September 10, 2026

This issue explores key policy and research developments shaping rheumatology, from immigration and federal funding changes to the proposed 2027 Medicare Physician Fee Schedule. We also highlight the power of patient advocacy during RDAM and a new webinar on the future of RISE research.

Immigration Changes Could Deepen Rheumatology Access Challenges

On July 17, 2026, the U.S. Department of Homeland Security (DHS) published a final rule that ends open-ended "duration of status" stays and replaces them with a fixed end date for F, J, and I visa holders. The rule is expected to take effect September 15, subject to congressional review and any subsequent notice from DHS.

The proposed and newly finalized visa-policy changes could make it harder for rheumatology programs and employers to recruit, retain, and transition international physicians at a time when the specialty already faces a serious workforce shortfall. The most immediate concern is added administrative risk for J-1 trainees moving through internal medicine residency, rheumatology fellowship, and post-training employment.

J-1 physicians are currently authorized to remain in the United States for as long as they continue participating in an approved training program and their sponsorship and Student and Exchange Visitor Information System (SEVIS) records are properly maintained. Duration is limited to a maximum of seven years. The final rule replaces this framework with admission until a specific calendar date.

For J-1 physicians, admission will generally correspond to the approved training period reflected on the original Form DS-2019 but may not exceed four years at a time. Physicians who need to remain in the United States beyond their authorized admission period will need to apply to U.S. Citizenship and Immigration Services (USCIS) for an Extension of Stay (EOS) or depart the United States and seek readmission.

Importantly, the rule does not change the Department of State regulations permitting J-1 physicians to participate in graduate medical education for up to seven years. The primary change is that program sponsorship and immigration status will become separate determinations. An organization may approve continued sponsorship and extend a physician’s training program in SEVIS, but USCIS may also need to approve an extension of the physician’s lawful stay in the United States.

For most J-1 physicians, day-to-day participation in residency and fellowship training are not expected to change. The greatest potential impact is expected for physicians who:

1. Participate in training extending beyond four years
2. Extend training beyond the original program end date
3. Complete one program and enter another
4. Otherwise need to remain beyond the period authorized on their admission record

A timely filed EOS application will generally permit a J-1 physician to remain in the United States while USCIS considers the request. Because physician training/employment is authorized incident to J-1 status, the rule also generally permits continued authorized employment for up to 240 days while a timely filed application remains pending. (Note that “timely” filing mean filing while still in valid J-1 status or while in the 30-day grace period afforded J-1 participants.)

The final rule will require new coordination among employers, physicians, training institutions, USCIS, U.S. Customs and Border Protection, and the Department of State. It will also increase the importance of tracking admission expiration dates, completing renewals early, reporting training changes promptly, and ensuring that physicians understand the distinction among the Form DS-2019, the SEVIS record, the Form I-94, and any USCIS EOS approval.

J-1 Exchange Visa Proposed Rule

On July 30, the Administration issued a proposed rule that would introduce new restrictions to the J-1 exchange visitor program operated by the State Department. The proposal would require visa sponsors to terminate program participation for exchange visitors who do not maintain health and accident coverage, even if the failure to maintain this coverage is inadvertent. Current policy only terminates program participation for visitors who willfully do not maintain insurance coverage.

Exchange visitor program termination will also be terminated if the visitor’s documentation in their application is falsified in any way. Exchange visitors may be asked to provide proof of a U.S. address, educational qualifications, or attendance at the site of their program. Exchange visitors would not have the option to challenge the Department’s termination decision for unauthorized employment or falsified information within 10 business days of notification.

The proposed rule aligns exchange visitor program rules with new rules for international students that take effect on September 15 referred to above.

H-1 B Petition Fee

The Administration issued another proposed rule on August 25 that would establish a $103,265 fee for all H-1 B visa cap-subject petitions. The public comment period for this proposed rule ends on September 24 and the ACR will be submitting comments citing our concerns.

Federal policy keeps H-1 B visas capped at an annual limit of 85,000 (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-1 B cap and would not be required to pay the new fee. This is a contrast with the $100,000 entry fee for H-1 B visa holders introduced through presidential proclamation last year, as that fee would apply to all petitions. The $100,000 fee is not currently being implemented due to ongoing litigation.

ACR Advocacy

The ACR recognizes that the rheumatology community is a global enterprise and advocates to ensure the rights and freedoms of immigrants and visa holders serving in the healthcare workforce. Join us to advocate for access to the workforce for visa holders through the ACR’s grassroots action center.

You can also review the ACR’s written petitions to Congress for policies supporting visa holders below:

Congress: Medical Workforce – ACR joins physician group letter calling on the administration to reduce barriers to visa access for qualifying physicians – 4/8/2026

Congress: Medical Workforce – ACR Joins coalition letter supporting the H-1Bs for the Physicians and Healthcare Workforce Act, legislation which would exempt healthcare professionals from the new $100,000 H-1B visa petition fee – 4/15/2026

Congress: Medical Workforce – ACR joins physician group letter requesting national interest exceptions and expedited processing for physician visas – 6/22/2026

Congress Passes CR to Fund Government through December 11

On September 1, Congress passed H.R. 6500, a continuing resolution (CR) that funds the federal government at currently authorized levels through December 11, 2026. The bill was signed into law on September 2, 2026. The ACR has analyzed the legislation and identified two particularly salient provisions for the rheumatology community.

