CMS & CMMI Updates

Key Actions:

CMS advanced a broad July payment-policy package under the Trump administration that centers on accountable care expansion, site-of-service payment reform, program integrity, and Medicare operations modernization. The biggest VBC signal is the CY 2027 Medicare Physician Fee Schedule Proposed Rule — CMS-1848-P, which CMS framed as “transformational” reforms to expand accountable care and shift from “sick care to healthcare” (press release; PFS fact sheet). CMS also issued a dedicated Medicare Shared Savings Program fact sheet tied to CMS-1848-P, signaling continued use of the PFS as the main annual vehicle for ACO policy changes (MSSP fact sheet).

CMS also proposed CY 2027 OPPS/ASC changes — CMS-1850-P, described as strengthening care quality, reducing drug costs, and cutting beneficiary out-of-pocket spending (press release; OPPS/ASC fact sheet). In post-acute care, CMS proposed home health updates emphasizing program integrity, fraud prevention, and expanded access to home health care (home health press release).

On Medicare drug policy, CMS released Manufacturer Effectuation of MFP Draft Guidance for 2028 Medicare Drug Price Negotiation, moving the next cycle of Maximum Fair Price implementation into operational guidance for manufacturers and downstream supply-chain actors (draft guidance fact sheet). CMS also published a policy blog on Strengthening Original Medicare, reinforcing fee-for-service modernization as a strategic priority rather than ceding innovation solely to Medicare Advantage (blog).

Operationally, CMS issued multiple transmittals affecting claims, payment files, and systems: SSI Ratio expansion on the Inpatient PSF, implementation July 4, 2027 (R13877OTN); VMS APIs for DME MAC migration, implementation Oct. 5, 2026 (R13873OTN); FY 2027 MCE and ICD-10-CM/PCS annual updates, implementation Oct. 5, 2026 (R13813CP); home health grouper and consolidated billing updates, implementation Oct. 5, 2026 (R13793CP; R13794CP); DMEPOS fee schedule update, implementation July 6, 2026 (R13846CP); and CLFS/CLIA and lab NCD edit updates (R13855CP; R13849CP). CMS also modernized nursing home oversight through a new risk-based survey approach (press release) and announced emergency resources and flexibilities for Guam and CNMI (news alert).

Implications for VBC Stakeholders:

ACOs and physician groups should treat CMS-1848-P as the key 2027 contracting roadmap. The explicit pairing of physician payment modernization with MSSP expansion suggests CMS wants more providers in accountable care while tightening the link between primary care investment, quality, and total-cost accountability. ACOs should model proposed benchmark, attribution, quality, and risk-track changes once full rule text is reviewed; prepare comment letters; and assess whether independent practices need infrastructure support to remain viable under updated PFS economics.

Health systems