April Government Affairs—What You Need to Know

ACOI Asks Administration to Rescind NIH Policy  

As ACOI previously reported, on February 7, the Trump administration issued a policy that dramatically cuts National Institutes of Health (NIH) grants that support research institutions. Specifically, for any new grants, as well as existing awards, the NIH will cap the rate grants pay for “indirect funding” at 15 percent.  

A federal judge has issued a nationwide preliminary injunction that blocks the NIH from instituting the 15 percent cap. U.S. District Judge Angel Kelley had temporarily blocked the cuts in February and, on March 5, issued a preliminary injunction that puts the cuts on hold for a longer period while legal challenges proceed.  

On March 5, ACOI joined other medical societies on a letter to the NIH asking that the policy be rescinded. The letter was delivered to the NIH the same day as the Senate confirmation hearing for Jayanta Bhattacharya, MD, who has been nominated to serve as NIH director. During the hearing, Senators Susan Collins (R-ME) and Patty Murray (D-WA) voiced objections to the 15 percent cap.

The letter emphasized the importance of indirect cost rates for sustaining scientific work, and expressed concern the new policy circumvented administrative procedures that allow for public comment and a regulatory impact analysis.  

Relatedly, in accordance with the Presidential Memo on “Radical Transparency About Wasteful Spending” a list of terminated grants awarded through the Department of Health and Human Services, including NIH grants, is now publicly available.

Congress Passes CR without Physician Pay Cut Relief  

Earlier this month, congressional lawmakers passed up yet another opportunity to provide physicians relief from a 2.83 percent Medicare cut that took effect on January 1, 2025. Congress approved a continuing resolution (CR) to keep the federal government funded until September 30, 2025. That CR had been considered the most likely vehicle for addressing the payment cut.  

After Congress failed at the end of 2024 to stop the payment cut from taking effect, the physician community was hopeful lawmakers would step in to reverse some or all of the cut early in the new Congress. By not attaching a “doc fix” to the CR, it is unclear if or when physicians will see relief this year from the latest drop in Medicare reimbursement.  

Physician payment continues to decline while practice costs rise. It is projected that the Medicare Economic Index — a measure of practice cost inflation — will be 3.5 percent this year. When adjusted for inflation in practice costs, physician Medicare reimbursement has now been reduced by 33 percent since 2001.

Rep. Greg Murphy (R-NC), the lead sponsor of the “Medicare Patient Access and Practice Stabilization Act of 2025" (H.R. 879), said he has received a commitment from House Speaker Mike Johnson to address the Medicare physician payment cut as part of a bill that Republicans hope to pass to extend the tax cuts and boost border security. Even with a commitment from the House leader, timing is unclear on a tax bill that would move under the rules of reconciliation and, therefore, require only a simple majority vote in the Senate. Addressing physician payment is complicated by cost, which could range from $1-$2 billion just to stop the 2.83 percent cut, as well as opposition by Democrats, and potentially some Republicans, of extending tax cuts if it means cuts to other programs like Medicaid.  

In the weeks leading up to the vote on the CR, ACOI joined other medical societies in a letter to House and Senate leaders requesting passage of H.R. 879.  

ACOI thanks those physician members who made their voices heard on this important issue. More than 80 ACOI members contacted their representatives in February through the ACOI Action Center.  ACOI will continue to press Congress to halt the Medicare physician payment cut and encourages ACOI members to continue to make their voices heard by contacting lawmakers.  

MIPS Data Submission Deadline Extended and New Hardship Exception

The Centers for Medicare and Medicaid Services (CMS) has announced it will extend the Merit-based Incentive Payment System (MIPS) data submission window for the 2024 performance period for two weeks — March 31 until April 14, 2025, at 8 pm ET.  

CMS will also hold physicians harmless from MIPS penalties as a result of the nationwide IV fluid shortage. Physicians who have been affected by the shortage will need to apply for an Extreme and Uncontrollable Circumstances (EUC) hardship exception.  

• Physicians will be able to submit an EUC hardship exception application between March 31 and April 14, 2025, to avoid a MIPS penalty of up to -9 percent if they were affected by the shortage.  
• Using the EUC application, physicians can request reweighing of all four MIPS categories.
• CMS will not reweigh any performance category for which it has already received data.
• The hardship exception will apply to the 2024 performance period, which will adjust Medicare payments in 2026.  

Because the MIPS cost performance category relies entirely on claims-based measures that do not require submission from physicians or groups, it is recommended that physicians request reweighting of the cost category if a physician or group needed to conserve IV fluids, use alternatives, restrict access to elective surgery or take any other measures due to the nationwide IV fluid shortage.

CMS has created a fact sheet with links to additional information and resources.  

Telehealth Flexibilities Extended

Included in the continuing resolution signed into law on March 15, 2025 is an extension of the COVID-era telehealth flexibilities through September 30, 2025. Those flexibilities include:

• Medicare patients can receive telehealth services for non-behavioral/mental health care in their home;
• No geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services;
• Telehealth services can be provided by all eligible Medicare providers;
• Federally Qualified Health Centers and Rural Health Clinics can serve as Medicare distant site providers for non-behavioral/mental telehealth services;
• An in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, is not required; and  
• Non-behavioral/mental telehealth services in Medicare can be delivered using audio-only communication platforms.  

Learn more about recent federal legislation and policies related to telehealth.