CMS seeks feedback on applying MAHA guidelines in the U.S. healthcare system

The Medicare FY26 proposed rule for hospital inpatient payments offers clues as to how the Trump administration will seek to integrate principles of the Make America Healthy Again (MAHA) movement in the healthcare infrastructure.

The rule includes a request for information (RFI) on using mandatory hospital quality measurement to foster improvements in nutrition and physical activity. As described by HHS Secretary Robert F. Kennedy Jr., a core goal of MAHA is to reduce the prevalence of chronic disease by promoting good health habits and mental health.

Per the RFI, the Hospital Inpatient Quality Reporting (IQR) Program could incorporate “tools and measures that assess overall health, happiness and satisfaction in life that could include aspects of emotional well-being, social connections, purpose and fulfillment.”

The IQR Program also could expand on current measures that gauge nutrition adequacy, potentially adding assessments of physical activity and sleep. Electronic clinical quality measures reflecting hospital assessments of patient needs and behaviors in those areas could be included in the Promoting Interoperability Program.

As indicated in the proposed rule, stakeholder feedback on the RFI is less likely to be applied in the FY26 inpatient payment final rule than to be used in future years or separate rulemaking.

MAHA policies should be geared, in part, toward “a world where hospitals are incentivized for beds to be empty, not full,” Calley Means, a White House adviser who works closely with Kennedy, said April 2 during Politico’s 2025 Health Care Summit.

Full steam ahead

Although substantive changes to the U.S. healthcare system were only hinted at in the newly released proposed rule, Means said stakeholders should prepare for a new paradigm.

By installing a government outsider such as Dr. Mehmet Oz in the role of CMS administrator, Means said, the agency will have a leader and team that “are ready to talk about improvements in chronic disease prevention and deregulation and transparency and conflict [of interest] reduction.”

“This is a group that wants to work with the industry but is absolutely, defiantly saying: We need a new direction,” he added.

Many industry stakeholders, Means said, support Kennedy “when he says: Let’s get Medicare and Medicaid not to a top-down system where you jab certain pills down kids’ throats who are sick, but [instead] actually have a system where there are more HSA-type accounts for Medicare and Medicaid, where a mom with their kid who’s depressed and obese could [have them] take the pills, but also get that kid on a functional medicine program, get more blood tests.”

He added, “The two big principles Secretary Kennedy’s talked about is let’s get gold-star science and then let’s trust the American people to make the best decision with their doctor.”

Means called out the American Medical Association (AMA) for promoting Medicare payment codes that give providers insufficient incentives to prevent or reverse disease.

In a separate interview at the Politico event, AMA President Bruce Scott, MD, responded that a balanced approach is needed.

“There does need to be an emphasis on prevention,” Scott said. “That said, I’m a surgeon, and one of the things we have to do is take care of the acute problems that exist right now. We can’t have a slash-and-burn technique.”

Oz gets to work

On April 10, during Oz’s first week as administrator, CMS issued a news release in which he and Kennedy specified their plans for the agency in the context of MAHA.

Strategies described in the release include:

• Empowering Americans with personalized solutions they can use to better manage their health and navigate the healthcare system, starting with implementation of President Donald Trump’s recently signed executive order on price transparency
• Equipping providers with better information about the patients they serve and holding them accountable for health outcomes, rather than paperwork that distracts them from their mission
• Identifying and eliminating fraud, waste, and abuse in Medicare, Medicaid, the Children’s Health Insurance Program and the Affordable Care Act insurance marketplaces
• Shifting from a system that focuses on sick care to one that advances prevention, wellness and chronic disease management

Oz emphasized the first three goals March 14 during his confirmation hearing before the Senate Finance Committee.

“CMS should work with Congress to find efficiencies that can help stabilize our insurance markets, which will make it easier and more affordable for Americans to adopt healthy lifestyles,” Oz said during the hearing.

Incentives for providers to deliver optimal care, he said, require offering “real-time information while they’re taking care of patients, and within their workflow. Artificial intelligence, I believe, can help. It can liberate doctors and nurses from all the paperwork.”

Looking to simplify

Another tenet of the Trump administration is deregulation, which CMS is seeking to advance through an RFI on streamlining regulations.

Trump’s Jan. 31 executive order requires any agency proposing new regulations to also identify at least 10 existing regulations for repeal. Separately, the Department of Justice (DOJ) undertook its own formal effort to look into reducing regulations that hinder competition across industries, and this week the Federal Trade Commission did the same.

“Laws and regulations in healthcare markets too often discourage doctors and hospitals from providing low-cost, high-quality healthcare and instead encourage overbilling and consolidation,” the DOJ wrote in its announcement. “These kinds of unnecessary anticompetitive regulations put affordable healthcare out of reach for millions of American families.”

CMS’s RFI cites Medicare conditions of participation and conditions of coverage as possible examples that can “create redundancy with existing state requirements or have no measurable impact on improving the quality of patient care.”

In addition, “Reporting and documentation requirements for quality [programs], value-based purchasing programs and payment policies can necessitate significant additional administrative resources from providers and duplicate private insurance requirements.”

Replies to the RFIs associated with the inpatient payment proposed rule are due June 10. Comments on new approaches to quality measurement can be submitted as part of responses to the overall rule. The deregulation RFI was issued in conjunction with the rule but is a stand-alone document that should be addressed separately, also by June 10.