Final Payment Rule
News
- CMS & States Launch $275M Initiative to Recruit and Retain Nurses in Nursing Homes
- Alaska: $249M to Bring Healthcare Closer to Home
- Florida: $193M to Expand Preventive Care & Bring Specialty Care Closer
- Georgia: $219M to Expand the Rural Healthcare Workforce & Advance Technology-Enabled Care
- Mississippi: $32M to Recruit Rural Doctors, Train Healthcare Workers & Expand Emergency Mental Healthcare
- Texas: $8M for 28 Rural Providers to Strengthen Healthcare
- Wyoming: $205M to Strengthen Emergency Care, Expand the Rural Health Workforce & Modernize Healthcare Technology
- ACCESS: Refer Your Patients with Chronic Conditions
Health Technology
Fraud, Waste & Abuse
- CMS Seeks Industry Input on Future Fraud Defense Contracts by November 4
- Medicaid Program Integrity Pillars
- CMS Proposes New Verification Requirements to Implement Law that Combats Exchange Fraud & Protects Taxpayer Dollars
Final Payment Rule
CY 2027 End Stage Renal Disease Prospective Payment System Final Rule
Combating kidney disease starts with prevention, early detection, and timely treatment to help protect kidney health and slow disease progression. For Americans who depend on dialysis, high-quality care is vital to their health and daily lives. CMS is committed to improving how our kidney care system serves patients by supporting access to lifesaving treatment so more Americans can live longer, healthier lives.
CMS is advancing its goals for dialysis access and quality through the CY 2027 Medicare End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule. CMS issued this final rule to update payment rates and policies under the ESRD PPS for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2027. This rule also finalizes updates to the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities for CY 2027 and updates requirements for the ESRD Quality Incentive Program.
Read the full fact sheet.
News
CMS & States Launch $275M Initiative to Recruit and Retain Nurses in Nursing Homes
Nursing students and licensed nurses interested in working in a nursing home may now qualify for up to $40,000 in student loan repayment and/or a $10,000 stipend in exchange for a 3-year commitment to serve in a qualifying nursing home in a rural or higher labor-shortage area through a new $275 million nationwide initiative announced by CMS.
The Nurses for Nursing Homes initiative is expected to support more than 4,000 nurses nationwide. Funded through civil monetary penalties collected by CMS and states from nursing homes, the initiative directs resources to licensed nurses and nursing students who provide hands-on care to nursing home residents. CMS has committed $100 million, with states committing at least an additional $175 million.
More Information:
Alaska: $249M to Bring Healthcare Closer to Home
This federal investment will connect Alaska's remote clinics through telehealth, equip community health aides with new tools, and grow the local health workforce.
The Trump Administration announced nearly $249 million in Rural Health Transformation Program (RHTP) funding for 254 projects that will strengthen healthcare for rural Alaskans. This investment will expand maternal and child health services, strengthen the rural health workforce, bring new technology to village clinics, and improve access to care in communities statewide. The announcement completes Alaska's Year 1 RHTP funding cycle.
Read the full press release.
Florida: $193M to Expand Preventive Care & Bring Specialty Care Closer
This federal investment will expand telehealth, mobile health, and community paramedicine to bring preventive, specialty, and acute care closer to rural Floridians.
The Trump Administration announced $193.7 million in Rural Health Transformation Program funding to 45 organizations across Florida to improve rural health across the state. This investment will help build regional capacity and expand options for rural Floridians to receive high-quality healthcare closer to home.
Read the full press release.
Georgia: $219M to Expand the Rural Healthcare Workforce & Advance Technology-Enabled Care
This federal investment will help expand access to care, strengthen prevention and chronic disease management, and build a more sustainable rural health system.
The Trump Administration announced nearly $219 million in Rural Health Transformation Program funding to expand the rural healthcare workforce and advance technology-enabled care. This investment will support clinician recruitment and training, expand mobile and telehealth services, and modernize rural hospitals and clinics to help more Georgians receive care in their communities. Georgia has committed its full $219 million in funding to improve healthcare in rural communities across the state.
Read the full press release.
Mississippi: $32M to Recruit Rural Doctors, Train Healthcare Workers & Expand Emergency Mental Healthcare
This federal investment will help rural communities recruit healthcare professionals and establish 3 psychiatric emergency units to connect patients with timely behavioral healthcare.
The Trump Administration announced $32 million in Rural Health Transformation Program funding to strengthen Mississippi’s rural healthcare workforce and expand access to emergency mental health services. This investment will provide 60 awards for rural healthcare providers and workforce programs across Mississippi.
