This is a reconstructed leadership chain and Thompson background.
Until very recently, the head of HAPG as a whole was Ryan Howe, PhD. He succeeded Carol Blackford and served as Director, Hospital and Ambulatory Policy Group.
However, Howe has now moved upward to become Deputy Director of the Center for Medicare, leading Original Medicare policy and operations. CMS’s July 2026 biography describes HAPG director as his “most recent” former position. CMS biography
The HAPG directorship is therefore presently vacant—or at least undergoing permanent recruitment. CMS is advertising one Senior Executive Service vacancy for Director, HAPG, with applications closing September 21, 2026. Current USAJobs announcement
I cannot find a publicly named acting HAPG director. Therefore, the most accurate current formulation is:
HAPG was headed by Ryan Howe, who has been promoted to Deputy Director of the Center for Medicare.CMS is currently recruiting his permanent successor; no acting HAPG director is publicly identified.
The hierarchy is:
- Ryan Howe: Deputy Director, Center for Medicare—Original Medicare
- HAPG director: currently being filled
- Donald Thompson: Director, Division of Acute Care—inpatient hospital/IPPS
- David Rice: Director, Division of Outpatient Care—HOPPS/ASC
- Gift Tee: Director, Division of Practitioner Services—PFS
- Division of Ambulatory Services: clinical lab, Part B drugs, RHC/FQHC and related benefits
- HAPG director: currently being filled
So Thompson is a division chief, one level below the HAPG director and two levels below Howe’s new position.
Yes—you’re remembering Chris Klomp. The title was slightly different:
- Klomp was CMS Deputy Administrator and Director of the Center for Medicare. CMS identified him in that role.
- In February 2026, RFK Jr. made him HHS Chief Counselor, overseeing day-to-day HHS operations—effectively Kennedy’s No. 2.
- President Trump subsequently nominated Klomp to be HHS Deputy Secretary, the formal No. 2 position. As of August 24, HHS still lists him as Chief Counselor, suggesting his Senate confirmation remains pending. Official HHS profile
The resulting CMS reshuffle appears to be:
- Chris Klomp moved from leading the Center for Medicare to HHS.
- John Brooks became CMS Deputy Administrator and Director of the Center for Medicare.
- Ryan Howe, formerly director of HAPG, became Deputy Director of the Center for Medicare for Original Medicare.
- That left the HAPG director position vacant; CMS is recruiting a permanent replacement.
- Don Thompson remains below that level as Director of HAPG’s Division of Acute Care.
The August 14, 2026 federal regulatory agenda identifies him as Director, Division of Acute Care, Center for Medicare, with telephone 410-786-6504 and email donald.thompson@cms.hhs.gov. The CMS organization chart places the Division of Acute Care within the Hospital and Ambulatory Policy Group (HAPG). Federal Register, August 14, 2026; CMS description of HAPG.
In practical terms, he is CMS’s career division chief for hospital inpatient payment policy. His division defines inpatient hospital Medicare benefits and develops and maintains IPPS, including MS-DRGs, operating and capital payment, wage-index and geographic-reclassification policy, DSH, GME, outlier policy and the LTCH PPS. The 2026 IPPS rule continues to list Thompson and Michele Hudson as the principal contacts for most of that very large policy portfolio. FY 2027 IPPS proposed rule.
Reconstructed CMS/HCFA history
This is best treated as a documentary reconstruction rather than a conventional résumé. CMS apparently has never published a full biography.
| Period | Documented position or activity |
|---|---|
| 1994–1998 | Already at HCFA, CMS’s predecessor, working on the Medicare Physician Fee Schedule update and physician-volume/SGR calculations. Federal Register notices repeatedly identify “Don Thompson” as the substantive contact, although they do not state his formal grade or title. The earliest record I found is December 1994. 1994 Federal Register notice; 1997/1998 conversion-factor notice |
| By 2003 | Director, Ambulatory Services Division, CMS. A contemporaneous oncology-policy report identifies him in that position while discussing Part B drug/AWP policy. ACCC Action, 2003 |
| 2004–2005 | Described in trade reporting as Director of Outpatient Services, Center for Medicare Management—apparently a shortened or informal rendering of his ambulatory-services position. He was heavily involved in Part B drug reimbursement and the competitive-acquisition program. 2005 report |
| 2006 | One contemporaneous report calls him a senior technical adviser to CMS on physician-work RVUs. This may have been a functional description rather than a new formal organizational title. CMS physician-payment report |
| 2007 | Acting Deputy Director, Hospital and Ambulatory Policy Group, Center for Medicare Management. That is a notable group-level acting assignment, above the individual divisions. CMS PPAC agenda, August 27, 2007 |
| 2013–early 2014 | Acting Deputy Director, Division of Acute Care. He was one of CMS’s public officials explaining implementation of the controversial two-midnight inpatient-admission policy. Contemporaneous two-midnight report |
| By December 2014–November 2018 | Deputy Director, Division of Acute Care, Center for Medicare. This title is consistently reported in contemporaneous editions of the federal regulatory agenda. December 2014 Federal Register; November 2018 Federal Register |
| Between November 2018 and April 2019 | Promoted from deputy director to Director, Division of Acute Care. The April 2019 Unified Agenda gives the director title, while the November 2018 edition still says deputy director. April 2019 OMB regulatory record |
| 2019–present | Continues as Director, Division of Acute Care. The title appears repeatedly through the August 2026 federal regulatory agenda. 2022 Federal Register; August 2026 Federal Register |
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