July 2026

     In this issue we feature:

• Executive Summary 
• Federal Advocacy Priorities
• CMS & Regulatory Developments 
• Drug Pricing & Pharmacy Policy 
• Coverage & Clinical Policy 
• Coalition Advocacy  
• Healthcare Transparency & Consolidation
• State Advocacy Update  

Executive Summary

June was another active month for federal and state advocacy, with significant momentum building around Medicare physician payment reform, oversight of CMS innovation models, healthcare transparency proposals, and 340B policy. Congress advanced legislation to improve physician payment stability, held bipartisan discussions on long-term Medicare payment reform, and continued examining prior authorization and healthcare consolidation. At the same time, LUGPA remained actively engaged through coalition advocacy, comment letters, and direct outreach to federal contractors to protect independent urology practices and preserve patient access to specialty care.

Federal Advocacy Priorities

Provider Reimbursement Stability Act (H.R. 8163) Advances in House

At-a-Glance

What Happened
The House Ways & Means Committee unanimously approved the Provider Reimbursement Stability Act (H.R. 8163) by a 44-0 vote, marking a significant milestone for one of LUGPA's top federal advocacy priorities.

Why It Matters
The legislation addresses longstanding flaws in Medicare's physician payment system by modernizing budget neutrality policies and improving payment predictability for physician practices.

Key Policy Signals

• Modernizes Medicare's budget neutrality framework
• Requires periodic updates to practice expense data
• Creates payment stability guardrails to reduce annual reimbursement volatility
• Reflects strong bipartisan recognition that physician payment reform is necessary

LUGPA Takeaway

The unanimous committee vote demonstrates growing bipartisan consensus that Medicare physician payment requires structural reform. LUGPA will continue working with congressional leaders to advance the legislation through the legislative process.

LUGPA Position

LUGPA strongly supports H.R. 8163 and views it as an important step toward creating a more stable and predictable Medicare payment system for independent physician practices.

Ways & Means Advances Rep. Murphy’s Tax-Exempt Hospital Transparency Act

On July 1, the Ways and Means Committee approved Representative Greg Murphy’s (R-NC) Tax-Exempt Hospital Transparency Act (H.R. 9504), which would expand reporting requirements for nonprofit hospitals on IRS Schedule H (Form 990).   Nonprofit hospitals are providing substantially less charity care than private hospitals (2.3% vs 3.8%), and tax-exempt designation is a key criterion for 340B drug eligibility.   The bill would require additional disclosure regarding the financial benefits hospitals receive through their tax-exempt status and 340B net revenue and how those resources are used, including spending on community benefit activities (including charity care for indigent patients), advertising, and certain non-clinical expenditures.

LUGPA wrote a strong endorsement letter, stating that “improved transparency on how these nonprofit hospitals are using their tax advantages and 340B prescription drug profits will encourage a greater focus on community benefit and help deter increased provider consolidation, which only raises costs and hampers competition and patient choice.”   This is the first bill ever reported out of a committee that requires hospitals to disclose their 340B profits.  A link to LUGPA’s letter is available here.

House Energy & Commerce Health Subcommittee Advances Key Health Care Legislation

On June 25, the House Energy & Commerce Health Subcommittee advanced several bipartisan health care bills aimed at increasing transparency and improving patient access to care. Among the measures approved were:

H.R. 9393 – Lower Costs, More Transparency Act of 2026, which would expand hospital and ambulatory surgery center price transparency requirements, strengthen reporting obligations, and improve public access to health care pricing information.

H.R. 9390 – Prices on the Wall Act of 2026, which would require providers to publicly post cash prices for shoppable health care services in a standardized, consumer-friendly format.

H.R. 3514 – Improving Seniors' Timely Access to Care Act, which would streamline prior authorization requirements in Medicare Advantage through electronic prior authorization, increased transparency, and standardized response timelines.

LUGPA Takeaway

LUGPA continues to support efforts that improve transparency for patients on their out-of-pocket obligations.  However, it is concerning that the Lower Cost, More Transparency Act only increases unnecessary administrative burden for providers without providing patients with useful information, such as their out-of-pocket costs.  The reporting requirements on gross charges of ambulatory surgery payments would only arm insurers with leverage to negotiate even lower payment rates.  LUGPA strongly supports bipartisan efforts to modernize prior authorization and improve timely patient access to medically necessary care.

Congressional Hearing Highlights Momentum for Medicare Physician Payment Reform

At-a-Glance

What Happened
The House Energy & Commerce Health Subcommittee held a hearing examining Medicare physician payment, MACRA, MIPS, and broader payment reform.

Why It Matters
Lawmakers from both parties expressed growing concern about declining physician reimbursement, administrative burdens, and financial pressures contributing to physician practice consolidation.

