Thursday, July 3, 2025
Proposed Payment Rules
- ESRD: CY 2026 Proposed Rule — Submit Comments by August 29
- Home Health: CY 2026 Proposed Rule — Submit Comments by August 29
News
- CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare
- National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud
- Skilled Nursing Facilities: Revalidation Deadline August 1
- Hospice Quality Reporting Program: Vendor Update Slide Deck & Errata for Data Specifications Effective October 1
MLN Matters® Articles
- Inpatient Rehabilitation Facility Prospective Payment System: FY 2026 Pricer Update
- Hospital Outpatient Prospective Payment System: July 2025 Update
Publications & Multimedia
Information for Patients
Proposed Payment Rules
ESRD: CY 2026 Proposed Rule — Submit Comments by August 29
CMS issued the CY 2026 ESRD Prospective Payment System proposed rule to update payment rates and policies for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2026. This proposed rule would also update the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities for CY 2026 and proposes to update requirements for the ESRD Quality Incentive Program.
See a summary of proposed provisions. Comments are due by August 29; see the proposed rule for details on how to submit them.
Home Health: CY 2026 Proposed Rule — Submit Comments by August 29
CMS issued the CY 2026 Home Health Prospective Payment System proposed rule that proposes updates for Medicare payment policies and rates for home health agencies.
See a summary of proposed provisions. Comments are due by August 29; see the proposed rule for details on how to submit them.
News
CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare
CMS announced a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars.
CMS issued a Request for Applications for companies interested in participating in the WISeR Model.
More Information:
- Full press release
- Federal Register notice
- Model Overview (PDF) fact sheet
- WISeR Model webpage
National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud
The Justice Department announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the U.S., for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss. The Takedown involved federal and state law enforcement agencies across the country and represents an unprecedented effort to combat health care fraud schemes that exploit patients and taxpayers.
Read the full press release.
Skilled Nursing Facilities: Revalidation Deadline August 1
Enrolled skilled nursing facilities should collect data on ownership, managerial, and related party information and submit their revalidation by August 1, 2025.
More Information:
Hospice Quality Reporting Program: Vendor Update Slide Deck & Errata for Data Specifications Effective October 1
CMS released a Hospice Vendor Update (PDF) slide deck and Data Submission Specifications Errata V1.00.2 (PDF) for the final Hospice Outcomes and Patient Evaluation (HOPE) data specifications V1.00.1, effective October 1, 2025. This information will help you prepare for HOPE implementation. Get more information on the HOPE Technical Information webpage.
MLN Matters® Articles
Inpatient Rehabilitation Facility Prospective Payment System: FY 2026 Pricer Update
Learn about updates (PDF) effective October 1, 2025:
- Rates
- Rural transition policy
- Wage index cap
Hospital Outpatient Prospective Payment System: July 2025 Update
Learn about updates (PDF) effective July 1, 2025, including coding and billing changes for:
- New COVID-19, influenza, and respiratory syncytial virus vaccines
- COVID-19 monoclonal antibody therapy products, proprietary laboratory analyses codes, and Hospital Outpatient Prospective Payment system device categories
- Status indicator changes
- Drugs, biologicals, and radiopharmaceuticals
- Skin substitutes
Publications & Multimedia
Screening, Brief Intervention & Referral to Treatment (SBIRT) Services — Revised
Learn what’s changed (PDF):
- Updated:
- Telehealth service requirements
- Information on prescribing controlled medications like buprenorphine using telehealth through December 31, 2025
- Added information on what Medicare covers:
- Opioid treatment programs
- Safety planning intervention for patients in crisis and post discharge follow-up contacts intervention
- Medication for opioid use disorder treatment in the emergency department
Information for Patients
CMS Notifies Individuals Potentially Impacted by Data Incident
CMS is notifying Medicare beneficiaries whose personal information may have been involved in a data incident affecting Medicare.gov accounts. CMS identified suspicious activity related to unauthorized creation of certain beneficiary online accounts using personal information obtained from unknown external sources. CMS takes this situation very seriously. The safeguarding and security of personally identifiable information is of the utmost importance to CMS.
Read the full press release.
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