This Week at a Glance
The Health Subcommittee convened its first drug-focused legislative hearing of the 119th Congress this week, examining fourteen bills targeting an illicit drug supply that witnesses described as evolving faster than the federal regulatory framework can track. Nitazene detections have increased 780 percent since 2020; medetomidine is emerging as a successor to xylazine in the fentanyl supply; and DEA seizures in 2025 reached 9,900 kilograms of fentanyl and 47.5 million counterfeit pills. The hearing generated significant member engagement and produced a clear legislative agenda centered on drug scheduling, pill press regulation, and treatment access.
Separately, Democratic members of the full committee formally escalated an oversight dispute with the Centers for Medicare and Medicaid Services, accusing the agency's chief operating officer of providing inaccurate testimony at a March 17 hearing regarding CMS's handling of a compliance proceeding with Minnesota. CMS has been given until April 7 to reconcile the record.
HEALTH SUBCOMMITTEE
Hearing: Policies to Protect Our Communities from Illicit Drug Threats (March 26, 2026)
The Health Subcommittee held a legislative hearing on March 26 examining fourteen bills addressing the illicit drug supply chain. Chair Morgan Griffith (R-VA) opened by building on the committee's recent record — the HALT Fentanyl Act and the SUPPORT for Patients and Communities Reauthorization Act, both signed into law last year — while acknowledging that some bills under consideration require additional work before they can advance.
The witness testimony established a consistent picture of a supply landscape outpacing regulatory detection. Scott Oulton, president of INTR3PID Solutions and a former DEA chief of forensics, testified that nitazene reports increased 780 percent from 2020 to 2024, while DEA seized nearly 9,900 kilograms of fentanyl and 47.5 million counterfeit pills in 2025. He urged Congress to expand adoption of the DEA's GUARDS method — which captures all substances in a tested sample, not just controlled ones — and to modernize the National Forensic Laboratory Information System (NFLIS) to enable near real-time intelligence sharing between public health and law enforcement.
Xylazine dominated much of the hearing. Dr. K. Fred Gingrich II, executive director of the American Association of Bovine Practitioners, testified that xylazine — known as "tranq" in street use — remains indispensable in large-animal veterinary medicine with no viable alternative for cattle and horses, and that there is no evidence of significant diversion from domestic veterinary channels. He urged swift passage of H.R. 1266, the Combating Illicit Xylazine Act, which would place xylazine in Schedule III of the Controlled Substances Act while amending the definition of "ultimate user" to protect legitimate veterinary administration. Rep. John Joyce, M.D. (PA-13) expressed strong support, noting that coroners in south-central Pennsylvania consistently identify xylazine as the most common adulterant in fentanyl samples.
Dr. Nabarun Dasgupta of UNC Chapel Hill introduced a forward-looking concern: medetomidine is rapidly displacing xylazine in the illicit supply, particularly in states that have already moved to schedule xylazine at the state level. The clinical consequences are severe — medetomidine withdrawal does not respond to standard buprenorphine treatment, and an estimated eight to nine out of ten withdrawal patients require intensive care. Dasgupta framed the current moment as a narrow public health window, citing 28 consecutive months of declining overdose deaths and a roughly 40 percent reduction from the peak, and warned that cutting treatment access would forfeit that progress.
Rep. Neal Dunn, M.D. (FL-02) placed the crisis in national security terms, citing approximately 72,000 overdose deaths in 2025 and arguing that Chinese Communist Party policy — not negligence — has subsidized the fentanyl precursor supply reaching the United States. Sheriff Dennis Lemma of Seminole County, Florida flagged the emergence of synthetic 7-hydroxymitragynine (7-OH), a potent kratom derivative marketed as a safe natural product, and prioritized H.R. 5880, the Fight Illicit Pill Presses Act, which would impose serialization and registration requirements on pill press equipment used by cartels.
Dr. Yngvild Olsen, a former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA) and now advising Manatt Health, testified that medications for opioid use disorder (MOUD) reduce the risk of fatal overdose by more than 50 percent, yet only one in four people who would benefit from treatment are currently receiving it. She urged the committee to protect pandemic-era telehealth flexibilities and expanded take-home methadone access, both of which have demonstrated safety and effectiveness. She specifically flagged the six-month Medicaid re-enrollment requirement included in H.R. 1 as a provision that could strip coverage from individuals actively in recovery — a concern shared by overdose death trend data that witnesses said must not be squandered.
Rep. Mariannette Miller-Meeks (IA-01) highlighted her bill, H.R. 1227, the Alternatives to Pain Act, which would require Medicare Part D plans to place qualifying non-opioid pain management drugs on their lowest cost-sharing tier and prohibit deductibles from applying to those drugs. The bill is jointly referred to the Energy and Commerce and Ways and Means Committees.
