The Regulator

CMS proposed cutting Medicare’s physician payment rate for 2027, with most doctors facing a bigger cut than physicians in accountable care organizations, and the public has until September 14 to comment. The Centers for Medicare and Medicaid Services published its Calendar Year 2027 Physician Fee Schedule proposed rule (CMS-1848-P) on July 14, 2026. It would cut the conversion factor, the dollar multiplier behind every Medicare physician payment, from 33.40 dollars to 32.84 dollars for most clinicians, a 1.68 percent reduction, and from 33.57 dollars to 33.17 dollars for clinicians in qualifying alternative payment models, a smaller 1.19 percent cut; both changes reflect a 0.53 percent bump for updated work relative value units offset by the scheduled expiration of a temporary statutory increase. The rule would also change how CMS pays for an office visit billed the same day as a procedure with a global period, paying the more expensive service at 100 percent and the other at 50 percent, and would let Accountable Care Organizations start waiving Medicare Part B cost sharing for patients on April 1, 2027. Comments are due September 14, 2026, ahead of a final rule expected around November 1 for January 1, 2027 implementation. Confidence: High on the conversion factor figures and dates; Low on the rule’s ultimate dollar impact on Medicare spending, since CMS’s fact sheets do not include an aggregate estimate. Sources: Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule fact sheet, CMS, Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule, Medicare Shared Savings Program Proposals fact sheet, CMS.

HHS finalized the removal of a 2024 rule that required foster care agencies to guarantee placements for LGBTQI+ children, closing out a regulation a federal court had already vacated. The Administration for Children and Families, part of HHS, published a final rule July 14, 2026 rescinding the Designated Placement Requirements Under Titles IV-E and IV-B for LGBTQI+ Children, effective the same day. The 2024 rule would have required every state and tribal title IV-E and IV-B agency to guarantee a placement for foster children who identify as LGBTQI+ when the child requested or would benefit from one, but the U.S. District Court for the Eastern District of Texas vacated the rule before it ever took effect, and ACF said it is removing the language from the Code of Federal Regulations to give the public and regulated entities clarity. The change has no immediate operational impact on states, since the requirement was never enforced, but it permanently closes out the 2024 policy. Confidence: High on the effective date and the court history; Low on whether any states had begun voluntary compliance with the 2024 rule despite the vacatur, since ACF’s notice does not address it. Source: Designated Placement Requirements Under Titles IV-E and IV-B for LGBTQI+ Children; Rescission, Federal Register.

The FDA finalized new guidance for psychedelic drug clinical trials and opened a comment window on how clinics should safely deliver approved psychedelic therapies, both published the same day. The Food and Drug Administration on July 14, 2026 announced final guidance titled “Psychedelic Drugs: Considerations for Clinical Investigations,” spelling out trial-design expectations for compounds like psilocybin and MDMA, and separately requested public input on training and care-delivery models for administering FDA-approved psychedelic therapies in outpatient clinical settings, with comments due August 13, 2026. The request for information traces to President Trump’s April 18, 2026 executive order “Accelerating Medical Treatments for Serious Mental Illness,” and FDA will hold a public hearing on the broader therapeutic use of psychedelic drugs September 14, 2026, with registration due August 21. Confidence: High on the publication dates and deadlines; Low on when any psychedelic drug will actually reach full FDA approval, since none has yet cleared a new drug application. Sources: Psychedelic Drugs: Considerations for Clinical Investigations; Guidance for Industry; Availability, Federal Register, Request for Information, Training and Care Delivery Models for Safe Administration of Potential FDA-Approved Psychedelic Therapies in Ambulatory Clinical Settings, Federal Register.

Hawaii’s governor signed a law that could erase 91 million dollars in medical debt for up to 50,000 residents, funded by a 500,000 dollar state investment. Governor Josh Green signed Senate Bill 3025 (Act 220) on July 12, 2026, directing the state’s Office of Wellness and Resilience to run a Medical Debt Acquisition and Forgiveness Program that buys bundles of unpaid medical debt from collectors at steep discounts, then cancels it. Green signed two companion bills the same day: House Bill 1864 (Act 218) requires insurers to cover fertility preservation services for patients starting medically necessary treatment that may cause infertility, effective for policies issued or renewed after December 31, 2026, making Hawaii the 22nd state with that mandate, and House Bill 1969 (Act 219) expands colorectal cancer screening access, including no-cost follow-up colonoscopies, for uninsured and underinsured residents in a state where the disease kills roughly 260 people a year. Confidence: High on the bill numbers and dollar figures; Medium on the eventual number of residents helped, since actual debt relief depends on how much medical debt the state can buy and at what discount. Source: Gov. Green Signs Legislation to Expand Access to Healthcare and Relieve Medical Debt, Office of the Governor of Hawaii.

A House committee marks up three bills today targeting the pill presses and precursor chemicals cartels use to mass-produce counterfeit fentanyl pills domestically. The House Energy and Commerce Committee’s Subcommittee on Health holds a markup July 15, 2026 on the PRESS Act (H.R. 7184), which would restrict imports of tabletop pill presses and unlisted precursor chemicals; the Fight Illicit Pill Presses Act (H.R. 5880), which would require serial numbers on pill-press machines and their critical parts and criminalize removing them; and the Stop Pills That Kill Act (H.R. 8005), which would extend an existing enhanced criminal penalty for equipment used to make methamphetamine to equipment used to make fentanyl, its analogues, or counterfeit pills, and require DEA to publish an annual accounting of seized pill presses and related prosecutions. Confidence: High on the bill contents and markup date; Low on whether any will reach a House floor vote this year, since subcommittee passage does not guarantee scheduling. Source: Chairmen Guthrie and Griffith Announce Hearing to Discuss Legislation that Protects American Communities from Emerging Illicit Drug Threats, House Committee on Energy and Commerce.

HHS’s Inspector General cleared a “food as medicine” program for the first time, telling one health center it will not face kickback penalties for giving free produce to patients with chronic conditions. In Advisory Opinion 26-16, posted July 14, 2026, the HHS Office of Inspector General reviewed a proposal from a federally qualified health center to give free produce boxes or healthy-food vouchers, plus nutrition counseling and lab testing, to low-income patients with specified chronic conditions. OIG found the arrangement technically implicates the federal Anti-Kickback Statute and the Beneficiary Inducements Civil Monetary Penalty law, since free food counts as remuneration tied to federally reimbursable care, but said it would not impose sanctions because the program’s safeguards make the fraud risk low, the first time OIG has cleared this kind of food-as-medicine model in a published opinion. The opinion binds only the requesting health center, not any other provider, but it gives other FQHCs and health systems building similar nutrition programs a public template for how OIG evaluates the same fact pattern. Confidence: High on OIG’s conclusion; Low on which specific chronic conditions or dollar thresholds qualify, since OIG’s public summary does not disclose those details. Source: Advisory Opinion 26-16, HHS Office of Inspector General.