News
- CMS Proposed Rule Locks in Lower Prices & Fosters Innovation for the Medicare Drug Price Negotiation Program
- CMS Ensures Accrediting Organizations Uphold Trust in Standards & Oversight
- Short-Term Acute Care Hospitals: Download Your Q1 FY 2026 PEPPER
Compliance
Events
- PEPPER Updates for Critical Access & Short-Term Hospitals Webinar – June 23
- 2026 National Provider Compliance Conference – August 11–12
News
CMS Proposed Rule Locks in Lower Prices & Fosters Innovation for the Medicare Drug Price Negotiation Program
A new proposal from CMS would establish a permanent framework for the Medicare Drug Price Negotiation Program, creating a more transparent and sustainable process for lowering drug costs for millions of Medicare beneficiaries. The proposed rule would also create greater long-term certainty for drug manufacturers that participate in negotiations. It includes policies for negotiating and renegotiating high-cost, single-source drugs beginning with initial price applicability year 2029, while continuing to support innovation and strengthen the program.
More information:
- Full press release
- Proposed rule
- Fact sheet (PDF)
- Timeline: Medicare Drug Price Negotiation Program Proposed Rule (CMS-4215-P) (PDF)
- Medicare Drug Price Negotiation Program webpage
CMS Ensures Accrediting Organizations Uphold Trust in Standards & Oversight
CMS is taking steps to improve health care quality and patient safety through enhanced oversight of Accrediting Organizations (AOs). The final rule, Strengthening Oversight of AO and Preventing AO Conflicts of Interest, ensures that the organizations responsible for the oversight of more than 9,000 health care providers and suppliers use Medicare standards and creates greater consistency between state survey agencies and AOs in their respective survey processes. These changes will reduce provider burden, strengthen survey policies, and increase transparency.
More information:
Short-Term Acute Care Hospitals: Download Your Q1 FY 2026 PEPPER
CMS released the Q1 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals. The PEPPER helps you review your billing data to make sure claims are accurate. Use it to:
- Spot billing patterns that may need improvement
- Identify areas that may need audits or closer monitoring
- Find diagnosis-related groups that may be under-coded or over-coded
- Track areas where patient stays are getting longer
How to Get Your PEPPER
Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal.
How to become an SEU:
- Sign in to the CMS Identity & Access (I&A) Management System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function under your organization. The Comparative Billing Report business function is also available and can be requested at the same time.
- Your request must be approved by your AO or AM.
More Information:
- Review the User Guide
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
- Register for a webinar on June 23 at 1 pm ET
Compliance
Opioid Use Disorder: Learn about Services to Help Your Patients Continue Treatment
In a report, the Office of Inspector General determined that buprenorphine—the most common medication used to treat opioid use disorder (OUD) in Medicare—can decrease both opioid use and overdose deaths, leading to improved outcomes.
Medicare Part B covers many services that help your patients continue treatment for OUD for as long as reasonable and necessary. Visit the Opioid Treatment Programs webpage for more information.
Events
PEPPER Updates for Critical Access & Short-Term Hospitals Webinar – June 23
Tuesday, June 23 from 1–2 pm ET
Register for this webinar.
Join CMS to review the FY 2025 Critical Access Hospital Program for Evaluating Payment Patterns Electronic Report (PEPPER), released in May 2026 and the Q1 FY 2026 Short-Term Acute Care Hospital PEPPER, released in June 2026. The session will provide participants with guidance on navigating the recent changes, including a review of the reports.
Prior to the webinar, send your questions to CMS_CBRPEPPER@cms.hhs.gov.
2026 National Provider Compliance Conference – August 11–12
Tuesday, August 11 from 9 am – 5:30 pm ET and Wednesday, August 12 from 9 am – 1 pm ET
Charlotte, NC
Register for this in-person event by July 23; limited spots are available.
The National Provider Compliance Conference will bring together Medicare Administrative Contractors (MACs) and Center for Program Integrity experts to provide compliance professionals with the information and tools they need to efficiently and effectively submit Medicare Part A, Part B, Home Health and Hospice, and Durable Medical Equipment claims. Learning opportunities include individual presentations, Q&A segments, and panel discussions. Additionally, a dedicated exhibit area will allow for individual engagement between MACs and providers.
Target audience: Medicare Fee-for-Service providers only, including medical review contractors, compliance officers, nurse or billing managers, medical record staff, coders, and provider community associations.
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