CMS & CMMI Updates

Key Actions:

CMS issued a major CY 2027 Medicare payment package under the Trump administration, led by CMS Administrator Dr. Mehmet Oz, centered on accountable care expansion, physician payment modernization, home health access, outpatient payment, drug affordability, and program integrity. The headline action is the CY 2027 Medicare Physician Fee Schedule proposed rule, CMS-1848-P, framed by CMS as “transformational” Medicare reform to expand accountable care and move from “sick care to healthcare” (press release; PFS fact sheet). CMS also released dedicated Medicare Shared Savings Program proposals within CMS-1848-P, signaling continued use of MSSP as the core Medicare ACO platform (MSSP fact sheet).

CMS proposed the CY 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center rule, CMS-1850-P, including policies CMS says would strengthen care quality, lower drug costs, and reduce beneficiary out-of-pocket costs (OPPS/ASC fact sheet; press release). CMS also issued the CY 2027 Home Health Prospective Payment System proposed rule, CMS-1844-P, paired with a program-integrity and access message for home health (fact sheet; press release).

On prescription drug access, CMS launched the Medicare GLP-1 Bridge, expanding access to GLP-1 medications (announcement). CMS also announced emergency Medicare flexibilities for Guam and the Commonwealth of the Northern Mariana Islands during a public health emergency (news alert).

Operationally, CMS released multiple transmittals: the FY 2026 Q4 Medicare overpayment/underpayment interest rate notice, implementation July 21, 2026 (R13869FM); PACE inpatient IME editing (R13854OTN); DMEPOS fee schedule, CLFS/CLIA, I/OCE, lab NCD edit, home health grouper, consolidated billing, MCE/ICD-10 updates, EDI front-end changes, hospice telecommunications claim reporting, ECRS prescription drug inquiry edits, transplant enrollment/FISS updates, Spanish HCPCS file conversions, hospital cost report revisions, and CY 2027 swing-bed rate corrections (R13846CP; R13855CP; R13844CP; R13849CP; R13793CP; R13794CP; R13813CP; R13865OTN; R13860CP; R13856MSP; R13863CP; R13867CP).