Monday, July 6, 2026

CMS released the proposed Calendar Year 2027 Home Health Prospective Payment System rule, which would reduce base payments by 2.0%. The proposed cut results from a 2.8% market basket increase offset by a 4.8% productivity adjustment. The rule includes updates to the HH Quality Reporting Program and the expanded HH Value-Based Purchasing Model, plus changes to Medicare provider enrollment and DME/DMEPOS policies. Comments on the proposed rule are due 60 days after its July 6, 2026, publication in the Federal Register. Monitor the rule's progress as CMS finalizes rates and policies later this year.

Long-term care and post-acute providers are cautioning CMS to avoid overly broad enforcement as the agency pursues new avenues for Medicare disenrollment. The agency's recent push to expedite enrollment revocation and disenrollment of 'problematic' providers, proposed earlier this month, is raising operational concerns. Providers argue that aggressive disenrollment actions could disrupt patient continuity and disproportionately affect facilities serving complex populations. The comment period for CMS's proposed enrollment safeguards closed July 1, 2026; track the agency's final rule and implementation timeline for any changes to provider enrollment risk.

CMS's temporary Medicare GLP-1 Bridge program, which launched July 1, 2026, now covers weight-loss drugs like Wegovy and Zepbound for eligible beneficiaries with a $50 monthly co-pay. The program provides temporary coverage for individuals who meet BMI and comorbidity criteria, bridging them until Medicare Part D formulary updates take effect. Practices should ensure front-office staff and billing teams understand the program's eligibility requirements and documentation needed for prior authorization. Confirm patient eligibility and co-pay details before submitting claims for GLP-1 medications under Medicare to avoid denials.

The Supreme Court denied Big Pharma's constitutional challenge to Medicare's drug-price negotiation powers established by the Inflation Reduction Act. The ruling preserves HHS's authority to set maximum fair prices for certain high-cost Part D drugs. The first round of negotiated prices takes effect in 2028 for ten initial drugs. Manufacturers have no further legal avenue to block the program, which could put downward pressure on drug spend for practices managing high-cost Part D therapies. The decision solidifies the regulatory landscape, ending years of litigation uncertainty.

Several states are exploring policies to charge employers whose workers enroll in Medicaid. The approach aims to shift some Medicaid program costs back to employers who may offer inadequate health coverage. The proposals vary but could include fees based on the number of employees enrolled in Medicaid. This signals growing state-level fiscal pressure on Medicaid programs and potential new employer reporting or fee obligations. The concept remains in early discussion phases, but it reflects a trend of states seeking non-traditional Medicaid funding sources as enrollment remains elevated post-pandemic.