own employees deliver it. The final 2027 rule, effective Jan. 1, would settle it.
DOJ and HHS-OIG Set One Door for Criminal Health Care Fraud Self-Disclosures. Know Who Holds the Key in Your Practice.
Under a joint policy signed Oct. 15, a company that self-discloses potentially criminal conduct to the Justice Department's Health Care Fraud Section gets the benefits of the HHS-OIG protocol too. A disclosure to OIG alone generally will not count with DOJ.
CVS Will Pay $315 Million Over Controlled Substance Prescriptions. Expect More Pharmacist Calls About Yours.
The Justice Department said on Oct. 13 that CVS will pay $315 million and agree to monitor prescribers suspected of illegal prescribing. CVS admits no wrongdoing, but the red flags the government listed are the prescriptions most likely to be questioned.
Treasury Proposes Narrower Premium Tax Credit Rules. Comments Are Due Nov. 30, and Your Marketplace Patients Are Affected.
The Oct. 15 proposal would carry out the 2025 law's limits on Marketplace subsidies: fewer lawfully present immigrants eligible from 2027, verification before credits from 2028 and no cap on paying back excess advance credits. Comments close Nov. 30.
CMS Can Now Exclude Physicians From Medicare and Medicaid. The Inspector General Keeps the Same Power.
A Federal Register notice published Oct. 14 gives the CMS administrator the HHS secretary's permissive exclusion authority, effective immediately. Two agencies can now bar a physician from federal health programs, and CMS has not said how it will use the power.
CDC Cancels Its Vaccine Advisers' October Meeting, the Third Called Off This Year. Here Is What Stays in Force.
The Advisory Committee on Immunization Practices has not met since a federal judge blocked 13 of its members in March. A federal appeals court heard the government's appeal on Oct. 6 and has not ruled.
DEA Moves to Schedule 7-OH and a Second Kratom-Derived Opioid. The Control Would Apply Above a Threshold.
A DEA notice published Oct. 14 would place 7-hydroxymitragynine and mitragynine pseudoindoxyl in Schedule I for two years when a product is above 1 mg per gram or its mitragynine ratio is below 100. The order cannot come before Nov. 13.
FDA Launches a Rare Disease Framework Initiative. Comment Slots for the Oct. 28 Meeting Close Oct. 20.
The FDA announced on Oct. 14 a plan to tailor rare disease drug review to each disease and product. Written comments go to docket FDA-2026-N-12214 through Dec. 11, and clinicians are named among the groups it wants to hear from.
HHS Wants Evidence on Step Counts and Muscle Strengthening for the Physical Activity Guidelines. Comments Close Nov. 12.
A Federal Register notice published Oct. 13 asks for evidence to inform a 2027 supplement to the 2018 Physical Activity Guidelines that would add federal step-count and muscle-strengthening guidance. The docket is HHS-OASH-2026-0463.
Federal Funding for Full Medicaid Ended Oct. 1 for Refugees, Asylees and Other Lawfully Present Noncitizens. Check Your Denials.
Under CMS guidance, federal matching funds for full Medicaid and CHIP now go to a narrower group of noncitizens, and emergency Medicaid is matched at each state's regular rate. Whether a patient keeps coverage now depends heavily on the state.
Four PBMs Now Manage 75 Percent of the Market, an AMA Report Finds. It Shows Concentration, Not Prices.
The AMA's September analysis finds 94 percent of local PBM markets highly concentrated, up from 82 percent in 2022. The study is descriptive and comes from a physician advocacy group; the practical stake is in your prior authorization workload.
The $50 Billion Rural Health Fund Is Reaching Clinicians. Nebraska Reports Contracts in 51 Counties.
CMS announced more than $177 million for Nebraska and $2.3 million for two Missouri workforce projects on Oct. 13. Recruitment, childcare and remote-monitoring money is being directed at the state level, and CMS lists no application path for individual providers.
HHS Wants to Pay Physicians for Vaccine Injury Reports. Here Is the Medicare Code Already on the Table.
HHS said Oct. 8 that CMS has proposed paying physicians who report suspected vaccine injuries to VAERS and that EHRs will have to capture them. The only matching CMS proposal on record, add-on code GADV1, pays for evaluation time and does not mention VAERS.
Medicare's 2027 Fee Schedule Would Cut the Conversion Factor and Turn G2211 Into a Percentage Modifier. Model It Before the Final Rule.
CMS proposed 2027 conversion factors down 1.19 percent and 1.68 percent, a 16 percent modifier in place of G2211 and half payment for some same-day visits billed with modifier -25. Comments closed Sept. 14, and the final rule is still pending.
The 2027 Medicare Advantage Star Ratings Are Out. New Drug Safety Measures Will Reach Your Prescribing.