Key Policy Signals

• Broad bipartisan support for tying physician payment updates to the Medicare Economic Index (MEI)
• Continued criticism of the Merit-based Incentive Payment System (MIPS)
• Interest in expanding Alternative Payment Models (APMs)
• Continued support for site-neutral payment reforms

LUGPA Takeaway

The hearing reinforced that physician payment reform remains a bipartisan priority. Many of the issues raised closely align with LUGPA's long-standing advocacy agenda, including annual inflationary updates, reduced administrative burden, and payment stability.

CMS & Regulatory Developments

LUGPA Raises WISeR Model Concerns with Novitas

At-a-Glance

What Happened
LUGPA submitted a formal letter to Novitas regarding implementation challenges associated with CMS's WISeR Model affecting sacral nerve stimulation (SNS) trial procedures (CPT 64561) in Oklahoma, Texas, and New Jersey.

Why It Matters
Member practices reported reimbursement delays, repeated documentation requests, and administrative burdens due to reviewers' difficulty distinguishing temporary SNS trial procedures from permanent implantation services.

LUGPA Recommendations

LUGPA urged Novitas to:

• Issue clearer billing guidance
• Improve reviewer education
• Standardize review processes
• Reduce unnecessary documentation requests
• Protect timely patient access to medically necessary care

Congressional Scrutiny of the WISeR Model Continues

Congressional concerns regarding CMS's WISeR prior authorization demonstration continued to grow following the Government Accountability Office's determination that the model qualifies as a rule under the Congressional Review Act. A Senate resolution has since been introduced seeking to overturn the demonstration.

LUGPA Concerns

• AI-assisted prior authorization requirements
• Increased administrative burden
• Potential delays in medically necessary care
• Expansion of utilization management within Traditional Medicare

No Surprises Act & Independent Dispute Resolution (IDR) Update (Expanded)

CMS finalized updates to the Independent Dispute Resolution (IDR) process under the No Surprises Act. Key changes include lower filing fees for certain disputes, improved functionality of the federal IDR portal, more standardized provider-payer communications, and enhanced screening of ineligible disputes.

Additional Context
Considerable attention has recently been paid to how the IDR process has unfolded, including the high volume of claims submitted and examples of extremely high rates awarded in certain disputes. Congress is starting to take notice and explore whether legislative adjustments are needed. While there is still a long way to go before any new legislation becomes a serious prospect, LUGPA is continually monitoring ongoing activity and its implications for independent physician practices.

LUGPA Takeaway
The operational improvements in the final rule should modestly reduce administrative burden and improve access to the federal arbitration process for independent physician practices. LUGPA will continue to track both regulatory implementation and emerging congressional interest to ensure the process remains fair and balanced.

CMS Strengthens Medicaid Waiver Budget Neutrality Requirements

CMS released new guidance requiring stricter budget neutrality standards for Medicaid Section 1115 demonstrations beginning January 1, 2027.

Key Provisions

• CMS Chief Actuary certification for new demonstrations, renewals, and amendments
• Greater fiscal oversight of waiver spending
• Increased scrutiny of high-cost demonstration programs

LUGPA Outlook

LUGPA is monitoring potential impacts on specialty care access, telehealth initiatives, and Medicaid reimbursement policies.

Drug Pricing & Pharmacy Policy

Senate Democrats Release Drug Pricing Reform Framework

Senate Democrats released a policy white paper and Request for Information outlining potential prescription drug pricing reforms.

Major Proposals

• Expanded Medicare drug negotiations
• Increased PBM transparency and oversight
• Expanded affordability programs for Medicare beneficiaries
• Greater manufacturer accountability

LUGPA Takeaway

Future reforms could significantly affect physician-administered therapies, oncology reimbursement, and patient access to innovative treatments. LUGPA will continue monitoring proposals as they develop.

340B Program Developments

LUGPA continued monitoring disputes involving pharmaceutical manufacturers and 340B-covered entities. In late June and early July, two notable developments occurred:

• CMS released the Calendar Year 2027 Outpatient Prospective Payment System (OPPS) proposed rule, which includes further adjustments and policy considerations related to the 340B Drug Pricing Program. The bill reduces Medicare payments to 340B hospitals from ASP+6% to ASP-33.4%.
• The House 340B Working Group released comprehensive legislative proposals aimed at reforming the 340B program. The bill focuses on enhancing transparency, improving program integrity, tightening eligibility and compliance requirements, and ensuring that discounts more directly benefit vulnerable patients rather than hospital margins.

LUGPA Position
LUGPA supports comprehensive 340B reform that improves transparency, accountability, and program integrity while preserving patient access to medically necessary therapies. LUGPA has long expressed concerns that insufficient oversight and the expansion of the program by large hospital systems have contributed to market distortions and healthcare consolidation, often without clear evidence that 340B savings are consistently passed on to benefit vulnerable patients. These latest developments represent important steps toward addressing long-standing program abuses.

