Survey Finds Rural Americans Face Wider Gaps in Cancer Screenings

A new Prevent Cancer Foundation survey found that rural Americans are less likely than urban and suburban adults to receive routine care or cancer screenings, with 48% of rural respondents reporting a routine medical visit or screening in the past year compared with 56% of urban and suburban adults. Cost remains a major barrier, with nearly four in 10 rural respondents saying they are behind on screenings because they cannot afford them. The survey also found lower trust in the healthcare system among rural adults, including 55% who said the system prioritizes profit over patient care and one-quarter who reported feeling dismissed by a provider. Respondents pointed to clearer provider communication, more convenient screening options, mobile screening units, community-based programs, and better information on costs and financial assistance as ways to improve access and trust in rural communities (Fierce Healthcare, June 30).

CMS Releases Proposed Rule for CY2027 Medicare Hospital Outpatient Payment and Policy Adjustments

On July 2, CMS issued the Calendar Year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule. The proposed rule would update Medicare payments and policies, including updating annual payment rates. CMS proposes a 2.4% payment rate adjustment for OPPS and ASC rates in 2027. The rule would also expand the services included in the agency’s method to control increases in imaging without contrast services furnished in off-campus provider-based departments and aim to curb the volume of botulinum toxin injection procedures.

Other policies in the proposed rule include eliminating the inpatient only list; updating payment rates for intensive outpatient and partial hospitalization program services furnished in outpatient departments and community mental health centers; permitting Accrediting Organizations to assess compliance with EMTALA administrative requirements; requiring off-campus hospital outpatient departments to obtain and bill under a separate NPI; and revising and seeking feedback from the public regarding various quality reporting programs.

Notably, CMS proposes to reduce payments for 340B drugs. The agency conducted a survey in early 2026 which indicated significant disparities between hospital acquisition costs for 340B drugs compared to drugs purchased outside of the program. According to CMS, the survey revealed instances where the beneficiary cost sharing amount was greater than the total 340B price paid by the hospital. As a result of the survey, CMS proposes to pay for 340B acquired drugs at the drug’s Average Sales Price (ASP) minus 33.4%. To achieve budget neutrality for this policy as required, CMS would increase OPPS payments for non-drug services by an equivalent amount. The annual offset percentage for non-drug items and services would change from 0.5% to 3%, excluding certain hospitals that enrolled in Medicare after 2018, until the estimated payment reduction reaches $7.8B. CMS expects this to occur in CY2029. The proposed rule was published in the Federal Register on July 7, with the public comment period ending on August 31. Stakeholders have already spoken against the proposed change to 340B drug pricing, citing concerns about affordability and the potential for seniors to face higher drug costs (CMS Newsroom, July 2; Inside Health Policy, July 2).

CMS Releases Proposed Hospital and Ambulatory Payment Rule and RFI

On July 2, CMS included a request for information (RFI) with the CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule (CMS-1850-P) release. Through the RFI, CMS looks to gather feedback on how to strengthen machine-readable file (MRF) requirements to facilitate increased standardization of hospital pricing data and improvements in accuracy of free text fields. CMS also requests feedback on enhancements for more consumer-friendly display requirements, such as the modification or elimination of current compliance policies for estimator tools and updates to the required list of shoppable services. MRF data will be leveraged to ultimately stimulate competition and drive healthcare costs down, while also making shopping for healthcare services easier for consumers. The RFI is said to align with the President’s EO 14221, in its commitment to improve health pricing and care transparency. The public comment period ends on August 31, 2026 (CMS, July 2; Inside Health Policy, July 6).

CMS Releases Home Health Payment Proposed Rule

On July 1, CMS released the CY 2027 Home Health Prospective Payment System proposed rule (CMS-1844-P). The proposed rule includes an aggregate payment increase of $420M or 2.4% compared to the previous calendar year. In addition to the proposed payment updates, CMS also proposes Medicare provider enrollment provisions such as retroactive revocations and expanding reasons for revocation or denial including program or license suspension or termination, requiring re-enrollment in situations of majority ownership changes in hospice, home health aide (HHA) and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. This rule comes as the federal government increases scrutiny on fraud, waste, and abuse (FWA) on state Medicaid programs, especially within home health programs.

CMS also looks to improve alignment between the Home Health Quality Reporting Program (HH QRP) and Home Health Value-Based Purchasing (HH VBP) Model through revisions to digital information transfers, reporting timeframes, and submission deadlines. The agency requests feedback on a variety of topics within the proposed rule, including how to promote access to community-based palliative care services, the development of a home-health specific wage index, and a potential Advanced Care Planning measure. The public comment period ends on August 31, 2026 (CMS, July 1; Fierce Healthcare, July 1).

CMS Rescinds Fast-Track Review Process for Section 1115 Demonstration Extensions

On July 7, CMS released a CMCS Informational Bulletin rescinding its 2015 fast track federal review process and related application templates for certain Section 1115 Medicaid and CHIP demonstration extensions, citing new budget neutrality requirements under the Working Families Tax Cut legislation. Section 71118 created the new Section 1115(g) budget neutrality requirement, which takes effect January 1, 2027, and bars CMS from approving Medicaid Section 1115 applications, renewals, or amendments from any state, D.C., or territory unless the CMS Chief Actuary certifies that the demonstration is not expected to increase federal spending compared to what spending would have been without the project. CMS said the new actuarial certification requirement, along with the need to evaluate whether demonstrations require updates under the WFTC legislation, makes the fast-track renewal process no longer feasible. CMS will continue reviewing demonstration renewals under existing Section 1115 statutory and regulatory requirements and said additional guidance on the new budget neutrality provision is expected (CMS, July 7).