October 8, 2026

In this issue, learn how the ACR is advocating for research, the future physician workforce, sustainable Medicare reimbursement, and prior authorization reform. You’ll also find important ICD-10-CM updates, registration details for the Practice Innovation Summit, and information about RheumPAC’s annual donor appreciation event.

From Grant Review to Student Loans and Visas, ACR Defends Science and the Future Physician Pipeline

Research

ACR Pushes Back Against Politics in the Grant Approval Process

This year, a series of proposed rules and statements has made the administration's plan clear: it wants to add political approval to discretionary research grants. The ACR is pushing back against changes that disrupt how merit-based research grants are approved and paid out.

On May 29, the White House Office of Management and Budget (OMB) published the most sweeping overhaul of federal grant regulations since 2013. It would require political pre-approval of every discretionary grant, starting October 1, 2026. The ACR submitted comments on this proposal. It also encouraged researchers to submit their own comments to OMB and to ask Congress to act through our Grassroots Action Center. When the Senate passed its bipartisan continuing resolution (CR) to fund the federal government through December 11, it included a provision that temporarily blocked the May 29 OMB proposed federal grants rule. Congress is reacting to the research community's concerns, but the block is temporary. Please make sure your legislators understand how critical this provision is to the rheumatology community through the ACR Grassroots Action Center.

On August 14, the National Institutes of Health (NIH) issued a Request for Information (RFI) (NOT-OD-26-088). It proposes to stop releasing numerical overall impact scores and percentile rankings to grant applicants and program officers. The proposal moves away from paylines tied to exact numerical scores. Its stated aim is to give NIH more flexibility to weigh merit alongside broader portfolio, workforce and strategic priorities. That flexibility could be used to bring political priorities into the assessment process. Instead of a final numerical score, discussed grant applications would be placed in one of three broad categories:

• Most Competitive: Top 25% of final overall impact scores
• Competitive: Next 25% (26%–50%)
• Not Discussed: Scores outside the top 50%, or applications not discussed during review

Applicants would still receive written critiques, summaries of panel discussions and individual reviewer criterion scores. However, hiding the numerical scores reduces transparency and makes it harder for applicants to benchmark their proposals. The ACR will respond to this RFI on behalf of the membership.

Last month, it was reported that President Trump directed White House budget director Russ Vought to create a board that would decide which grants NIH would fund, with veto power over grant funding. Some senators noted that this would add a layer of political review similar to the May 29 OMB rule that the Senate temporarily blocked in its CR. The White House has reportedly stepped back from this proposal, a move celebrated by the ACR.

Workforce

Access to Student Loans Limited

On July 1, an overhaul of federal student loans passed in the One Big Beautiful Bill Act took effect. It limits access to federal loans for students at every level of education that leads to a role in the healthcare workforce. As of July 1:

• Students pursuing one of the eleven "professional" degrees, such as an MD or DO, can borrow up to $200,000 in federal loans
• Graduate students pursuing any other degree are capped at $100,000
• GradPLUS loans have ended
• Parental contributions through ParentPLUS loans are capped at $65,000 per student
• Undergraduate students now have a lifetime maximum of $257,500

Repayment requirements for federal student loans have also changed. The new requirements, guidance and additional resources are available in the Special Edition of the Rheum Advocate on How Your Student Loans Are Changing.

The ACR supports broad access to education and education funding for anyone pursuing a healthcare career. We led a letter from 17 physician organizations to Secretary McMahon raising concerns about how these changes will affect the healthcare workforce. The ACR also submitted comments directly to the Department of Education (DOE) on behalf of our members, both before and after the new rules took effect.

After the new rules took effect, the ACR joined coalition comments to the DOE led by the Association of American Medical Colleges (AAMC). The comments asked the DOE to let medical students borrow above the $200,000 cap, citing the cost of a medical degree, the physician shortage and the financial limits of private loans. The ACR also continues to advocate for the Resident Education Deferred Interest Act (H.R. 2028/S. 942), which would pause student loan interest during physician training. Graduating from medical school usually starts years of low-wage training. When large loans build interest during that time, physicians face a specific hardship, and many choose a specialty or a non-practicing career path to manage their education debt. Encourage Congress to support this important legislation through ACR's Grassroots Action Center.

