[REVISION HISTORY]
CMS Medicare and Medicaid payment reforms
Updated 2 times since CLSTR started tracking revisions of this situation.
What changed
2026-07-31 19:17 UTC → 2026-08-14 20:32 UTC ·
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Since early July 2026, CMS has rolled out a suite of Medicare and Medicaid payment reforms for FY 2027. A proposed rule raised Proposed rules for Medicare home‑health rates by about home health include a 2.4% while imposing aggregate increase, offset by a temporary 3% cut to the standardized rate, added anti‑fraud provisions, and introduced modest OPPS adjustments. A six‑month rate to recoup prior overpayments. To curb fraud, CMS announced a six-month moratorium on new Medicare home‑health home-health enrollments was announced, along with and expanded its authority to revoke enrollment, projected to save potentially saving $82 million annually. Medicaid work‑reporting requirements were tightened, and conversion factors for APM participants were lowered. New 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 were introduced, hospital-based care. Additionally, CMS proposed restricting remote physiologic (RPM) and RPM/RTM therapeutic monitoring (RTM) services were limited to direct‑practice employees. A 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 overhauled to overhaul the Medicaid provider tax system, targeting a $246 billion reduction in system. This overhaul aims to reduce federal Medicaid spending by $246 billion over 2026‑2035. A separate physician fee‑schedule proposal would lower overall physician reimbursement 2026–2035 by about 2.5% while raising endocrinology payments. 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 COVID-19 vaccination measures, shortening data‑submission deadlines, measures and expanding mandatory assessment reporting to all patients.
Versions
- 2026-08-14 20:32 UTC CMS Medicare and Medicaid payment reforms
- 2026-07-31 19:17 UTC CMS Medicare and Medicaid payment reforms
- 2026-07-31 17:54 UTC CMS Medicare and Medicaid payment reforms
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