Congressional Shift Could Shape Federal Priorities for Health IT, AI, and Data Privacy. The shift to Democratic party control of both the US Senate and House of Representatives following the midterm elections could influence the direction of federal policy and oversight involving health information technology (IT), interoperability, artificial intelligence (AI), and privacy and security. Democratic committee leadership could place greater emphasis on accelerating health information exchange, improving patient access to electronic health information, reducing administrative burden, and examining the implementation of existing federal interoperability requirements. AI oversight may also become a more prominent issue, specifically related to transparency, algorithmic bias, patient safety, accountability, and the appropriate use of AI in clinical and administrative workflows. Privacy and cybersecurity policy could also become areas of increased legislative interest for strengthening existing federal protections to address the expanding use of health data by consumer applications, technology companies, and other entities outside the Health Insurance Portability and Accountability Act’s traditional regulatory provisions. These developments will be important for WEDI’s members as Congress considers the future direction of health IT policy, standards adoption, responsible AI, and the privacy and security framework governing health information.
ONC Launches Industry ePA Testing Events in Partnership with CMS. The Office of the National Coordinator for Health Information Technology (ONC), in partnership with the Enters for Medicare & Medicaid Services (CMS), is launching industry testing events to advance electronic prior authorization (ePA) interoperability. Participant matching and collaborative testing are available for payers, providers, electronic health record developers, intermediaries, and other industry partners. To expand nationwide ePA collaborative testing, ONC has engaged the support of the MITRE-led Health Federally Funded Research and Development Center and the Drummond Group to support stakeholder recruitment, readiness discussions, participant matching, and testing coordination.
The testing platform will include scenarios and supporting resources coordinated for each event with a focus on the Health Level 7 Fast Healthcare Interoperability Resources® (FHIR®) Da Vinci implementation guides for Coverage Requirements Discovery, Documentation Templates and Rules, and Prior Authorization Support. Testing will take place in 10–12-week sprints and will help identify workflow gaps and technical barriers, with participant feedback and lessons learned informing future testing and implementation activities. Organizations interested in participating can learn more and express interest by November 20.
CMS Makes Changes to the Shared Savings Program in PFS Final Rule, Establishes ePA as MIPS Bonus Measure in 2027. CMS issued the calendar year (CY) 2027 Medicare Physician Fee Schedule (PFS) final rule (CMS-1848-F), which includes changes to the Medicare Shared Savings Program (Shared Savings Program), with the aim of accelerating accountable care service delivery. Key changes to the program include: (i) An increase in the shared savings rate for Level E of the BASIC track from 50% to 60%; (ii) A reduction in the maximum weight used in calculating the positive regional adjustment for lower-spending ACOs participating under the ENHANCED track from 50% to 35%; (iii) An increase in the prior savings adjustment’s scaling factor from 50% to 75%; (iv) Risk adjust the 5% cap on upward adjustments to the historical benchmark; (v) Implement a growth adjustment to the historical benchmark to incentivize new participation; (vi) Reform the ACPT component of the Benchmark update factor; and (vii) Allow ACOs to reduce or eliminate patient Part B cost sharing. Access the CMS Fact Sheet here.
The rule also finalizes the proposal to make the Electronic Prior Authorization measure optional for the CY 2027 performance period/2029 Merit-based Incentive Payment System (MIPS) payment year before requiring it beginning with the CY 2028 performance period/2030 MIPS payment year for standards-based electronic prior authorization.
CMS Issues Enforcement Discretion for use of CPT Codes for Maternity Care. CMS issued a statement of enforcement discretion providing temporary flexibility for HIPAA covered entities (CEs) regarding the use of Current Procedural Terminology (CPT) codes for maternity care services. Beginning January 1, 2027, and continuing through December 31, 2027, this enforcement discretion allows CEs to use 2026 CPT Maternity Care Services codes for billing and payment purposes when episodes of care begin in 2026 and extend into 2027, consistent with applicable payer and health plan business rules. Effective immediately, payers and health plans may issue business rules to providers, clearinghouses, and other trading partners regarding the use of 2026 CPT Maternity Care Services codes for episodes of care spanning 2026 and 2027. Read the Guidance Letter for additional information.
CMS Releases Procedure Code Materials from Fall 2026 ICD-10 Coordination and Maintenance Committee Meeting. CMS released update materials, slide presentations, and recordings for the procedure code portion of the Fall 2026 International Classification of Diseases, 10th Revision (ICD-10) Coordination and Maintenance Committee Meeting held on September 15-16. November 13 is the deadline to submit public comments on proposed new codes, addenda, and revisions being considered for implementation on October 1, 2027. Comments on procedure code topics should be sent to CMS at ICDProcedureCodeRequest@cms.hhs.gov.
CMS Expands CGT Access Model, Building on Early Success. The CMS Innovation Center is expanding the framework of the Cell and Gene Therapy (CGT) Access Model beyond sickle cell disease following early success identified in the first model evaluation report. Specifically, the findings show state buy-in and advantages to CMS-led negotiations, including reduced administrative burden and greater negotiating leverage for state Medicaid programs by pooling beneficiaries. The goal of broadening the model is to give more patients access to cell and gene related therapies. CMS expects to release a Request for Applications for manufacturers to consider outcomes-based agreements for approved therapies. Additional information is available on the CGT Access Model webpage.
South Carolina and White House Launch Project to Strengthen Cybersecurity in Rural Hospitals. South Carolina Governor Henry McMaster and White House National Cyber Director Sean Cairncross launched Project Lifeline 250, a joint federal, state, and private-sector effort to strengthen cybersecurity in rural hospitals in South Carolina. The six-month pilot will connect rural hospitals with technology companies and cybersecurity resources to help identify vulnerabilities, defend against cyberattacks and maintain critical health care services in the event of a cyber incident. The effort brings together the Office of the National Cyber Director, the South Carolina Critical Infrastructure Cybersecurity (SC CIC) program, private-sector partners, federal agencies, and local governments.
NIST Releases Report on Transitioning to Post-Quantum Cryptography Standards. The National Institute of Standards and Technology (NIST) released a report, “Transition to Post-Quantum Cryptography Standards (NISTIR 8547),” that serves as guidance on transitioning to its post-quantum cryptography (PQC) standards released in August 2024. The report outlines NIST’s approach and timelines for migrating from quantum-vulnerable algorithms to quantum-resistant standards. It is intended to be the primary technical document for federal agencies, industry partners, and standards organizations on this work. While quantum computers that threaten current encryption are still in development, the transition to PQC is urgent.