Heads up: this issue is from February 11, 2026. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.
President Trump on Tuesday signed into law a funding bill that ended a short-term partial government shutdown, funds the Department of Health and Human Services, extends telehealth and virtual care flexibilities, and enacts pharmacy benefit manager reform. What's not to like? See the next paragraph.
The minibus package did not revive Affordable Care Act enhanced premium tax credits that expired December 31, 2025. Nor did it include provisions from President Trump's healthcare plan to send money directly to consumers' health savings accounts.
The Senate on January 29 voted 71-29 to advance the package, and the House on February 3 voted 217-214 to send the bill to President Trump for his signature.
The bill includes the following:
- Telehealth--There will be a two-year extension of Medicare telehealth flexibilities. This means all provisions in effect before January 31, 2026, are reinstated. The provisions are slated to end December 31, 2027. The bill also requires HHS to issue guidance within one year on the furnishing of telehealth services to individuals with limited English proficiency.
- GPCI Floor--Fortunately for you people in more rural areas, this provision once again returns. I have lost count of how many times this provision has been extended.
- Hospital At Home--There is a five-year extension of the Acute Hospital Care at Home waiver. Acute Hospital Care at Home is extended through September 30, 2030.
- Cardiopulmonary Rehab--In-home cardiopulmonary rehabilitation flexibilities are extended through January 1, 2028.
- Drug Pricing Reforms--The government spending bill includes bipartisan prescription drug pricing reforms in a provision, known as Q1/Q2, which was previously included in the Lower Costs, More Transparency Act, according to Patients for Affordable Drugs Now. The Q1/Q2 provision would require the U.S. Food and Drug Administration to provide clearer guidance on ingredient differences in drugs, helping generic manufacturers bring more affordable alternatives to the market, according to P4ADNow.
- Multi-cancer Detection Screens--Medicare will enhance coverage for these.
- Disproportionate Share Hospitals--The spending package preserves funding to the Medicaid disproportionate share hospital (DSH) program, which was facing cuts. Those cuts are now averted until October 2027. The program provides additional support to hospitals with high Medicaid patient volumes.
- Site Neutrality--CMS will require hospital outpatient departments located outside the main campus to obtain and bill with a new National Provider ID. These departments must then attest to their compliance.
- Generic Drug Identification--This section modifies the Federal Food, Drug, and Cosmetic Act to provide manufacturers with transparency into the generic drug application process. It specifically requires FDA, upon request, toshare whether a prospective formulation is qualitatively and quantitatively the same as an existing reference drug. This includes data on whether the proposed formulation matches the reference drug in ingredients and amounts. If such metrics differ, the FDA must notify manufacturers of the ingredients and amounts that differ. The HHS Secretary may not rescind such a determination of equivalency unless an application’s formulation changes or an error is identified in the application process. These provisions come into effect immediately after enactment
- PBM Reform--These are part of the bill. Expect more reform in the future.
- PBMs shall not collect remuneration other than bona fide service fees, except rebates and discounts that lower the prices of Part D drugs.
- PBMs and Plan Sponsors contracted with Medicare must allow any pharmacy that meets standard contract terms to participate as 'any willing pharmacy'. This provision also strengthens the reporting of participating pharmacies.
- PBM revenue would be separated from the price of a drug in Medicare Part D, reducing incentives to steer patients toward higher-priced drugs. There will be increased oversight of formulary lists, DIR fees, and pricing.
- There will be detailed oversight of contracts, subcontractors, and who receives compensation from PBMs. PBMs are required to report pricing and other data to Part D plan sponsors and to pass 100% of rebates to Medicare plans.
To read the bill, check it out here.
