From Policy to Politics: The Shift as Election Year Begins
As the 2025 state legislative sessions drew to a close, lawmakers reflected on a year marked by ambitious agendas and hard-fought compromises. While significant progress was made on issues ranging from economic development to public safety, the road ahead promises new challenges.
With an election year looming, legislating becomes more complex as political calculations intensify, bipartisan cooperation grows harder to achieve, and the pressure to deliver quick wins for constituents often overshadows long-term policy goals. The coming months will test the balance between governance and campaigning like never before.
CMS Finalizes DMEPOS Competitive Bidding Rules
In July 2025, the Centers for Medicare and Medicaid Services (CMS) issued its proposed home health rule for 2026, which included plans to reinstate competitive bidding for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).
Under the proposal – aimed at driving down costs without sacrificing quality – suppliers of DMEPOS equipment will have to compete for contracts, with CMS awarding the work to the company that offers the best combination of quality and price. The agency formally adopted the proposed rule in late November. CMS will open the bidding process in the summer or fall of 2026 and announce winners and rates in the fall of 2027 with an effective date of January 1, 2028.
Supplier, patient and disability advocacy groups have raised the alarm on this program, worried that without proper guardrails to ensure quality and supply, this program and the patients served by it will experience delays, shortages and confusion as has been the case in previous attempts at competitive bidding for DMEPOS.
Utah Releases 2026 Proposed Workers’ Compensation Fee Schedule
Late in the fall of 2025, the Utah Labor Commission released its proposed 2026 workers’ compensation medical fee schedule with an effective date of January 1, 2026.
The proposal contained two notable changes from previous years: first, reimbursement for Physician Assistants, Nurse Practitioners, and Physical Therapy Assistants is increasing from 75% to 85% of the amount that would otherwise be allowed by these rules. Second, the proposed rule makes a change to how DMEPOS will be reimbursed, dividing it into two categories: ordinary supplies, materials and drugs, which will not be charged separately but will be included in the amount allowed for the underlying medical care; and, “special or unusual” DMEPOS that are “not included as a normal and usual part of the service or procedure” and will be paid at Medicare rates or cost plus 15% restocking fee and taxes, if a Medicare rate does not exist.
Pennsylvania House Bill 1998 would Remove Ninety-Day Limit on Employer-Directed Care
Under current law in the Commonwealth of Pennsylvania, if an employer has established a list of at least six designated health care providers (including at least three physicians and no more than four from a coordinated care organization), injured employees are required to seek care through one of these providers. After ninety days from the date of the first visit, however, the employee may choose their own providers. Pennsylvania State Representative Chad Reichard introduced House Bill 1998 in October 2025 which would eliminate the ninety-day time frame, removing any limit on how long the employer can direct care.
Different iterations of this bill have been introduced in the Pennsylvania Legislature in the recent past but have failed to gain traction. Rep. Reichard’s bill has secured some cosponsors and was discussed at a recent informational hearing of the Pennsylvania House Labor and Industry Committee.
Loss Cost Declines Slow; Modest Declines Still Expected, Per NCCI Report
In a report issued earlier in December, the National Council on Compensation Insurance (NCCI) showed that while modest decreases in loss costs and rates are expected to continue in the future, the pace of the decline has slowed relative to the post-pandemic high. Conversely, there has been an uptick in utilization of medical services, with a six percent increase in medical severity in accident year 2024. Unpredictable factors that might disrupt NCCI’s prediction that modest declines will continue going forward include legislative changes that affect cost, AI impact on reshaping the workforce, or accelerating medical inflation, among other things.