Coverage & Clinical Policy

Proposed Medicare Coverage for Urine-Based Biomarkers

Novitas and First Coast Service Options released Proposed Local Coverage Determination (DL40380) establishing Medicare coverage for select urine-based biomarker tests used in evaluating microscopic hematuria.

Potential Benefits

• Expanded access to non-invasive diagnostics
• Improved patient risk stratification
• Reduced reliance on invasive procedures
• Support for value-based care initiatives

LUGPA Position

LUGPA strongly supports the proposal and will continue monitoring the coverage determination process.

Coalition Advocacy

Safe Step Coalition Comments Submitted to CMS

LUGPA joined the Safe Step Ad Hoc Coalition in submitting comments urging CMS to strengthen protections against inappropriate step-therapy requirements.

Coalition Recommendations

• Faster exception processes
• Continuity-of-care protections
• Standardized review criteria
• Reduced administrative burden

Importance to Urology

Step therapy continues to affect treatments for overactive bladder, benign prostatic hyperplasia, advanced prostate cancer, and numerous chronic urologic conditions.

Illinois 340B Advocacy

LUGPA joined a coalition letter urging Governor J.B. Pritzker to veto HB 2371, legislation expanding protections for 340B entities.

Coalition Concerns

• Limited accountability within the 340B program
• Insufficient transparency regarding charity care and community benefit spending
• Potential market distortions favoring large hospital systems
• Need to evaluate recently enacted transparency requirements before expanding the program further

Healthcare Transparency & Consolidation

Ownership Reporting Legislation Under Consideration

Congress continues evaluating legislation requiring physician practices with more than 25 physicians, ambulatory surgery centers, hospitals, and other healthcare entities to report ownership and change-of-control information to HHS.

LUGPA Position

LUGPA supports appropriate transparency regarding healthcare consolidation while opposing unnecessary reporting requirements that create additional administrative burden for independent physician practices.

Patients Deserve Price Tags Act (H.R. 5582)

LUGPA continues evaluating legislation that would extend hospital-style price transparency requirements to ambulatory surgery centers.

Primary Concerns

• Significant compliance costs for independent ASCs
• Limited value of negotiated-rate disclosures for patients
• Potential acceleration of physician practice consolidation
• Duplication of existing payer transparency tools

State Advocacy Update

As of late June, 38 states have adjourned their 2026 legislative sessions. LUGPA continues monitoring active legislation in the remaining states while preparing for 2027 legislative pre-filing.

Current Priorities

LUGPA is actively tracking biomarker testing legislation in:

• Delaware
• Massachusetts
• North Carolina
• Ohio

These proposals seek to ensure coverage decisions are based on evidence-based clinical standards while promoting responsible utilization and patient access.

New York Site-Neutral Proposal Defeated

LUGPA successfully engaged on New York A.2140A, legislation that would have capped commercial reimbursement for designated outpatient services at 150% of Medicare's non-hospital payment rates.

Following referral to the Assembly Codes Committee, the legislation failed to advance before adjournment and is now dead for the 2026 legislative session.

Why It Matters

The outcome preserves appropriate reimbursement for independent physician practices and demonstrates the importance of early legislative monitoring and direct advocacy.

Looking Ahead

As legislative activity shifts toward 2027, LUGPA will continue expanding relationships with physician leaders, coalition partners, and key legislative committees to identify emerging threats earlier and strengthen grassroots engagement.

LUGPA will remain focused on advancing physician payment reform, protecting in-office specialty care, reducing unnecessary administrative burden, and opposing policies that accelerate healthcare consolidation. Upcoming priorities include continued advocacy for Medicare payment reform, oversight of CMS innovation models, developments in the 340B program, healthcare transparency proposals, and state legislation affecting independent urology practices.

Share Your Story —
Amplify the Voice of Urology 

Have reimbursement issues, administrative burden, patient access, workforce challenges, or sustainability affected your practice? 

LUGPA is renewing its call for member stories to strengthen our advocacy at the federal and state levels. Policymakers respond to real-world impact, and your experiences with the Medicare Physician Fee Schedule, MACRA, prior authorization, step therapy, telehealth, workforce shortages, genetic testing, and other coverage and reimbursement challenges bring urgency and credibility to our message.

Personal stories from physicians and patients help humanize the data, influence legislative conversations, and build support among local lawmakers. Whether you submit a brief written account or record a short video, your perspective can directly shape policy discussions affecting independent urology.

Members may also record stories at upcoming LUGPA meetings as part of our expanded advocacy outreach.

To participate, submit your story to Matthew Glans. Please ensure all shared patient information complies with HIPAA requirements and includes appropriate consent.

Your voice matters, and together, we can ensure independent urology is heard loud and clear.