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Rural Health Information Hub
Rural Health Information Hub

Rural Health
News by Topic: Reimbursement and payment models

Dec 2, 2025 - Notice of a final rule from the Centers for Medicare & Medicaid Services (CMS) updating the home health payment rates for calendar year (CY) 2026. This rule also finalizes changes to the face-to-face encounter policy, Home Health Quality Reporting Program (HH QRP), and the expanded Health Value-Based Purchasing (HHVBP) Model requirements; updates the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP); and makes a technical change to the home health conditions of participation. Among other things, this rule also finalizes permanent and temporary behavior adjustments and recalibrates the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. These regulations are effective January 1, 2026.
Source: Federal Register
Nov 28, 2025 - Notice from the Centers for Medicare & Medicaid Services (CMS) making technical corrections to the November 5, 2025, final rule. This correction is effective January 1, 2026.
Source: Federal Register
Nov 28, 2025 - Notice of a proposed rule from the Centers of Medicare & Medicaid Services (CMS) that would revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and Medicare cost plan regulations. Proposed revisions would implement changes related to Star Ratings, marketing and communications, drug coverage, enrollment processes, special needs plans, and other programmatic areas for contract year 2027. Among other things, this proposed rule also includes a request for information regarding changes to the Medicare Advantage (MA) that would modernize and improve the MA program and could be implemented through either programmatic changes or through a CMS Innovation Center (CMMI) model. Comments are due by January 26, 2026.
Source: Federal Register
Nov 25, 2025 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) making changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2026, including changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment systems. Among other things, this rule also updates the requirements for the Hospital Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, Overall Hospital Quality Star Rating, and hospitals to make public their standard charge information and enforcement of hospital price transparency. This rule also announces the closure of a teaching hospital and the opportunity to apply for available slots. This rule is effective January 1, 2026. Applications for available resident spots are due by February 19, 2026.
Source: Federal Register
Nov 24, 2025 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) making changes related to End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2026 and updating the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). Among other things, this rule also updates requirements for the ESRD Quality Incentive Program and modifying and terminating requirements for the ESRD Treatment Choices Model. These regulations are effective January 1, 2026.
Source: Federal Register
Nov 21, 2025 - Notice from the Department of Veterans Affairs (VA) withdrawing the January 3, 2025, proposed rule titled "Exempting Whole Health Well-Being Services From Copayment." This withdrawal is applicable on November 21, 2025.
Source: Federal Register
Nov 19, 2025 - The Centers for Medicare & Medicaid Services (CMS) is seeking comments on an information collection titled "Methods for Assuring Access to Covered Medicaid Services Under 42 CFR 447.203 and 447.204." CMS will use the information to monitor ongoing compliance with section 1902(a)(30)(A) of the Social Security Act, and to make informed approval decisions on State plan amendments that propose to make Medicaid rate reductions or restructure payment rates. Beneficiaries, providers, and other affected stakeholders may use the information to raise access issues to state Medicaid agencies and work with agencies to address those issues. Comments are due by January 20, 2026.
Source: Federal Register
Nov 19, 2025 - The Centers for Medicare & Medicaid Services (CMS) will hold a virtual public meeting on December 17, 2025 from 9:00 a.m. until 5:00 p.m. Eastern to discuss CMS preliminary coding, Medicare benefit category, and Medicare payment determinations, if applicable, for new revisions to the HCPCS Level II code set for non-drug and non-biological items and services. If all of the agenda items are not addressed on December 17, 2025, a subsequent virtual session will be held on December 18, 2025 at 9:00 a.m. Eastern. All individuals who plan to speak must register by December 3, 2025.
Source: Federal Register
Nov 12, 2025 - Describes a medical coding and billing training for rural healthcare providers in Texas. The training aims to help small clinics accurately submit reimbursement claims so that financially vulnerable facilities can stay open.
Source: KBTX
Nov 5, 2025 - Notice of a final rule from the Centers for Medicare & Medicaid Services (CMS) addressing: 1) changes to the Physician Fee Schedule and Medicare Part B payment policies; 2) policies for the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; 3) the Ambulatory Specialty Model; 4) updates to the Medicare Diabetes Prevention Program expanded model; 5) updates to drugs and biological products paid under Part B; 6) Medicare Shared Savings Program requirements; 7) updates to the Quality Payment Program; 8) updates to policies for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); 9) updates to the Ambulance Fee Schedule regulations; 10) codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions; and 11) updates to the Medicare Promoting Interoperability Program. These regulations are effective January 1, 2026.
Source: Federal Register