Reconstructed CMS Hierarchy, including HAPG, including Don Thompson

 This is a reconstructed leadership chain and Thompson background.

 Don Thompson heads the Division of Acute Care, essentially the inpatient-hospital division. Hospital outpatient policy is a separate HAPG division.

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

So Thompson is a division chief, one level below the HAPG director and two levels below Howe’s new position.

Some guy was deputy direcot and got bumped up to #2 under RFK jR.

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:

1. Chris Klomp moved from leading the Center for Medicare to HHS.
2. John Brooks became CMS Deputy Administrator and Director of the Center for Medicare.
3. Ryan Howe, formerly director of HAPG, became Deputy Director of the Center for Medicare for Original Medicare.
4. That left the HAPG director position vacant; CMS is recruiting a permanent replacement.
5. Don Thompson remains below that level as Director of HAPG’s Division of Acute Care.

CMS confirms the current top Center for Medicare lineup as Brooks, Principal Deputy Alec Aramanda, and Original Medicare Deputy Ryan Howe. Current CMS leadership

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Don Thompson is a senior career Medicare official whose current title is:

Director, Division of Acute Care [hospital], Hospital and Ambulatory Policy Group, 

Center for Medicare, Centers for Medicare & Medicaid Services.

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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