Access to Visas

The Administration has recently issued several proposed rules that, if finalized, would make it harder for international medical students and graduates to get visas to study and work in the United States. These include a July 30 proposed rule that would add new restrictions to the J-1 exchange visitor program. This State Department non-immigrant visa program lets foreign nationals study, teach or conduct research in the United States. The proposed rule would require visa sponsors to end program participation for exchange visitors who do not maintain health and accident coverage, even if the lapse is unintentional. Current policy only ends participation for visitors who willfully fail to maintain coverage.

On August 25, the Administration also issued a proposed rule that would set a $103,265 fee for all H-1B visa cap-subject petitions. Federal policy caps H-1B visas at 85,000 per year, including 20,000 for foreign nationals with U.S. advanced degrees. Certain entities, such as universities and national nonprofit organizations, are exempt from the H-1B cap and would not have to pay the new fee. This differs from the $100,000 entry fee for H-1B visa holders that President Trump introduced through presidential proclamation last year, which would have applied to all petitions. That earlier fee is not currently being enforced because of ongoing litigation.

The ACR supports and continues to monitor the bipartisan H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961). This bill would exempt physicians and other healthcare workers from the proposed $100,000 fee on H-1B visas. H.R. 7961 currently has 66 co-sponsors but has not yet had a committee mark-up or vote.

ACR Fights Proposed 2027 Medicare Cuts and Presses Congress for Payment Reform and Prior Authorization Relief

Medicare Reimbursement

Reimbursement remains one of the top concerns for ACR members, if not the biggest. The proposed 2027 Medicare Physician Fee Schedule (MPFS) has been released, and once again it offers no relief to rheumatologists. They are struggling to provide quality care while meeting the financial demands of that care, and inflation makes those demands worse.

On September 14, the ACR submitted comments on CMS's proposed CY 2027 MPFS. The comments focused on these concerns:

• Cuts to modifier 25: The proposed fee schedule would cut Medicare payments for E/M services provided at the same time and place as surgical procedures. This could sharply reduce reimbursement for rheumatology practices. The new policy would replace modifier 25, which is currently used to show that a separately identifiable E/M service was performed alongside a procedure. The ACR's comments described the possible effects on rheumatology practices.
• Reduced conversion factor: The ACR strongly opposed the proposed rule's reduced conversion factor for CY 2027.
• New practice expense methodology: The rule proposes a new method for calculating indirect practice expenses. The ACR requested specialty-level modeling of its potential impacts.
• Transition from MIPS to MIPS Value Pathways (MVPs): The rule proposes major changes to the Quality Payment Program. The ACR asked CMS for more detail on how Qualified Clinical Data Registry (QCDR) measures will be included in MVP measure sets.

The ACR expects the final fee schedule to be released later this year.

The comment period on the proposed MPFS has closed, but we can keep educating Congress about the harm of the cuts to modifier 25. Urge your lawmakers to oppose this cut through the ACR's Grassroots Action Center.

Besides urging CMS to drop the proposed cut to same-day services from the 2027 MPFS, the ACR is urging Congress to act if the proposal is finalized. In a letter to the House Ways and Means and Senate Finance Committees, the ACR led 24 patient and clinician groups from the rheumatology community in urging Congress to protect patient access to same-day care. The ACR also joined several other letters to lawmakers and CMS opposing this cut, including one led by the American Medical Association. In addition, 62 lawmakers signed a bipartisan Dear Colleague Letter urging CMS not to finalize the proposal.

In Congress, the ACR also continues to monitor two key bipartisan bills on Medicare reimbursement: the Patients First Act (H.R. 9693) and the Provider Reimbursement Stability Act (H.R. 8163/S. 5180). Both bills were discussed favorably at an Energy and Commerce Health Subcommittee Legislative Hearing on September 15. The ACR submitted a Statement for the Record supporting both proposals.

The Patients First Act would:

• Create inflation-linked payment updates in the MPFS
• Set MPFS payment parameters so payments are more predictable
• Raise the budget neutrality threshold that triggers payment offsets
• Make important changes to MIPS

The Provider Reimbursement Stability Act is much narrower in scope. It makes important adjustments to the budget neutrality threshold and keeps year-to-year conversion factor changes more stable.

Both bills have broad bipartisan support in the House. The Provider Reimbursement Stability Act is slightly further along: it has a Senate companion, and the Ways and Means Committee advanced it unanimously, 44-0, in May. It currently has 80 House co-sponsors and 7 Senate co-sponsors. The Patients First Act has 58 House co-sponsors, still awaits a full committee markup, and does not yet have a Senate companion. As Congress considers proposals for an end-of-year package, the ACR will keep urging lawmakers to prioritize this issue.