Read the full press release.
Texas: $8M for 28 Rural Providers to Strengthen Healthcare
This federal investment will support the rural healthcare workforce, improve medical equipment and facilities, and help prevent and manage chronic disease across Texas.
The Trump Administration announced $8 million in Rural Health Transformation Program funding to 28 rural healthcare providers through the Rural Texas Strong initiative. This investment will support chronic disease prevention, improved health outcomes, recruitment and retention of healthcare professionals, and medical equipment and facility improvements to expand access to high-quality care across rural Texas.
Read the full press release.
Wyoming: $205M to Strengthen Emergency Care, Expand the Rural Health Workforce & Modernize Healthcare Technology
This federal investment supports emergency medical services, grows the rural health workforce, expands telehealth, and improves primary care access for Wyomingites.
The Trump Administration announced $205 million in Rural Health Transformation Program funding to strengthen healthcare delivery across Wyoming’s rural communities. This investment will improve access to emergency medical services, grow the rural healthcare workforce, and modernize healthcare technology statewide. Wyoming has committed its full $205 million in funding toward improving rural healthcare in communities across the state.
Read the full press release.
ACCESS: Refer Your Patients with Chronic Conditions
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model focuses on chronic conditions affecting three-quarters of people with Medicare, including high blood pressure, diabetes, musculoskeletal pain, and depression. It offers ongoing, technology-supported chronic care between visits—such as lifestyle support (including nutrition, exercise, and sleep), remote monitoring, wearables, coaching, and medication management—from Medicare-enrolled healthcare providers at low or no cost to your patients.
Visit the ACCESS for Primary Care Providers & Referring Clinicians webpage to learn about:
- Patient eligibility
- Current tracks
- How to refer your patients
How ACCESS works:
- Connect your Original Medicare patient with an ACCESS care provider
- Receive care updates
- Bill for the co-management payment
More Information:
- ACCESS Model webpage
- Co-Management Payment Billing Guidance webpage
- Support for chronic health condition information for your patients
Health Technology
Electronic Prior Authorization: Employers Back Expansion to Self-Funded Health Plans
More patients and doctors could spend less time navigating faxes, phone calls, and paperwork as leading employers work to expand electronic prior authorization for their self-funded health plans. CMS and the U.S. Department of Labor announced that 5 leading employers have signed a statement of support to make the technical improvements and other capabilities being developed through the 2025 Prior Authorization Pledge available to employers that sponsor self-funded health plans.
More Information:
- Press release
- Interoperability and Prior Authorization final rule
- Electronic Prior Authorization webpage for providers
Fraud, Waste & Abuse
CMS Seeks Industry Input on Future Fraud Defense Contracts by November 4
CMS released a Request for Information (RFI) on a new approach to Medicare and Medicaid fraud investigations. The proposed framework gives us a greater role in directing investigations, and we want industry feedback on how to make this model work.
Review the proposed Statement of Objectives and submit your ideas by November 4, 2026, at 11 am ET. This RFI is for planning purposes only—we won’t award a contract as a result.
Medicaid Program Integrity Pillars
CMS released the Medicaid Program Integrity Pillars on October 26, 2026. This new framework organizes new and existing CMS guidance into 6 best practice areas to assist States, Medicaid managed care plans, and law enforcement partners to effectively crush fraud in the Medicaid program:
- Claims Editing & Data Analytics
- Provider Enrollment
- Targeted Reviews & Audits
- Managed Care Oversight
- Investigations & Law Enforcement Referrals
- Robust Administrative Actions
Learn more at the Program Integrity Pillars for Medicaid and the Children’s Health Insurance Program webpage.
CMS Proposes New Verification Requirements to Implement Law that Combats Exchange Fraud & Protects Taxpayer Dollars
CMS has taken another step to combat fraud and strengthen program integrity in the Affordable Care Act Exchanges by improving the consumer eligibility verification process for premium subsidies. Under the proposed rule, consumers seeking advance payments of the premium tax credit or income-based cost-sharing reductions must first pass eligibility verification before receiving subsidies, ending a vulnerability that has been used for fraudulent or ineligible enrollments.
This proposed rule advances the Trump Administration’s efforts to ensure that taxpayer-funded assistance goes only to eligible consumers by implementing relevant provisions of the Working Families Tax Cuts legislation and reflects CMS’ commitment to Exchange integrity.
More Information:
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