CMS & CMMI Updates

Key Actions:

CMS activity over the last 30 days reflects three priorities: rural access investment, program integrity, and 2027 claims/payment system readiness under the Trump administration.

CMS announced new Medicare options intended to help beneficiaries manage substance use disorder, heart failure, and other chronic conditions in CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic Conditions. Details will matter for ACOs, MA plans, and physician groups if these options alter care management, benefit design, network strategy, or chronic-condition coding workflows.

CMS also continued a state-by-state rural health investment push, including $104 million for Mississippi for technology and care closer to home; nearly $17 million for rural Kansas for emerging technologies and interfacility transportation; expanded preventive and behavioral health access for rural North Carolina students; $11.7 million for Vermont nursing homes and long-term care workforce capacity; $4.8 million for West Virginia rural workforce and preventive care; $76 million for New York regional coordination and technology modernization; $5.48 million for rural Rhode Island workforce pipeline; $25 million for Michigan telehealth, technology, and broadband; $120 million for Indiana maternal/infant health, primary care, and workforce; $58 million for Hawaii ambulances and emergency communications; $149.3 million for rural Arkansas telehealth, specialty access, and preventive screenings; and $122 million for Virginia access, workforce, and innovation (MS, KS, NC, VT, WV, NY, RI, MI, IN, HI, AR, VA).

Program integrity actions were prominent: CMS announced action against a $3.4 billion medical equipment supplier fraud scheme and separately said it prevented $1.6 billion in fraudulent Medicare laboratory payments (DME fraud, lab payments).

Operationally, CMS issued multiple transmittals: R13930CP implements FY 2027 IPPS/LTCH PPS changes on October 5, 2026; R13943CP updates SNF consolidated billing HCPCS enforcement for October 2026; R13934OTN updates HIPAA EDI front-end processing for October 2026; R13945MPI updates Medicare Program Integrity Manual vetting and overpayment-record processes; R13942CP updates 2027 HPSA bonus payments effective implementation January 4, 2027; R13952CP updates Laboratory NCD edit software for January 2027; R13944CP adds hospice claim reporting for face-to-face recertification encounters conducted via telecommunications technology; R13912CP updates MPFSDB record-layout instructions; and R13928OTN implements the Jurisdiction H A/B MAC award (R13930CP, R13943CP, R13934OTN, R13945MPI, R13942CP, R13952CP, R13944CP, R13912CP, R13928OTN).