CMS published the 2027 Star Ratings on Oct. 8: 37 percent of drug-plan contracts earned four stars or more, down from 44 percent. New opioid-benzodiazepine and anticholinergic measures and triple-weighted outcome measures will shape plan outreach to practices.
The FDA Is Asking for Public Input on Ibogaine Trial Design. Comments Close Nov. 20.
On Oct. 5, the Food and Drug Administration asked for comment on how early-phase ibogaine trials should run, including a starting dose of no more than 10 mg/kg and inpatient cardiac monitoring. Comments are due Nov. 20. This is trial design, not an approval.
Drugmakers Sue to Stop Medicare's GLOBE Model Before It Reaches the Infusion Chair
PhRMA asked a federal court on Wednesday to vacate the international reference pricing model for Part B drugs. Until a judge rules, the model's timeline for practices that bill for infused and injected drugs still stands.
Insurers' Price Files Are Getting a Rewrite. Your Negotiated Rates Will Be Easier to Find.
A final federal rule strips 'ghost' rates out of the Transparency in Coverage files, puts an executive's name on every one, and expands out-of-network data. For physicians, it means commercial rates that employers and competitors can actually compare.
Medicare's GLOBE Model Is Final. Here Is What Changes at the Infusion Chair.
CMS will tie rebates on certain physician-administered Part B drugs to prices in 19 other countries, starting in January for about a quarter of Original Medicare beneficiaries. Manufacturers are the participants, but the billing changes reach practices.
How to Read the Medicare Fee Schedule Without Losing an Afternoon
Every year the proposed rule lands. Here is where to look first and what actually affects your bottom line.
What the Physician Shortage Actually Means for Your Practice
Workforce projections are national. The effects are local. How supply gaps show up in recruiting, compensation, and scope debates.
Price Transparency Has Reached the Exam Room
Federal transparency rules started with hospitals and insurers. The expectations now shape what patients ask physicians, and practices that answer clearly will earn trust others lose.
Why the Same Visit Can Cost More Down the Hall
Site neutral payment would pay the same rate for a service regardless of where it happens. The debate touches hospital finances, independent practice survival, and what patients owe.
Noncompetes Are Being Rewritten One State at a Time
Federal efforts to ban noncompete agreements stalled, but states keep narrowing how they apply to physicians. What that shift means for anyone signing or renegotiating a contract.
Inside the Scope of Practice Fight Physicians Keep Losing and Winning
Every legislative session brings new bills expanding what nonphysician clinicians can do. A clear eyed look at the arguments, the stakes for patients, and how physicians can engage credibly.
How to Build a Telehealth Program on Temporary Rules
Much of Medicare telehealth still runs on short term extensions. Practices that plan for several policy outcomes will keep virtual care stable no matter how Congress acts.
What Information Blocking Rules Mean for Your Inbox
Federal rules now expect patients to receive notes and results quickly, sometimes before their physician reviews them. Here is how practices can comply without leaving patients alone with the data.
Should Physicians Unionize? A Balanced Look at a Growing Movement
Residents and some employed attendings have turned to collective bargaining. The reasons are real, the tradeoffs are too, and the choice depends on how and where you practice.
How to Get a State Legislator to Return Your Call
Most health policy that reaches your clinic is written in state capitols. Physicians who build relationships early, and bring clinical stories, have more influence than they assume.
Medicaid Churn Is Quietly Reshaping Your Patient Panel
Patients cycling on and off Medicaid lose continuity, miss follow up, and leave practices with unpaid visits. Understanding why churn happens helps practices keep patients covered and cared for.
Across The Script Pad
Home →
Pimicotinib Gives Tenosynovial Giant Cell Tumor a Third Oral Drug, and the First Taken Once a Day
The FDA approved pimicotinib on Nov. 10 after a 56 percent week-25 response rate, the third CSF-1R inhibitor for TGCT and the only one dosed daily.
How Does Oral Orforglipron Compare With Tirzepatide for Obstructive Sleep Apnea?
Orforglipron cut sleep apnea events 12 to 13 an hour more than placebo in ATTAIN-OSA, against 20 to 24 on tirzepatide's label, largely tracking weight loss.
Seventeen Physician Specialties Are Now Severe Shortages at One in Five VA Facilities or More
The VA inspector general's 2026 survey found severe physician shortages at 135 of 139 facilities, with radiology, urology and anesthesiology rising most.
The CDC's Ebola Entry Ban Reaches Its Eighth Order in 176 Days, Still Limited to Three Countries
CDC renewed its Ebola entry ban on Nov. 10 as Congo's confirmed cases reached 10,879, but it still omits Kenya and Nigeria, which had travel-linked cases.