Thursday, July 30, 2026

CMS has finalized the annual update to the Master List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that are potentially subject to a face-to-face encounter, a written order prior to delivery, and/or prior authorization. The agency also updated the Required Prior Authorization List and the Required Face-to-Face Encounter and Written Order Prior to Delivery List. These changes dictate which specific HCPCS codes will be subject to these requirements in the coming year, impacting suppliers and ordering providers. Billing teams for DME suppliers and referring practices must cross-reference the new lists against their product catalogs and update internal compliance checklists. The rule is effective upon publication; claims for newly added items submitted without the mandated documentation will be denied.

The HHS Office of Inspector General (OIG) has issued a critical report on prior authorization practices within Medicare Advantage plans, citing high rates of inappropriate denials and delays. The report underscores findings that a significant portion of prior authorization requests for services that meet Medicare coverage rules are still denied by MA plans, with appeals often overturning these decisions. This adds regulatory and political pressure on CMS to enforce existing rules and potentially tighten oversight. For practices, this report validates the operational burden of MA prior auths but does not change immediate workflows. It does, however, strengthen the case for appealing MA denials, as the OIG data suggests a high likelihood of reversal.

CMS is terminating the Part D Premium Stabilization Demonstration, a subsidy program that has helped limit premium increases for stand-alone Prescription Drug Plans (PDPs). The change is set for the 2027 plan year. Analysts warn this could lead to larger premium hikes for some beneficiaries next year, shifting more out-of-pocket costs to patients. This economic shift may increase patient sensitivity to drug costs and co-pays, potentially affecting medication adherence and leading to more patient questions about affordability at the point of care. Practice financial counseling and front-desk staff should be prepared for these inquiries as the 2027 Annual Election Period approaches this fall.

Humana announced it will exit Medicare Advantage plans in 89 more counties for 2027, a retreat from its aggressive growth strategy. The insurer cited ongoing pressure from CMS reimbursement rates and rising medical costs. This follows significant plan exits in 2026 and signals a broader industry recalibration as payers face tighter margins in the MA program. The move will displace thousands of seniors who will need to find new coverage during the next Annual Election Period. For practices, this means potential churn in patient insurance panels and a shift toward other MA carriers or original Medicare in affected markets. Monitor Humana’s final service area announcements later this year.