The Rheum Advocate: January 15, 2026
In This Issue
- ACR Opposes DOE Plan That Threatens Health Workforce
- Funding Fight in Congress Puts NIH, CDC, and Telehealth Access at Stake for Rheumatology Patients
- 2025 By the Numbers: Advocating for Rheumatology Together
- CMS Efficiency Adjustment: What 2026 Payment Changes Mean for Rheumatologists
- CMS Announces State Grants for Rural Health Transformation Program
- MIPS and MVP Reporting Now Open—Submit Through RISE Registry by March 16
ACR Opposes DOE Plan That Threatens Health Workforce
ACR urges the U.S. Department of Education (DOE) to reverse its proposed redefinition of “professional degrees,” warning that it will restrict federal loan access for key health professions and worsen already severe workforce shortages.
What the DOE proposal does
- The DOE draft rule would treat only 11 programs as “professional degrees” for federal student loan purposes, including Pharmacy (PharmD), Dentistry (DDS or DMD), Veterinary Medicine (DVM), Chiropractic (DC or DCM), Law (LLB or JD), Medicine (MD), Optometry (OD), Osteopathic Medicine (DO), Podiatry (DPM, DP, or PodD), Theology (MDiv, or MHL), and Clinical Psychology (PsyD or PhD).
- Advanced nursing (MSN, DNP, and research-focused nursing PhDs), physician assistant, physical and occupational therapy, audiology, speech-language pathology, and public health degrees would be shifted into the “non professional” graduate category, subject to lower federal loan caps despite comparable rigor and licensure requirements.
New loan caps under OBBBA
- The One Big Beautiful Bill Act eliminated the Graduate PLUS program and created two tiers of federal loan limits for graduate students starting July 1, 2026.
- Under these rules, “professional degree” students can borrow up to $50,000 annually with a $200,000 lifetime cap, while all other graduate students—including many health professions are limited to $20,500 annually and $100,000 in total.
Why this harms the health workforce
- Tuition and fees for advanced nursing, PA, physical and occupational therapy, and public health programs commonly exceed $90,000 even before adding clinical costs, technology, and living expenses, so a $100,000 lifetime cap leaves many students with a large unfunded gap.
- With Graduate PLUS loans gone, students in reclassified programs would be pushed toward higher interest private loans or forced to abandon training, shrinking the pipeline into essential nonphysician roles.
Impact on shortages and equity
- National projections show the United States is already facing severe shortages across the health workforce, including an estimated shortfall of more than 187,000 physicians by 2037 and major gaps among nurses and other clinicians.
- Limiting affordable financing will disproportionately affect students from low-income and underrepresented backgrounds, undermining efforts to build a more diverse, culturally competent workforce and worsening access in rural and underserved communities.
ACR’s position and next steps
- The DOE argues that tighter loan caps will pressure institutions to reduce tuition, but available evidence suggests institutions instead anticipate declines in applications and enrollment rather than meaningful price cuts.
- ACR is joining a broad coalition of organizations to urge DOE to maintain professional degree status—and higher federal loan eligibility—for all advanced health related programs so patients can continue to rely on a robust, team-based care workforce.
Funding Fight in Congress Puts NIH, CDC, and Telehealth Access at Stake for Rheumatology Patients
Congress is advancing a set of spending bills that will determine FY26 funding levels for NIH, CDC, and key health programs, with major implications for rheumatology research, workforce, and patient access to care.
Why appropriations matter to rheumatology
- Funding decisions for the Departments of Labor and Health and Human Services will shape NIH and CDC budgets, affecting rheumatology research, surveillance, and public health programs that support patients with arthritis and autoimmune disease.
- Ongoing negotiations also include whether Medicare telehealth flexibilities are extended beyond January 30, 2026, which directly impacts patients’ ability to access rheumatology care, especially in rural and underserved areas.
Current funding proposals
- The House bill would provide about $48 billion for NIH (slightly below FY25) and reduce CDC funding by about 19%, which could slow progress in rheumatologic research and weaken public health infrastructure important for immunosuppressed patients.
- The Senate bill includes $48.7 billion for NIH (slightly above FY25) and generally maintains CDC and other health agency funding, offering a more stable outlook for rheumatology-related research and programs.
Risks and uncertainty
- If Congress cannot agree on final FY26 funding levels, it may rely on a short-term measure that keeps current funding in place but prolongs uncertainty around NIH/CDC budgets and Medicare telehealth policy.
- This uncertainty complicates long-term planning for rheumatology practices, academic centers, and patient access initiatives that depend on federal support and reliable payment and telehealth rules.
How rheumatologists can engage
- Rheumatologists and their teams can help protect research funding and telehealth access by contacting their lawmakers and sharing how these policies affect patients’ ability to receive timely rheumatologic care.
