MLN Connects Newsletter for July 30, 2026

Date
2026-07-30
Title
In This Edition: SNF & IPF Final Payment Rules | Clinical Labs | Vaccine Pricing
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Final Payment Rules

News

Claims, Pricers & Codes

 

 

Final Payment Rules

FY 2027 Skilled Nursing Facility Prospective Payment System Final Rule

CMS issued a final rule for updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for FY 2027. 

For FY 2027, CMS finalized updating SNF PPS rates by 2.4% based on the final SNF market basket of 3.3%, reduced by a 0.9% productivity adjustment, for an estimated increase of $882.74 million in aggregate payments to SNFs.

The final rule also includes:

  • Final updates to the SNF Quality Reporting Program (QRP)
  • SNF QRP request for information (RFI)
  • Final updates to the SNF Value-Based Purchasing Program (VBP)
  • RFI on updating the Patient Driven Payment Model Payment System to address case-mix upcoding

More Information:

 

FY 2027 Inpatient Psychiatric Facility Prospective Payment System Final Rule

CMS issued a final rule to update Medicare payment policies and rates for inpatient psychiatric facilities (IPFs) under the IPF Prospective Payment System (PPS) for FY 2027.

The final rule includes annual updates to the prospective payment rates, the outlier threshold, the wage index, and associated impact analysis. In addition, the rule finalizes a policy effective for FY 2028 to limit outlier payments at the facility level to no more than 20% of an IPF’s total IPF PPS payments in a year, for IPFs with at least 50 stays per year. For the IPF Quality Reporting Program (QRP), CMS is removing 2 measures from the program, as well as implementing a standardized IPF patient assessment instrument.

For FY 2027, CMS is updating the IPF PPS payment rates by 2.3%, based on the 2021-based IPF market basket increase of 3.2% less a 0.9 percentage point productivity adjustment. Additionally, CMS is updating the outlier threshold so that estimated outlier payments remain at 2% of total IPF PPS payments. Total estimated payments to IPFs would increase by 2.3%, or $60 million, in FY 2027, relative to IPF payments in FY 2026. 

More Information:

 

 

News

CMS Medicaid Fraud War Room Stops More Than $203 Million in Improper Payments During First 88 Days

CMS announced that enforcement efforts from its Medicaid Fraud War Room (MFWR) stopped more than $203M in potentially improper Medicaid payments in just under 90 days, highlighting significant progress in protecting taxpayer dollars and strengthening Medicaid program integrity. Since its launch on April 23, the MFWR has coordinated actions against 50 unique, high-risk Medicaid providers identified through advanced data analytics and representing more than $203 million in Medicaid payments subject to federal exclusions and state enforcement efforts.

More information:

 

Clinical Diagnostic Laboratories: Last Chance to Report Your Data

Are you an independent laboratory, physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS)? If so, you must report your data by July 31, 2026, or you may be subject to civil monetary penalties. Report data from January 1 – June 30, 2025, including:

  • Applicable HCPCS codes
  • Associated private payor rates
  • Volume data

How do I report?

  1. Review CLFS Data Collection System resources:
  2. View the applicable HCPCS codes (ZIP)
  3. Use the Data Reporting Template (ZIP); see training video (14:51)

More Information:

 

Clinical Laboratories: New Diagnostic Tests

Learn about Medicare Advisory Panel on Clinical Diagnostic Laboratory Services recommendations for new clinical diagnostic laboratory tests for CY 2027:

 

DMEPOS Requirement Updates

CMS added 20 items to the Master List of DMEPOS Items Potentially Subject to Conditions of Payment. We didn’t remove any items. 

If these items are selected for a face-to-face encounter, written order prior to delivery, or prior authorization, you may be required to do one or both:

  • Meet with your patient and give them a written order before delivering the item
  • Ask your Medicare Administrative Contractor to authorize the item in advance

Learn more about extra order requirements:

 

Nursing Homes: Get Health & Fire Safety Deficiency Information

Find out about health and fire safety deficiencies for nursing homes. Now, CMS lists the most severe level of harm first to:

  • Help users quickly identify critical facility issues
  • Improve our home inspection result transparency

Get detailed deficiency information:

 

 

Claims, Pricers & Codes

Seasonal Influenza & COVID-19 Vaccine Pricing for 2026–2027 Season

Visit the CMS Vaccine Pricing webpage to get 2026–2027 seasonal influenza and COVID-19 vaccine pricing, including Medicare payment allowances and effective dates. CMS will make updates as additional pricing information becomes available. Check back to ensure you’re getting the most current information.

Use the vaccine crosswalk (ZIP) if you need to identify the corresponding National Drug Codes.

More Information: 

 

 

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