Puerto Rico Connection
The treatment access debate before the subcommittee carries direct implications for Puerto Rico. The island's Medicaid program administers substance use disorder treatment through the Administration of Mental Health and Anti-Addiction Services (ASSMCA), which receives SAMHSA funding tied to the same federal frameworks witnesses urged the subcommittee to protect — including telehealth initiations for opioid use disorder and take-home methadone flexibilities. The six-month Medicaid re-enrollment requirement at issue in H.R. 1 would apply to Puerto Rico's Medicaid population, potentially disrupting coverage continuity for individuals in active recovery. The subcommittee's decisions on MOUD access and xylazine scheduling will define the federal framework within which Puerto Rico's behavioral health system operates.
COMMITTEE OVERSIGHT
Democratic Members Allege CMS Chief Operating Officer Misled Congress
Democratic members of the House Energy and Commerce Committee formally demanded answers from CMS Chief Operating Officer Kimberly Brandt during the week of March 23, alleging she provided inaccurate testimony at a committee hearing on March 17.
At that hearing, Brandt stated that CMS had "been stayed" from scheduling a compliance hearing with the state of Minnesota — a hearing CMS is required to conduct within 30 to 60 days of a noncompliance determination. CMS had issued that determination on January 6, 2026, after concluding that Minnesota's state-regulated health insurance mandate covering abortion conflicted with federal standards. Minnesota submitted its hearing request on January 9. The 30-to-60-day scheduling window had already elapsed by the time of Brandt's March 17 testimony.
Two days after that testimony, Brandt personally signed a letter to Minnesota requesting that the hearing "be stayed" — a request that, on its face, is inconsistent with her sworn claim that a stay was already in place. The letter also reflects that no court order or identifiable authority had actually stayed CMS. Democratic members subsequently identified a gap between Brandt's testimony and the documentary record.
Brandt has been given until April 7 to identify who authorized the stay, explain the scheduling gap, reconcile the conflicting statements, and produce supporting documentation. Committee Democrats have reserved the right to pursue further action.
The picture is further complicated by a separate development on March 23 — the same day the demand letter was being prepared. On that date, Brandt signed a letter approving Minnesota's corrective action plan and signaling that the administrative appeal over the withheld funds could be rendered moot if implementation continues on track. That communication suggests CMS was already moving toward a policy resolution with Minnesota even as the testimony dispute escalated. The core allegation about the accuracy of Brandt's March 17 sworn statements remains unresolved and pending her April 7 response.
This dispute was initiated and is being advanced by minority members, including Ranking Member Frank Pallone Jr. (D-NJ) and Oversight Subcommittee Ranking Member Yvette D. Clarke (D-NY). Majority members have not joined in the demand letter or made public statements on the substance of the allegations.
OTHER DEVELOPMENTS
CMS Finalizes National Standards for Electronic Claims Attachments
CMS finalized rule CMS-0053-F on March 20, establishing the first national standards under HIPAA for electronic health care claims attachments. The rule replaces fax and mail-based submissions with a standardized digital system using authenticated electronic signatures. CMS projects annual savings of approximately $782 million across the healthcare industry from reduced paperwork, mailing costs, and processing inefficiencies. The rule takes effect May 26, 2026, with a 24-month compliance window extending through May 26, 2028.
Puerto Rico Connection
The administrative burden the rule targets — manual claims submissions, fax-dependent attachments, processing backlogs — has been particularly pronounced in Puerto Rico, where provider reimbursement timelines and administrative capacity have historically lagged mainland benchmarks. A standardized electronic claims system could accelerate reimbursements and reduce compliance costs for providers participating in Puerto Rico's Medicaid program, whose administrative infrastructure stands to benefit from the shift to a uniform national standard.
CMS Launches ASPIRE Initiative for Complex-Need Children on Medicaid
CMS launched ASPIRE on March 24, a new initiative to fund up to five state Medicaid agencies through cooperative agreements to build coordinated, whole-person care systems for children up to age 21 enrolled in Medicaid or the Children's Health Insurance Program (CHIP) who have or are at risk of developing complex medical or behavioral conditions. A notice of funding opportunity is expected later in 2026. Interested states and territories should monitor the NOFO when published to determine eligibility and application requirements.
CDC Director Position Remains Vacant
The Trump administration has yet to nominate a permanent CDC director. The vacancy reflects the difficulty of identifying a candidate who aligns with the Department of Health and Human Services' current policy priorities without drawing criticism on vaccine-related matters. The position oversees an agency central to infectious disease surveillance, overdose mortality data, and public health guidance — all of which fall within the Health Subcommittee's legislative jurisdiction. The committee has not publicly called for a timeline on the nomination.
LOOKING AHEAD
Upcoming Committee Activity
No Health Subcommittee hearings or markups have been announced for the week of March 30. Monitor the committee calendar at energycommerce.house.gov for scheduling updates.
On Our Radar
Ginnell Torres
Health Law Attorney
gtorres@mzls.com
Maceira Zayas Law
