CMS Payment Policy
Expert articles and analysis related to cms payment policy.
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CMS is becoming the main near-term driver of VBC expansion as Medicare Advantage plans pull back, with activity clustering around mandatory and specialty models such as CJR-X and the Ambulatory Specialty Model for heart failureâraising both opportunity and readiness pressure for hospitals, ACOs, post-acute providers, and specialty networks. At the same time, payment-model scale is colliding with operational burden: new research pegs just four mandatory hospital VBP programs at roughly $3 billion in annual administrative costs, while Medicaid state directed payment limits under the 2025 reconciliation law could reduce hospital funding across at least 37 states, intensifying the margin and infrastructure tensions behind VBC participation (Home Health Care News; KFF). Trump administration CMS policy is also pushing data and utilization-management transparencyâthrough FHIR-enabled prior authorization incentives and insurer-level denial reportingâwhich could strengthen population health operations but will expose wide payer variation and force providers to build more sophisticated contracting, documentation, and care-management capabilities.
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