CMS & CMMI Updates

Key Actions:

CMS under the Trump administration issued a major Medicaid eligibility/compliance action: the Medicaid Community Engagement Requirement for Certain Individuals Interim Final Rule with Comment Period, CMS-2454-IFC (fact sheet) and announced a nationwide framework to implement Medicaid work requirements (press release). The IFC creates the federal operating framework for state implementation of community engagement requirements for certain Medicaid beneficiaries, with states expected to build eligibility, reporting, exemption, and beneficiary-noticing processes.

CMS finalized operational changes to the Federal Independent Dispute Resolution (IDR) process under the No Surprises Act through the Federal Independent Dispute Resolution Operations Final Rule (fact sheet; press release). CMS framed the rule as reducing administrative burden, lowering dispute fees, and increasing transparency in out-of-network payment disputes.

In Medicare coverage and claims operations, CMS released a cluster of National Coverage Determination and claims-processing transmittals: NCD 20.37 Transcatheter Tricuspid Valve Replacement (TTVR), CR 14149, implementation Jan. 5, 2026 (NCD; claims); NCD 20.38 Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER), CR 14200, implementation Jan. 5, 2026 (NCD; claims); NCD 20.40 Renal Denervation for Uncontrolled Hypertension, CR 14302, implementation Apr. 6, 2026 (NCD; claims); Cardiac Contractility Modulation for Heart Failure, CR 14311, implementation Apr. 6, 2026 (transmittal); and home NIPPV for COPD-related chronic respiratory failure, CR 14177, implementation Oct. 22, 2025 (NCD; claims).

CMS also updated payment and reporting operations for ESRD PPS (R13770CP), July 2026 CLFS/CLIA HCPCS coding (R13807CP), RHC/FQHC care coordination and Category II code edits (R13803CP), CAH line-level rendering providers (R13799CP), and prior authorization denial-reason data submission to the Integrated Data Repository (R13798OTN). CMS also updated cost report instructions for FQHCs (R9P244i), RHCs (R7P246i), home health agencies (R7P247i), and SNFs/SNF complexes (R3P249i). CMS used Medicare Fraud Prevention Week to reinforce anti-fraud beneficiary education and reporting expectations (blog).