Monday, June 1, 2026

CMS has finalized the Increasing Organ Transplant Access (IOTA) Model as an Alternative Payment Model starting in 2027. The rule targets Medicare payments for organ transplant services, specifically kidney and liver transplants from living donors. It introduces new performance-based payment adjustments tied to transplant volume, waitlist outcomes, and post-transplant graft survival. CMS expects the model to shift financial incentives toward increasing living donor transplants and improving long-term patient outcomes. The final rule includes participation criteria for transplant centers, beneficiary protections, and data reporting requirements. Practices performing transplant procedures should review the final rule's impact on their Medicare revenue and participation timeline. Monitor CMS's IOTA Model website for implementation guides and enrollment details later this year.

Major payers have not updated their radiation oncology fee schedules to align with significant 2026 CPT and HCPCS code changes, creating unsustainable reimbursement shortfalls for oncology clinics. A leading oncologist warns this payment gap may force some independent clinics to close. The coding overhaul shifted billing for complex treatments like stereotactic body radiation therapy (SBRT) and intensity-modulated radiation therapy (IMRT), but payer systems are still applying outdated rates. This creates a 15-30% reimbursement cut on high-cost services, eroding margins. Oncology practices must immediately audit their payer contracts and recent remittance advices for these services. Contact your payer representatives to demand fee schedule updates and consider filing corrected claims if you billed under the new codes but were paid at old rates. Escalate through provider dispute resolution if payers refuse to align.

Home health and hospice providers describe facing "death by 1,000 cuts" as Medicare and Medicaid reimbursement fails to keep pace with rising labor and supply costs. The article details how chronic underpayment, combined with increased regulatory scrutiny and prior authorization hurdles, is forcing consolidation and service reductions. Specific pressure points include Medicare's Home Health Prospective Payment System rates, which providers say do not reflect actual cost inflation, and Medicaid managed care plans imposing restrictive network requirements. This reimbursement strain is pushing smaller independent agencies toward acquisition or closure, reducing patient access in rural areas. Home-based care practices should model their 2027 revenue under current proposals and prepare to advocate for rate adjustments during the upcoming comment periods. The trend signals broader payment instability across post-acute care sectors.

Governor Cooper signed legislation on May 31 that fills a $319 million shortfall in the state's Medicaid budget. The gap threatened provider payment reductions and potential service cuts. The funding patch uses a mix of state dollars and inter-budget transfers, securing rates for the current fiscal year. However, healthcare leaders warn that long-term structural challenges remain. Providers in rural counties, in particular, are still bracing for workforce pressures and the risk of future cutbacks. Monitor the state budget process this summer for next year's Medicaid appropriations; this stopgap does not resolve ongoing federal payment pressure.