AMA Urges CMS to Drop 2027 Medicare Physician Fee Schedule Proposed Rule
In an August 20 viewpoint post, American Medical Association (AMA) president Dr. Willie Underwood called on CMS to reject the proposal that would implement a 50% Medicare payment cut for outpatient Evaluation and Management (E/M) visits that are billed the same day as other procedures. The rule raises concern for independent practices who may bear the burden of the change, as they pay for their own staff and medical supplies, and could affect access to care for rural and underserved communities if independent practices close their doors. The AMA calls for CMS to withdraw the proposal and instead work with physicians and stakeholders on a more suitable solution for the payment system (AMA, August 20; Inside Health Policy, August 28).
CMS Announces Recent RHTP Investments Focused on Technology and Robotics
CMS has announced several states that will address telehealth, technology advancements, and robotics through their Rural Health Transformation Program (RHTP) plans. So far, the agency has announced Alabama, Alaska, North Dakota, Ohio, Pennsylvania, South Dakota, Virginia, and West Virginia as states looking to expand these services through RHTP investments. In Alaska, funding will be used to initiate robotic-assisted surgeries and an AI imaging network across acute care hospitals. Many states also have plans to invest in workforce supports, mobile services, and enhanced care coordination for rural clinicians and populations. In a recent weekly newsletter, the Director of the Health Care Policy for The American Action Forum, Michael Baker, recommended that CMS evaluate RHTP actions on their execution, not effectiveness, as the first RHTP rescore approaches. Baker highlights that the short timeline from fiscal disbursement to program rescoring, only about seven months, could disincentivize complicated, long-term projects that could potentially produce the greatest change in rural healthcare systems (Inside Health Policy, August 28; Inside Health Policy, August 28).
CMS Ends DME Enrollment Moratorium
On August 27, the six-month suspension on Medicare enrollment for certain durable medical equipment (DME) providers ended. CMS Administrator Mehmet Oz had previously hinted at an extension of the moratorium in June, but the agency instead announced in a memo that the National Provider Enrollment Contractors are now accepting initial enrollment applications from interested DME suppliers. It’s unclear if Florida, Missouri, New York, Nevada, Ohio, and Rhode Island, which opted to enact moratoriums, will follow suit and lift theirs. The American Association for Homecare (AAHomecare) plans to help states come up with alternative strategies to combat fraud, waste, and abuse (FWA), and has echoed recommendations made by the OIG, including electronic verification of physician orders, oversight on new providers, and the usage of AI and predictive analytical tools for payment oversight (Inside Health Policy, August 27).
NPA Seeks Changes to PACE Care Coordination Requirements
The National PACE Association (NPA) is asking CMS to revise care coordination requirements established in a 2025 rule for Programs of All-Inclusive Care for the Elderly (PACE). Under the rule, PACE interdisciplinary teams have 48 hours to act on recommendations following hospital, emergency department, and urgent care visits and seven calendar days for other provider recommendations. NPA says those timelines can be difficult to meet when outside providers delay sending records, especially since they are not subject to federal deadlines for providing that documentation. To address that issue, NPA proposed extending the 48-hour timeframe to 72 hours and allowing organizations to demonstrate compliance through documented efforts to obtain missing information. NPA is also asking CMS to clarify which routine and preventive services are exempt from the requirements. CMS has acknowledged concerns about documentation delays but said any alternative would need to be objective and auditable (Inside Health Policy, August 28).
New Study Suggests Medicaid Expansion Disenrollments Will Be Higher Than Previously Thought
A recent study published in JAMA Health Forum suggests that more Medicaid expansion enrollees will be at risk of disenrollment due to community engagement requirements than previously thought. Using the Current Population Survey Annual Social and Economic Supplement data from 2023 through 2025, researchers found that 19.8% of adults aged 18 to 64 living in Medicaid expansion states would be at risk of noncompliance with community engagement requirements because they were near the weekly 20-hour minimum threshold and/or reported variable hours.
As a result, up to 10 million individuals could lose Medicaid coverage compared to previous estimates of 4 million to 7 million. Risk of noncompliance varied for different groups for gender, race, education, and geography. Women had a 22% higher probability of being noncompliant compared to male adults. Hispanic and non-Hispanic Black adults of any race had a lower risk of noncompliance compared to non-Hispanic White individuals. Individuals with higher levels of education had a lower risk of noncompliance compared to individuals who did not hold a high school diploma.
Finally, risk varied substantially by state, with individuals in the West and Midwest generally at higher risk of noncompliance. Some states in the Northeast also had higher proportions of their population at risk. The researchers note that their results may be conservative due to some states planning to require more than one month of compliance with community engagement requirements at application (Health Payer Specialist, August 31).
