Tuesday, August 25, 2026

CMS has finalized a new rule for skilled nursing facility payments that will have wider implications for documentation and healthcare data capture across settings. The rule mandates more granular patient assessment data, which will flow downstream to impact documentation requirements for referring physicians and post-acute care providers. For independent practices, this change means ensuring your documentation and EHR workflows for patient transfers to SNFs capture the required detail to support the facility's claim and avoid denials. Review the final rule's patient assessment instrument updates; compliance is required for discharges and referrals occurring after the rule's effective date, expected in early 2027.

Providence Health Plan will shut down following the failure of a planned Medicare Advantage deal. The closure will force tens of thousands of enrollees, including Medicare Advantage members, to find new coverage during the next open enrollment period. For independent practices, this means a payer will disappear from your contracted list. Begin identifying which of your patients are covered by Providence Health Plan, especially those in Medicare Advantage plans. You will need to help those patients transition to new coverage to avoid disruptions in care and payment delays starting in 2027.

CMS's 2027 Medicare Physician Fee Schedule and Outpatient Prospective Payment System proposed rules, released on August 24, detail key payment changes for Remote Patient Monitoring and Remote Therapeutic Monitoring. The agency is targeting reductions to these services as part of a broader budget-neutrality framework, signaling a move to curtail pandemic-era expansions. While the rules are not final, the proposed cuts indicate a significant reimbursement shift for practices that have built workflows around RPM and RTM codes. Practices should monitor the comment period for CMS-2027-P and CMS-2027-OPPS and model the potential revenue impact on their 2027 projections.

Vermont agencies are actively preparing Medicaid recipients for an upcoming overhaul of the program, according to state communications. This follows a report that Virginia is also preparing for significant Medicaid changes. The dual announcements signal a coordinated shift in state-level Medicaid administration, likely tied to federal waivers or new work requirements. For practices, this means patient coverage may shift mid-year, leading to eligibility verification errors and coverage gaps. Monitor your state's Medicaid agency announcements for exact effective dates and new enrollment or reporting requirements.

The Community Oncology Alliance has publicly endorsed significant hospital payment reforms included in CMS's 2027 Outpatient Prospective Payment System proposed rule. The group's support highlights provisions that would shift payment for certain drug administration services from the hospital outpatient setting to the physician office, a move aimed at reducing site-of-service disparities. For medical oncology and multispecialty practices, this signals CMS's continued push toward payment parity across settings, which could affect future contract negotiations with commercial payers that follow Medicare's lead. The proposed changes are part of the broader OPPS rule now open for public comment.