CMS threatens clawbacks of $50B rural health fund

CMS Administrator Mehmet Oz earlier this month said the agency has the power to rescind funding from the $50 billion Rural Health Transformation Fund (RHTP) if states don't follow rules or meet their goals, adding that the mechanism gives governors leverage to press legislatures to adopt the Trump administration's priorities.

"We will take the money back" if states "don't abide by what they wrote, if they don't do a good job," Oz said, adding that the clawback mechanism "gives you a little extra umph, a little bit of gusto to go after these issues."

The RHTP was created under the One Big Beautiful Bill Act to provide states with multiyear funding to help stabilize and transform rural healthcare delivery. The program functions as a partial stopgap, intended to mitigate the impact of broader federal funding pressures while states pursue longer-term rural health strategies.

In a call with reporters in December, Oz said, "one of the smartest things the president and Congress" did when creating the RHTP was including the threat of "clawbacks," or rescinding money if states don't do what they promised in their applications.

Michael Hendrix, policy director for the governor's office in Tennessee, said federal officials suggested during a hearing that the state "would be more competitive for funding through policy change." He added that CMS told the state that "some share of this year's funding, if policies are not implemented, might be clawed back."

Instead of usual grants, the RHTP uses cooperative agreements, which require a back-and-forth partnership, according to Charlie Sagona, a grant specialist at Assel Grant Services, a consulting firm that helps organizations manage grants and is helping several large health systems with RHTP funding.

"You are going to be working very, very closely with them; things will ebb and flow and change and move," Sagona said.

(Tribble/Zionts, KFF Health News, 6/16)

Federal judge throws out $100K H-1B visa fee

A federal judge on Monday ruled that the Trump administration's order imposing a $100,000 fee on any employers seeking visas for skilled foreign workers amounts to an unlawful tax and should be voided entirely.

Last year, President Donald Trump issued an executive order implementing a $100,000 fee for any new H-1B visa petitions, arguing the fee was designed to help combat "systemic abuse" in the visa program. In December, a coalition of 20 states sued to end the policy, arguing it would exacerbate shortages of skilled workers including teachers, academic researchers, and healthcare workers.

In his ruling, Judge Leo Sorokin of the Federal District Court for the District of Massachusetts said the policy appeared to step on Congress' "exclusive power" to levy taxes under the Constitution, noting that the Supreme Court has stated throughout multiple cases, including one against the Trump administration's tariffs, that the president may only impose a tax or penalty when explicitly authorized by Congress.

Sorokin also dismissed claims from the Trump administration that the fee was a "regulatory payment" that would have been within the executive branch's authority to set.

"This is mere ipse dixit," he wrote, meaning the claim was offered without evidence. "Defendants offer no definition for what constitutes 'a regulatory payment,' cite no cases or statutes employing the term, and advance no reasoned argument explaining how this term encompasses something different than a tax or a penalty."

In response to the ruling, Taylor Rogers, a spokesperson for the White House, said President Trump "has clear legal authority to restrict entry of any class of aliens he determines is not in America's best interest" and added the administration is "confident this order will be reversed on appeal."

(Montague, New York Times, 6/8)

After a hearing to dispute Perryman's quarantine order, Michael Bell, CDC's quarantine medical reviewer, recommended Perryman be allowed to return home for the remainder of her quarantine with remote symptom monitoring and access to 24-hour help "in the event she develops symptoms."

"In my professional judgment, this less restrictive alternative is adequate to protect public health," Bell wrote in his review.

In an interview with the New York Times, Perryman said she has not had any symptoms and has tested negative for the virus. She added that her temperature is taken twice a day and she's provided with food upon request. She's also allowed to request access to a rooftop for around an hour a day, under the watch of armed guards.

"They're polite and they're not using physical violence against me, but otherwise it's a prison," Perryman said.

(Mandavilli, New York Times, 6/15)

Trump administration requests expedited appeal of ruling that blocked overhaul of vaccine schedule

In a social media post on Friday, HHS Secretary Robert F. Kennedy Jr. announced that the Trump administration has filed a motion to expedite the appeal of a federal court ruling that blocked HHS from implementing recent vaccine policy changes.

In March, Judge Brian Murphy of the U.S. District Court for the District of Massachusetts ruled that Kennedy's reconstitution of CDC's Advisory Committee for Immunization Practices (ACIP) and changes made to the childhood vaccine schedule were likely illegal, arguing those policy changes violated the Administrative Procedure Act. As a result, all decisions made by the reconstituted ACIP were reversed.

Murphy ruled in a lawsuit brought by several medical groups, including the American Academy of Pediatrics, the American College of Physicians, and the Infectious Diseases Society of America.

In his post, Kennedy said the administration requested an expedited appeal so federal vaccine advisors could meet to decide whether to recommend shots before the fall flu season.

"The 2026-2027 respiratory virus season (i.e., R.S.V., influenza, Covid) begins in the fall, and while the A.C.I.P. cannot act, no newly licensed or reformulated vaccine for those conditions can be added to the immunization schedule," the administration argued in its motion.

Richard Hughes, a lawyer for the medical organizations suing the administration, said in a statement the administration's motion was a "misleading attempt to shift blame for what Secretary Kennedy broke."

"We will oppose his motion to expedite appeal because we refuse to pave the way for his further destruction," Hughes said.

(Mandavilli, New York Times, 6/15)