September 4, 2025

CMS Proposes Updates to Medicare Physician Fee Schedule Payments, Comment by September 12

On January 31, 2025, President Trump issued Executive Order (EO) 14192 “Unleashing Prosperity Through Deregulation,” which states the Administration policy to significantly reduce the private expenditures required to comply with Federal regulations to secure America’s economic prosperity and national security and the highest possible quality of life for each citizen.

CMS is seeking public input on approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries, and other stakeholders participating in the Medicare program.

This major proposed rule addresses:

• changes to the physician fee schedule (PFS);
• other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice,
• relative value of services, and
• changes in the statute; codification of establishment of new policies for the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022;
• the Ambulatory Specialty Model;
• updates to the Medicare Diabetes Prevention Program expanded model;
• updates to drugs and biological products paid under Part B; Medicare Shared Savings Program requirements;
• updates to the Quality Payment Program;
• updates to policies for Rural Health Clinics and Federally Qualified Health Centers
• update to the Ambulance Fee Schedule regulations;
• codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions;
• updates to the Medicare Promoting Interoperability Program.

Click Here to Read More and Comment

September 4, 2025

CMS Proposes New Mandatory Alternative Payment Model, the Ambulatory Specialty Model (ASM) – Comment by September 12

The proposed Ambulatory Specialty Model (ASM) aims to improve prevention and upstream management of chronic disease, which would lead to reductions in avoidable hospitalizations and unnecessary procedures.

Participation in ASM would be mandatory for specialists who commonly treat people with Original Medicare for heart failure or low back pain in an outpatient setting across selected regions. ASM would begin on January 1, 2027 and run for five performance years through December 31, 2031.

Key Points

• Problem: Delayed detection of chronic conditions, financial incentives that encourage unnecessary procedures, and the lack of care coordination among specialists and primary care providers all contribute to poor health outcomes for people who are at risk for or living with chronic disease. These include delayed diagnosis and poor disease management.
• Solution: ASM would promote preventive care and more effective upstream chronic disease management by rewarding specialists for improving patient health outcomes and coordination with primary care providers.
• Outcomes: ASM would reduce avoidable hospitalizations and unnecessary procedures, improve patient experience and outcomes, and lower costs to Original Medicare.
• Strategy: ASM would help to Make America Health Again by promoting preventive care through interventions like screening, increasing transparency by making provider performance assessments more widely available, and protecting American taxpayers by holding specialists accountable for the cost of care.

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Click Here to Read Proposed Rule and Comment