Medicare Payment Policy
Expert articles and analysis related to medicare payment policy.
AI Summary — Last 7 Days
CMS is signaling a broader Medicare payment-policy shift toward technology-enabled chronic care and primary care rebalancing: the Trump administration is expanding the ACCESS model in 2027 to COPD, substance use disorder, and tobacco cessation, while CY 2027 PFS/MSSP proposals aim to address longstanding primary care undervaluation and strengthen accountable care participation. Provider and VBC coalitions are pressing CMS to pair those reforms with lower administrative burden, better interoperability, and stronger incentives for MSSP/ACO participation, even as OIG audits of Medicare Advantage diagnosis coding keep risk adjustment integrity and coding compliance under scrutiny. The near-term dynamic for ACOs, health systems, and payers is a tightening link between payment innovation, chronic-condition management, and documentation accountability—creating upside for organizations that can align primary care, specialty models, and population-health infrastructure with CMS’s 2027 direction (ACCESS expansion; Premier CY 2027 comments).
Related Articles
Half of Medicare Advantage stars thresholds harder to reach in 2027
The CMS released draft star ratings, including the thresholds for reaching those ratings, to plans earlier this week. The grading sheet got stricter, which doesn’t bode well for insurers, one MA exper...
Brooklyn Adult Daycare Owner Sentenced to Prison for Leadership Role in $64M Medicaid Fraud Scheme - Department of Justice (.gov)
Brooklyn Adult Daycare Owner Sentenced to Prison for Leadership Role in $64M Medicaid Fraud Scheme Department of Justice (.gov)
CMS expands Medicare TAVR coverage
CMS expands Medicare TAVR coverage Modern Healthcare
Medicaid will let states use ‘tiers’ to determine medical frailty
New Medicaid rules use allow use of tiers to determine work exemptions. Advocates fear complex guidelines could cause patients to lose insurance.
Vision services provider agrees to pay $8M for illegal Medicaid billing for child lenses - Office of Inspector General (.gov)
Vision services provider agrees to pay $8M for illegal Medicaid billing for child lenses Office of Inspector General (.gov)
Two Of Arizona Medicaid MCOs Did Not Complete Required Behavioral Health Parity Analyses - open minds
Two Of Arizona Medicaid MCOs Did Not Complete Required Behavioral Health Parity Analyses open minds
Indigenous Groups Are Exempt From Medicaid Work Rules, but Native Hawaiians Aren’t
Native Hawaiians will have to comply with the new work requirements in President Donald Trump’s signature One Big Beautiful Bill Act, despite facing significant obstacles to employment and healthcare.
The new Medicaid work requirement and how states are planning to implement it
The new Medicaid work requirement and how states are planning to implement it Association of Health Care Journalists
Owner Of Home Health Fiscal Intermediary, Adult Day Sentenced For $64M Medicaid Fraud Scheme
Understanding School Medicaid - Part 3: The Implications of H.R.1 on School Medicaid and School Health Services - academyhealth.org
Understanding School Medicaid - Part 3: The Implications of H.R.1 on School Medicaid and School Health Services academyhealth.org