September 4, 2025

CMS Proposes Updates to Medicare and Medicaid Programs, Comment by September 15

This proposed rule would revise the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2026 based on continuing experience with these systems.

Included are descriptions of the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment systems.

This proposed rule would also update and refine the requirements for the:

• Hospital Outpatient Quality Reporting Program,
• Rural Emergency Hospital Quality Reporting Program,
• Ambulatory Surgical Center Quality Reporting Program,
• Overall Hospital Quality Star Rating, and
• Hospitals to make public their standard charge information and enforcement of hospital price transparency.

This rule also contains requests for information on measure concepts regarding:

• Well-Being and Nutrition for consideration in future years for all three programs (OQR, REHQR, and ASCQR);
• expanding the method to control for unnecessary increases in the volume of covered OPD services to on-campus clinic visits;
• software as a service; and
• adjusting payment under the OPPS for services predominately performed in the ambulatory surgical center or physician office settings.

Click Here to Read Proposed Changes and Updates and Comment by September 15

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.

Click Here to Read More

Click Here to Read Proposed Rule and Comment

August 12, 2025

2025 National Shortage Designation Update

Health Professional Shortage Areas, also known as HPSAs, can be geographic areas, populations, or facilities that have a shortage of primary, dental, or mental health care providers.

The designations are to determine eligibility for programs like the National Health Service Corps, Nurse Corps, and other programs; they’re also used by the Centers for Medicare & Medicaid Services and other Health & Human Services programs to determine where resources and support are needed.

HRSA’s Bureau of Health Workforce intends to update the designations and publish new HPSAs on September 23, 2025.

To Learn More:

• View recording of May 29 information session
• Download the webinar FAQs
• Download the webinar slides

August 12, 2025

HRSA Announces New 340B Rebate Model Pilot Program, Apply by September 2

On July 31, the Health Resources and Services Administration (HRSA) announced a 340B Rebate Model Pilot Program for drugs on the Centers for Medicare & Medicaid Services’ (CMS) Medicare Drug Price Negotiation Selected Drug List for the year 2026 from qualifying manufacturers meeting specific criteria.

The Health Resources and Services Administration’s (HRSA’s)Office of Pharmacy Affairs, which currently oversees the 340B Drug Pricing Program, is inviting selected drug manufacturers to apply for participation in the pilot program for a minimum of one year. HRSA is implementing the program to better understand the merits and shortcomings of the rebate model from the perspective of affected stakeholders, and to help shape future 340B rebate models that align with 340B statue and the Administration’s goals.

Organizations may submit Rebate Model Pilot plan and/or provide comments by September 2, 2025, by visiting the 340B Program Notice: Application Process for the 340B Rebate Model Pilot Program Federal Register Notice.

Click Here to Learn More