- The ACR’s Legislative Action Center makes it easy to send personalized messages to Congress in a few clicks and amplify the rheumatology community’s voice during these high-stakes negotiations.
2025 By the Numbers: Advocating for Rheumatology Together
The ACR proudly partnered with our members throughout 2025 to champion the needs of the rheumatology community. Together, we made a powerful impact on policy, advocacy, and awareness. Here’s a look at what we accomplished:
RheumPAC – Driving Pro-Rheumatology Representation:
- $124,491.60 raised from 273 contributors committed to advancing rheumatology priorities.
- 50+ Political Events attended by ACR staff and members to support lawmakers who understand our mission.
- $79,000 Disbursed to 32 pro-rheumatology candidates and multi-candidate PACs, ensuring our voice is heard where it matters most.
Grassroots Advocacy - Amplifying Our Collective Voice:
- 125+ Hill Meetings engaging policymakers on critical issues.
- 736 Advocates Sent Over 3,000 Letters to all 435 Members of Congress, addressing topics like Medicare payment reform, telehealth expansion, and biomedical research funding.
- 125+ Media Mentions and Public Statements, including op-eds, letters, and comments that elevated rheumatology in the public discourse.
- 58 Policy Letters Signed, reinforcing our commitment to shaping legislation that benefits patients and providers.
Thank You for Making a Difference! These achievements reflect the strength of our community and the power of collaboration. Every contribution, letter, and conversation brought us closer to a future where rheumatology care is accessible, valued, and supported.
CMS Efficiency Adjustment: What 2026 Payment Changes Mean for Rheumatologists
The Centers for Medicare & Medicaid Services (CMS) implemented a new efficiency adjustment for many non–time-based CPT codes. Most time-based rheumatology services are exempt and may benefit from a shift toward cognitive care.
CMS efficiency adjustment
- As of January 1, 2026, CMS applies a -2.5% efficiency adjustment to the work RVU and intraservice time of many non-time-based CPT codes to reflect efficiency gains over time.
- Time-based services, including most evaluation and management and care management codes commonly used in rheumatology, are excluded from this adjustment.
Impact on rheumatologists
- Many rheumatology services are time-based and designed to capture significant face-to-face and care-planning time, so they are largely exempt and may see relative gains as value shifts toward cognitive, time-intensive care.
- The adjustment does not require physicians to spend less time with patients; it updates payment assumptions to better align with current resource use, supporting efforts to more accurately value long-term rheumatologic care.
Call to action
- This policy is a step toward more appropriate valuation of complex, longitudinal care, but broader Medicare payment reform is still needed to protect access to rheumatology.
- Urge Congress to pursue sustainable Medicare physician payment reform through the ACR Legislative Action Center.
CMS Announces State Grants for Rural Health Transformation Program
The Centers for Medicare & Medicaid Services (CMS) announced the first round of awards under the Rural Health Transformation Program (RHTP), a $50 billion federal initiative designed to expand access, improve quality, and modernize health care in rural communities nationwide.
This initiative was created under the One Big Beautiful Bill Act and requires states to submit detailed plans as part of a grant application. The ACR was able to provide detailed input during the creation of state plans. Funding will be disbursed over five years (FY 2026–FY 2030) at $10 billion annually, beginning in federal fiscal year 2026.
The largest awards went to Texas ($281.3 M) and Alaska ($272.2 M) who received the highest total funding in the first year.
The smallest awards went to New Jersey ($147.3 M) and Connecticut ($154.2 M) who received the lowest grants — reflective of the smaller rural populations.
The average state award was roughly $200 million for FY 2026.
What Comes Next
States agencies will begin the process of implementing plans early this year. Agencies will be putting out requests for proposals that touch on several issues important to rheumatology providers, including workforce initiatives, telehealth, health modernization and standardization, as well as access to care. States are expected to report regularly on progress, performance outcomes, and effective practices.
The program’s multi-year nature means that these initial awards are just the first step. Funding and programmatic shifts are possible in the future as states evaluate the efficacy of initiatives around the country. As the implementation process continues, the ACR will work to keep you informed of how rheumatology will be impacted and how rheumatology providers can take advantage of grant and funding opportunities at the state level.
MIPS and MVP Reporting Now Open—Submit Through RISE Registry by March 16
The 2025 Merit-based Incentive Payment System (MIPS) and MIPS Value Pathway (MVP) federal reporting submission period is now open; eligible providers must submit their data by 8:00 PM ET, March 31. MIPS submissions through the ACR’s RISE registry will open in February, and the deadline for practices to submit through RISE is March 16.
If you are unsure if you’re eligible, we encourage you to check your QPP Participation Status.
If you have general questions about MIPS reporting, please contact ACR staff at RISE@rheumatology.org or CMS directly at QPP@cms.hhs.gov.