News
- Arkansas: $54.6M to Fight Chronic Disease, Expand Maternal Health Care Services & Build the Rural Health Workforce
- Colorado: $169.6M to Expand Specialty Care, Strengthen Emergency Services & Bring Lifesaving Blood Transfusions Closer to Patients
- Delaware: Nearly $23M to Modernize Rural Health Centers, Expand Mobile Care & Make It Easier to Manage Chronic Disease
- Montana: $8.7M for New Ambulances & Lifesaving Medical Equipment Upgrades
- South Dakota: $13M Investment to Expand Behavioral Health Care & Create a 24/7 Mobile Crisis Response Service
- Texas: $51M for Nutrition & Chronic Disease Prevention Programs
- Medicare Advantage & Medicare Prescription Drug Programs Expected to Remain Stable in 2027
- Laboratory Testing: Medicare Denies Duplicate Tests
- Short-Term Acute Care Hospitals: Download Your Q2 FY 2026 PEPPER
- CMS Refocuses Medicaid Quality on Health Outcomes, Launches Innovative Partnership With 37 States
Claims, Pricers & Codes
- Hospices: Initial Implementation of the Mandatory Election Statement Addendum
- Acute Hospital Care at Home: Code Correctly for Telehealth Place of Service
MLN Matters® Articles
Information for Patients
News
Arkansas: $54.6M to Fight Chronic Disease, Expand Maternal Health Care Services & Build the Rural Health Workforce
This federal investment will support 54 projects including mobile preventive screenings, physical activity programs, rural residency and clinical training programs, and new health care workforce pipelines across Arkansas.
The Trump Administration announced that a $54.6 million investment is being delivered to recruit, train, and retain Arkansas’ rural health care workforce, expand maternal health care services, and help fight chronic disease in the state through the federal Rural Health Transformation Program.
Read the full press release.
Colorado: $169.6M to Expand Specialty Care, Strengthen Emergency Services & Bring Lifesaving Blood Transfusions Closer to Patients
This federal investment will support 91 grantees expanding telemedicine, mobile care, behavioral and maternal health care, and rural health care workforce initiatives across Colorado.
The Trump Administration announced that a $169.6 million investment is being delivered to strengthen and expand health care for rural Coloradans through the federal Rural Health Transformation Program. This investment will support 91 grantees and approximately 250 projects working to improve access to care, strengthen rural providers and emergency services, and modernize health care delivery across Colorado.
Read the full press release.
Delaware: Nearly $23M to Modernize Rural Health Centers, Expand Mobile Care & Make It Easier to Manage Chronic Disease
This federal investment will support new mobile health units, remote patient monitoring, cybersecurity upgrades, and expanded care teams serving rural Delaware and bringing better access and the latest technology to residents.
The Trump Administration announced that nearly $23 million in federal Rural Health Transformation Program funding is being delivered to strengthen health care delivery and expand access for rural Delawareans. The funding will support Delaware's 3 federally qualified health centers as they modernize technology, strengthen chronic disease management, and expand services for the communities they serve. The awards will support electronic medical record upgrades, remote patient monitoring, cybersecurity, expanded care teams, and care coordination, along with 2 new mobile health units and a passenger van to expand access to care for rural and agricultural communities.
Read the full press release.
Montana: $8.7M for New Ambulances & Lifesaving Medical Equipment Upgrades
This federal investment will replace aging ambulances and equip rural emergency medical service (EMS) agencies in Montana with ventilators, cardiac monitors, and other critical patient transport equipment.
The Trump Administration announced that an $8.7 million investment is being delivered to support rural health care for Montana residents through the federal Rural Health Transformation Program. This investment will provide 79 rural EMS agencies with new ambulances and lifesaving medical equipment, giving first responders the resources they need to respond to crises, transport critically ill patients, and deliver high-quality care.
Read the full press release.
South Dakota: $13M Investment to Expand Behavioral Health Care & Create a 24/7 Mobile Crisis Response Service
This federal investment will expand provider capacity, modernize IT infrastructure, and strengthen the behavioral health care workforce across South Dakota.
The Trump Administration announced that a $13 million investment is being delivered to create a same-day 24/7 mobile crisis response service for South Dakota residents in need of critical substance abuse and mental health services. This funding includes 12 modernization and infrastructure grants to providers participating in South Dakota’s Certified Community Behavioral Health Clinic initiative and will give participating providers the resources needed to expand crisis services and build a stronger behavioral health care workforce.
Read the full press release.
Texas: $51M for Nutrition & Chronic Disease Prevention Programs
This federal investment will support 68 rural hospital districts and authorities working to prevent and manage diabetes, cardiovascular disease, respiratory disease, and obesity.
