The Regulator

CMS will let up to 12 percent of the nation’s highest-performing nursing homes skip large parts of their federal inspection starting September 8, cutting survey time roughly in half for facilities that qualify. The Centers for Medicare and Medicaid Services announced July 16, 2026 that it will roll out a new Risk-Based Survey approach nationwide, letting state survey agencies give a streamlined, shorter inspection using fewer surveyors and reviewing fewer residents to nursing homes with a five-star overall quality rating, at least a three-star staffing rating, no recent citations for actual harm or immediate jeopardy, and no staffing waivers or recent ownership changes. CMS says the change frees up chronically underfunded state survey agencies to focus on complaint investigations and higher-risk facilities, citing survey backlogs, growing complaint workloads, and stagnant federal survey funding. The National Consumer Voice for Quality Long-Term Care, an advocacy group, said the change means less direct observation, fewer resident interviews, and a higher chance that problems go undetected at facilities that get the lighter inspection. Confidence: High on the eligibility criteria and September 8 start date; Medium on how many facilities will actually qualify once state agencies apply the criteria, since CMS’s 12 percent figure is a national projection. Sources: CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach, Centers for Medicare and Medicaid Services, CMS Announces Plans to Reduce Oversight of Some Nursing Homes through “Risk-Based Survey” System, The Consumer Voice.

A government watchdog found the ACA health insurance marketplace let agents and brokers make at least 160,000 unauthorized enrollment or plan changes in a single year, with confirmed complaints about the practice more than quadrupling since 2023. The Government Accountability Office reported July 13, 2026 that the Centers for Medicare and Medicaid Services lacks sufficient controls to verify a consumer actually authorized an agent or broker to enroll them or switch their plan, that multiple agents and brokers can access the same consumer’s records without restriction, and that CMS does little to notify consumers when their plan has changed. GAO found confirmed unauthorized-enrollment complaints grew more than fourfold from 2023 through 2025 and identified at least 160,000 federal marketplace applications in plan year 2024 alone with likely unauthorized changes, changes that can leave people with a plan that does not cover their doctors or drugs or facing an unexpected tax bill. GAO recommended CMS require stronger verification, such as a one-time passcode, before an agent or broker can act on a consumer’s account; the Department of Health and Human Services agreed and says it is considering options for the 2027 open enrollment period without committing to specifics. Confidence: High on the report’s own figures; Low on when or whether CMS will implement stronger verification, since HHS has not finalized a plan. Source: Health Insurance Marketplaces: CMS Needs Stronger Controls to Prevent Unauthorized Actions by Agents and Brokers, U.S. Government Accountability Office.

Hospitals are fighting a federal estimate that a new 340B drug-rebate system would cost them only 5 hours a week to administer, arguing the real burden is far higher and could determine whether hospitals even join the pilot. The Health Resources and Services Administration’s proposed 340B Rebate Model Pilot Program would switch participating drug manufacturers and covered entities, hospitals and clinics that serve low-income patients, from upfront point-of-sale discounts to after-the-sale rebates on 340B drugs. In comments filed July 15, 2026, the American Hospital Association told HRSA its 5-hour-per-week burden estimate badly understates the real cost, since the claims and reimbursement data needed to request a rebate live in separate billing systems that must be manually reconciled, work AHA says will require new staff, new technology, and new training before any hospital can safely participate. Confidence: High on AHA’s position and filing date; Low on whether HRSA will revise its burden estimate or the pilot’s design, since the program has not been finalized. Sources: 340B Rebate Model Pilot Program, Health Resources and Services Administration, AHA Responds to HRSA 340B Rebate Model Pilot Program Information Request, American Hospital Association.

A House subcommittee voted to send three anti-fentanyl bills targeting pill presses to the full Energy and Commerce Committee, advancing legislation that would let the Drug Enforcement Administration track pill-press equipment the way it already tracks controlled substances. The House Energy and Commerce Committee’s Subcommittee on Health held a markup July 15, 2026 and forwarded three bills by voice vote: 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, advanced as amended), which would extend an existing enhanced criminal penalty for methamphetamine-making equipment to equipment used to make fentanyl, its analogues, or counterfeit pills. All three now go to the full committee, though no floor vote is scheduled. Confidence: High on the markup date and vote outcome; Low on whether any bill reaches the House floor this year. 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.

A family planning provider group and the American Civil Liberties Union asked a federal judge to strike down new Trump administration screening rules for Title X family planning grants, arguing HHS is using vague “agency priorities” language to disqualify providers on ideological grounds. In National Family Planning and Reproductive Health Association et al. v. Kennedy et al. (M.D. Pa. No. 1:26-cv-01684), filed June 18, 2026, plaintiffs argue the Department of Health and Human Services’ new review process for Title X grants, the only federal program dedicated to family planning services like birth control and cancer and sexually transmitted infection screening for low-income patients, violates the Administrative Procedure Act. Plaintiffs filed a motion for summary judgment July 15, 2026, asking the court to rule without a trial that the new conditions are unlawful. Confidence: High on the case posture and filing date; Low on how or when the court will rule, since briefing is still underway. Source: National Family Planning & Reproductive Health Association et al. v. Kennedy et al., Health Care Litigation Tracker, Georgetown University O’Neill Institute.

A medical device maker will pay 550,959 dollars after admitting its sales staff doctored medical records to justify Medicare claims for compression devices patients did not need. The Department of Justice and HHS’s Office of Inspector General announced that Tactile Systems Technology and its owner agreed to resolve False Claims Act allegations that between January 1, 2019 and December 31, 2024, certain sales personnel fabricated or altered healthcare professionals’ medical records and other clinical documentation used to bill Medicare for pneumatic compression devices, machines prescribed for lymphedema and chronic venous insufficiency patients whose swelling does not improve after four weeks of standard compression therapy. Medicare only covers the devices when a clinician documents that conservative treatment failed first, the documentation requirement prosecutors say Tactile’s staff falsified. Confidence: High on the settlement amount and conduct period; Low on how many individual patients or claims were affected, since the announcement does not break out claim volume. Source: Medical Device Manufacturer and its Owner Agree to Pay $550,000 to Resolve False Claims Act Allegations, HHS Office of Inspector General.