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Rural Health Information Hub
Rural Health Information Hub

Rural Health
News by Topic: Reimbursement and payment models

Dec 23, 2025 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on a proposed rule implementing the Global Benchmark for Efficient Drug Pricing Model ("GLOBE Model"), a new Medicare payment model under section 1115A of the Social Security Act. The GLOBE Model would test whether a payment model that uses an alternative method for calculating Part B inflation rebate amounts for certain separately payable Part B drugs and biological products reduces costs for Medicare fee-for service (FFS) beneficiaries and the Medicare program while preserving quality of care. Comments are due by February 23, 2026.
Source: Federal Register
Dec 23, 2025 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on a proposed rule implementing the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model to test a new Medicare payment model under section 1115A of the Social Security Act. The model proposes a test of an alternative payment method for calculating inflation rebates for certain Part D drugs and biological products. The proposed GUARD Model would test whether changing the calculation of the Part D inflation rebate would reduce costs for the Medicare program while preserving or enhancing quality of care for Part D enrollees. Comments are due by February 23, 2026.
Source: Federal Register
Dec 23, 2025 - Notice of a request for information on what the U.S. Department of Health and Human Services can do to accelerate the adoption and use of artificial intelligence (AI) in clinical care. Feedback is requested on how the technology can be most effectively applied, to foster public trust, to reduce uncertainty that impedes innovation, and align federal incentives to deploy AI in a way that enhances productivity, reduces burden, lowers healthcare costs, and improves health outcomes. Comments will be used to inform regulations, reimbursement, and research and development. Comments are due by February 23, 2026.
Source: Federal Register
Dec 22, 2025 - Notice from the Centers for Medicare & Medicaid Services (CMS) is seeking comments on the following information collections: 1) External Quality Review (EQR) of Medicaid and Children's Health Insurance Program (CHIP) Managed Care, EQR Protocols, and Supporting Regulations; and 2) Medicaid Drug Program. Comments are due by February 20, 2026.
Source: Federal Register
Dec 17, 2025 - Notice from the Centers for Medicare & Medicaid Services (CMS) making technical and typographical corrections to the August 5, 2025, final rule titled " Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2026 and Updates to the IRF Quality Reporting Program."
Source: Federal Register
Dec 11, 2025 - Notice of a proposed rule from the Centers for Medicare & Medicaid Services (CMS) updating and revising the Increasing Organ Transplant Access Model (IOTA Model) for Performance Year (PY) 2, which will begin on July 1, 2026. The IOTA Model tests whether performance-based upside risk payments or downside risk payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures. Comments are due by February 9, 2026.
Source: Federal Register
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