The Trump Administration announced that a $51 million investment is being delivered to create or improve community-based chronic disease prevention, wellness, and nutrition programs through the federal Rural Health Transformation Program. This investment will help rural health care providers implement solutions to improve outcomes for rural Texans with diabetes, cardiovascular disease, chronic respiratory disease, or obesity, while also supporting efforts to prevent these chronic conditions.
Read the full press release.
Medicare Advantage & Medicare Prescription Drug Programs Expected to Remain Stable in 2027
CMS announced significant premium savings for millions of Medicare beneficiaries in 2027, with weighted average Medicare Advantage (MA) premiums projected to fall more than 16% from 2026 to 2027, and average prescription drug premiums in MA projected to plummet 38%.
Additionally, the average premium for stand-alone Part D prescription drug plans is projected to rise by less than $1 per month in 2027.
Read the full press release.
Laboratory Testing: Medicare Denies Duplicate Tests
Review the Medicare Claims Processing Manual, Chapter 16 (PDF) for information on laboratory services. Medicare doesn’t pay for duplicate tests unless they’re medically necessary:
- If you order a mix of panels and individual tests, review what tests are in each panel. Don't order other individual tests that may duplicate tests in the panel (section 90.5).
- Your Medicare Administrative Contractor will deny duplicate tests that aren’t medically necessary (section 90.3).
For example, Medicare won’t pay for a second vitamin D test unless it’s medically necessary.
If repeat tests are medically necessary, use CPT modifier 91 (repeat clinical diagnostic laboratory test). See the Repeat or Duplicate Services on Same Day billing and coding article.
Review Lab Test Order Requirements for more information.
The CY 2027 Physician Fee Schedule proposed rule included a request for information on Duplicate Laboratory Testing, Imaging, and Result Sharing and Interoperability. CMS is exploring options to address these issues in future rules.
Short-Term Acute Care Hospitals: Download Your Q2 FY 2026 PEPPER
CMS released the second quarter FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals. Your PEPPER helps you review your billing data to make sure claims are accurate. Use it to:
- Spot billing patterns that may need review or improvement
- Identify areas that may need closer monitoring or internal audits
- Find services that may be under-coded or over-coded
- Track trends like longer patient stays
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 for your organization. The Comparative Billing Report business function is also available, and you can request it at the same time.
- Your AO or AM must approve your request.
More Information:
- Visit the Training & Resources webpage for more information about the release, User Guide, and upcoming webinar
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
CMS Refocuses Medicaid Quality on Health Outcomes, Launches Innovative Partnership With 37 States
CMS launched the Investing in Health Outcomes initiative with a founding group of 37 state partners to focus on how quality is measured in Medicaid and the Children’s Health Insurance Program. The effort will put health outcomes — not processes and paperwork — at the center of how success is defined. CMS and its partners will prioritize measures that demonstrate meaningful improvements in prevention, chronic disease management, and behavioral health.
Read the full press release.
Claims, Pricers & Codes
Hospices: Initial Implementation of the Mandatory Election Statement Addendum
In the FY 2027 Hospice Prospective Payment System final rule, CMS made the following changes to the hospice election statement addendum:
- Mandatory for all hospice elections starting on and after October 1, 2026
- Must be furnished in writing (paper or electronic) to the beneficiary or their representative
- Must include the required content described in § 418.24(c)
- Must be furnished within 5 calendar days of the effective date of the hospice election
- Any updates to the addendum must be furnished within 3 calendar days of the plan of care change
- Condition for payment is satisfied when there’s a valid signed addendum in the beneficiary’s medical record with the hospice
To help hospices adjust to the new requirement, from October 1, 2026, to December 31, 2026, while hospices are required to furnish the addendum to every electing beneficiary, CMS will exercise enforcement discretion during this three-month window. During this time, Medicare Administrative Contractors will not deny claims solely because the addendum is missing or incomplete and will focus on educating hospices to help them come into full compliance.
Acute Hospital Care at Home: Code Correctly for Telehealth Place of Service
If you provide telehealth services to patients enrolled in Acute Hospital Care at Home (AHCAH), use the correct place of service (POS) code:
- POS 21 (inpatient hospital)
- Modifier 95 (synchronous telemedicine)
Medicare treats AHCAH patients as inpatients even when you deliver their care through telehealth at home.
MLN Matters® Articles
Laboratory National Coverage Determination Edit Software: January 2027 Update
Learn about added and deleted ICD-10-CM codes (PDF).
Information for Patients
2027 Medicare & You Handbook
Share the 2027 Medicare & You handbook with your patients and their caregivers. New and important this year:
- More login options for Medicare.gov accounts
- New health initiatives, including the ACCESS Model and GLP-1 drugs
- Improved fight against Medicare fraud
- Medicare eligibility requirement changes
- Medicare third-party apps available for personalized health experience
- Rural health care expansion
- Extended telehealth flexibilities
Encourage your patients to go digital and switch to electronic versions of the handbook and Medicare Summary Notices.
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