OMB Proposed Rule

The ACR applauds Congress for including language that would temporarily block the Office of Management and Budget (OMB) from finalizing a rule that would dramatically overhaul the process for awarding, administering, and terminating federal grants. The prohibition on implementation expires on December 11, however, and the ACR will continue to advocate for a complete reversal of this policy to both Congress and the administration. You can get involved from home with the ACR’s Legislative Action Center.

Conrad 30 Visa Program

Also included in the continuing resolution was a temporary reauthorization of the Conrad 30 visa waiver program. This program allows international medical graduates on J-1 visas to forego the two-year home country residence requirement by agreeing to work full-time for three years in a federally designated underserved area. The ACR continues to advocate for full, long-term funding of this critical program.

ACR to Submit Comments on Proposed CY 2027 Medicare Physician Fee Schedule

Next week, the ACR will be submitting comments regarding the Medicare Physician Fee Schedule proposed rule. The ACR’s comments will focus on the following areas, which, if finalized, could have a significant impact on rheumatology practices and on patient access to care:

• E/M reimbursement for multiple same-day services: The policy change in the proposed rule that will have the most significant impact on rheumatology practices, if finalized, would cut Medicare payment rates when an E/M service is furnished at the same time as a global surgical procedure. The less expensive procedure would be reimbursed at 50% of the standard payment rate. The ACR, along with every other major physician association, strongly opposes this policy because rheumatology patients often require evaluation and management of their chronic conditions while also needing in-office procedures to treat acute manifestations of disease. The ACR’s comments will discuss common rheumatology clinical encounters and differentiate the separate E/M work that may accompany a surgical procedure.
• Conversion factor: The ACR strongly opposes the proposed rule’s reduced conversion factor for CY 2027. The proposed rule represents an unusually dramatic decline in reimbursement. The proposed non-APM conversion factor of $32.84 is a decline of 1.68% from the current conversion factor ($33.40). For APM payments, the conversion factor of $33.17 is a decrease of 1.19% from the current conversion factor.
• New practice expense methodology: The proposed rule introduces a new methodology for calculating indirect practice expenses, but little detail is provided on how the new methodology may impact different specialties. The ACR’s comments request specialty-level modeling of the new practice expense methodology demonstrating the projected impact on rheumatology practices and commonly billed rheumatology procedures.

Transition to MIPS value pathways: The fee schedule includes major changes to the Quality Payment Program, with a transition from MIPS to MIPS Value Pathways (MVPs). ACR comments on changes to quality reporting urge CMS to continue advancing specialty-specific MVPs. The ACR also requests that CMS provide more detail on how Qualified Clinical Data Registry (QCDR) measures will be incorporated into MVP measure sets.

Make Your Voice Heard on Medicare Policy

We encourage members to take action on issues that directly affect rheumatology practices and patient access to care. Visit our grassroots advocacy campaigns to urge policymakers to support meaningful reimbursement reform and protect appropriate use of Modifier 25.

• Support reimbursement reform
• Take action on Modifier 25

During RDAM, One Teen’s Story Shows Why Advocacy Matters

As we recognize Rheumatic Disease Awareness Month (RDAM), Molly Talbot’s experience with juvenile idiopathic arthritis (JIA) offers a powerful reminder that rheumatic diseases affect children and teens—not only adults. Her story of diagnosis, treatment, resilience, and advocacy reflects the experiences of many young people and families navigating a chronic condition while trying to remain active at school, at home, and in their communities.

This year’s RDAM theme, “Little Joints, Big Impact,” emphasizes the importance of recognizing pediatric rheumatic disease early and connecting children with specialized care. Molly and her father attended this year’s Rheum Advocacy Conference in Washington, DC. Her advocacy helps make that message real: symptoms that may appear small or be overlooked can have a significant effect on a young person’s health, education, independence, and future.

Her voice also reinforces why ACR advocacy is essential. Children and teens with JIA need timely access to pediatric rheumatologists, affordable medications, insurance coverage without unnecessary delays, and supportive accommodations at school. By elevating patient stories during RDAM, we can help policymakers understand that their decisions have direct consequences for children living with rheumatic disease and the families who support them.

This month, we invite the rheumatology community to share Molly’s story and help raise awareness: children with rheumatic diseases deserve to be seen, believed, and connected to the care they need.

Watch New Webinar Recording! Tokenization, Data Linkages, and the Future of RISE Research

What if researchers could see a more complete picture of a patient’s rheumatology journey—across specialist visits, hospitalizations, treatments, outcomes, and other care settings—without compromising privacy?

Jeffrey Curtis, MD, MS, MPH, leads a practical discussion on why tokenization and data linkage are becoming increasingly important tools for rheumatology research.

Today, key parts of a patient’s experience are often fragmented across separate data sources. A specialist encounter may live in one dataset, while hospitalization records, medication use, clinical outcomes, and other care experiences appear elsewhere. That fragmentation can limit researchers’ ability to understand the full course of disease and treatment over time.

Dr. Curtis explains how secure, de-identified tokens can help responsibly link these disconnected data points while protecting patient privacy. By creating a more longitudinal, cross-setting view of care, tokenization can enable researchers to examine real-world patient journeys with greater depth, context, and confidence.

Watch the recording to explore:

• Why fragmented data remains a challenge in rheumatology research
• How privacy-preserving tokenization supports data linkage
• The value of connecting care experiences across settings and over time
• How a more complete patient view can strengthen real-world evidence generation