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[SITUATION] · [QUIET] · [HEALTH]

7 clusters · 19 sources · 43 days · First seen · Last updated

CMS Medicare and Medicaid payment reforms

Overview

Since early July 2026, CMS has rolled out a suite of Medicare and Medicaid payment reforms for FY 2027. Proposed rules for Medicare home health include a 2.4% aggregate increase, offset by a temporary 3% cut to the standardized rate to recoup prior overpayments. To curb fraud, CMS announced a six-month moratorium on new home-health enrollments and expanded its authority to revoke enrollment, potentially saving $82 million annually.

Physician reimbursement reforms include a proposed 2.5% overall cut, though endocrinology payments would rise. The Physician Fee Schedule proposal seeks to transition from volume-based metrics to outcomes, sunsetting traditional MIPS reporting after 2029 in favor of new Value Pathways for diabetes, hypertension, and hospital-based care. Additionally, CMS proposed restricting remote physiologic (RPM) and therapeutic monitoring (RTM) services to direct-practice employees and requiring an initiating visit. Recent updates also suggest changes for anesthesia practices, including the potential replacement of traditional MIPS with the Ambulatory Specialty Model.

Medicaid reforms include tightened work-reporting requirements and a July 23 proposal to overhaul the provider tax system. This overhaul aims to reduce federal Medicaid spending by $246 billion over 2026–2035 by replacing the uniform 6% federal threshold with state- and provider-specific limits.

On July 30, CMS finalized the FY 2027 Skilled Nursing Facility Prospective Payment System, increasing Medicare SNF rates by 2.4% (≈$883 million) and revising the SNF Quality Reporting Program by removing two COVID-19 vaccination measures and expanding mandatory assessment reporting to all patients.

Entities

Centers for Medicare & Medicaid Services · G2211 complex care code · Centers for Medicare & Medicaid Services (CMS) · Patients First Act · Endocrine Society

Timeline

  1. 29 days ago

    [HEALTH] 2 sources
    CMS proposes 2027 Physician Fee Schedule updates

    CMS has proposed the 2027 Physician Fee Schedule, featuring lower reimbursement conversion factors and updates to MIPS reporting for anesthesia, while seeking input on AI and technology in primary care.

  2. about 1 month ago

    [HEALTH] 3 sources
    CMS Announces 2.4% Medicare Payment Rise for Skilled Nursing Facilities

    CMS released the FY 2027 SNF payment rule, raising Medicare rates by 2.4% ($882 M) and revising quality reporting by dropping COVID‑19 vaccine measures and shortening data deadlines.

  3. about 1 month ago

    [HEALTH] 2 sources
    CMS proposes Medicare physician payment and billing rule changes

    CMS proposed a 2027 Medicare physician fee rule cutting overall payments, boosting endocrinology rates, changing code G2211, raising FNA fees, and tightening remote monitoring requirements, while also overhauls

  4. about 2 months ago

    [HEALTH] 3 sources
    CMS Proposes Medicaid Provider Tax Overhaul to Cut Federal Spending

    CMS proposes a Medicaid provider tax overhaul that would replace the 6% threshold with variable limits, add health insurers as a tax class, and cut federal Medicaid spending by about $246 billion over ten years

  5. about 2 months ago

    [HEALTH] 3 sources
    US CMS proposes 2027 Medicare Physician Fee Schedule changes and remote monitoring limits

    CMS proposes 2027 Medicare fee schedule cuts, ends temporary 2.5% boost, adds new value pathways, and limits outsourced remote monitoring services to practice‑staff, with reduced payments and new code bundles.

  6. about 2 months ago

    [HEALTH] 10 sources
    CMS proposes sweeping Medicare and Medicaid reforms

    CMS unveils a home‑health enrollment moratorium, a physician payment overhaul shifting to value‑based care, stricter Medicaid work‑reporting rules, and expanded authority to deny or revoke Medicare enrollment.

  7. 2 months ago

    [HEALTH] 2 sources
    CMS proposes 2027 Medicare payment adjustments for home health and hospitals

    CMS's 2027 proposals raise home health payments 2.4% with a -3% temporary cut, add anti‑fraud rules, and give hospitals a 2.4% base increase while slashing 340B drug rates and imaging payments, yielding mixed A

Sources

acs.org.au · beckershospitalreview.com · cloudrcmsolutions.com · distilnfo.com · employee.org · endocrinenews.endocrine.org · healthlawadvisor.com · hfma.org · lilesparker.com · natlawreview.com · newshealth.biz · ntd.com · royalexaminer.com · skillednursingnews.com · swissuniversities.ch · world-today-journal.com · wsau.com · wtvbam.com · wxerfm.com

This summary has been updated 2 times: see revision history