Administrative Burden

The Improving Seniors' Timely Access to Care Act (H.R. 3514/S. 1816) passed out of the House Committee on Energy and Commerce by a unanimous 45-0 vote at the committee's July 21, 2026, markup. With this vote, the bill has cleared both House committees of jurisdiction, after the Ways and Means Committee's unanimous 42-0 vote on July 15. It has broad bipartisan support, with more than 300 co-sponsors in the House and 70 in the Senate, and is well-positioned for a vote on the House floor. The ACR will keep advocating, alongside our partners in the Regulatory Relief Coalition, for this legislation to be included in an end-of-year package.

2027 ICD-10-CM Updates Are in Effect, What Rheumatology Practices Need to Know

Note: The FY 2027 ICD-10-CM code set took effect October 1, 2026. Rheumatology practices should confirm system readiness and reinforce documentation and coding guidance.

The 2027 ICD-10-CM code set is now in effect with some new and revised diagnosis codes, as well as some previously valid codes becoming inactive. For rheumatology practices, there were no major diagnosis code changes, but updates affect clinical documentation, diagnosis selection, claims processing, prior authorization, medical-necessity review, quality reporting, and other workflows that rely on diagnosis data.

Practices should confirm systems and reference tools are current for a smooth transition to the new coding year. It is also vital that providers and staff understand any changes relevant to their work and identify problems early before they lead to avoidable denials, reprocessing, and/or payment delays.

Why the Update Matters

ICD-10-CM changes affect more than the code selected on a claim. A new level of specificity or a revised code description may require updates to EHR selection lists, coding tools, payer edits, authorization workflows, quality-reporting logic, and other data interfaces.

For rheumatology, this is especially important because many musculoskeletal codes depend on site specificity, where applicable, and laterality. Documentation that clearly identifies the condition, anatomic site, and right or left side helps support accurate code selection and reduces the need for clarification.

What Practices Should Do Now

Confirm system updates: Verify the EHR, practice-management system, billing platform, coding tools, and other applicable systems are using the FY 2027 ICD-10-CM code set. Confirm that all crosswalks, value sets, payer rules, and reference data have also been updated.

Review workflow: Evaluate diagnosis selection, coding, claims submission, prior authorization, reporting, and other processes that depend on ICD-10 data. Look for outdated codes, incorrect mappings, or workflow gaps.

Monitor early results: Track denials, rejected claims, coding questions, prior-authorization issues, and reporting errors during the first several weeks of the new ICD-10 codes.

Correct issues promptly: If a problem is identified, determine whether the source is documentation, code selection, EHR mapping, a payer edit, or another system rule, and update the workflow before the issue is repeated across additional claims.

Successful implementation is a team effort, so rheumatology practices should verify systems, review rheumatology-relevant code changes, reinforce documentation and coding guidance, and closely monitor early claims and authorization activity so problems can be corrected quickly. Providers play a key role by documenting the clinical details needed for accurate code selection. Coding, billing, prior authorization, and practice-management staff should make sure those codes move correctly through every system for accurate claims processing.

For more information or questions on coding and billing, contact the ACR practice management department at practice@rheumatology.org.

Practice Innovation Summit Nearing Capacity – Register Now

Space is extremely limited for the 2026 Practice Innovation Summit, taking place November 6–7 in Orlando, Florida. Members planning to attend are encouraged to register now before the remaining spots are filled.

The Practice Innovation Summit brings together rheumatology professionals for practical education focused on strengthening practices, addressing current operational and business challenges, and exploring new approaches to delivering rheumatology care.

Attendees can earn 8.75 CME credits during the event. Registration also includes the popular ACR Review Course, which gives attendees the opportunity to earn even more CME. Don’t miss the opportunity to take advantage of both programs with a single registration.

Register today to secure your spot at the 2026 Practice Innovation Summit.

Serve Up Some Fun at RheumPAC's Annual Donor Appreciation Event

Exciting news! RheumPAC's Annual Donor Appreciation Event will take place on Monday, November 9, from 7:00–9:30 PM at Crush Yard Pickleball and Arcade in Orlando.

As a reminder, a $100 investment in RheumPAC ($25 for FITs) gets you full access to the event, complete with delicious food and great drinks. RSVP now to join us for a night of pickleball, food, and fun with colleagues!