CMS proposes sweeping Medicare and Medicaid reforms

The U.S. Centers for Medicare & Medicaid Services (CMS) announced a six‑month moratorium on new Medicare home‑health enrollments to curb fraud and protect patient safety. Industry leaders say the freeze is prompting a shift toward joint‑venture and affiliation models as providers seek growth without new enrollments.

CMS also released a major overhaul of the Medicare physician payment system. The proposal would update the Physician Fee Schedule, move payments away from volume‑based metrics toward outcomes, end traditional MIPS reporting in 2029, introduce specialty‑focused reporting for conditions such as diabetes and hypertension, and redirect $2.38 billion in bonus payments away from clinicians not in advanced value‑based care programs.

In addition, CMS issued new guidance on Medicaid work‑reporting requirements, tightening the definition of medical frailty and increasing documentation burdens for enrollees and providers. The agency also proposed expanding its authority to deny and retroactively revoke Medicare enrollment for providers deemed high‑risk for fraud, estimating $82 million in annual savings.