HHS Announces Proposals to Revamp Medicare Payment Policies

July 14, 2025, 9:36 PM UTC

The Trump administration plans to take a series of steps to revise the Medicare program’s operations and cut down on perceived fraud and wasteful spending.

The Centers for Medicare & Medicaid Services on Monday released its 2026 Medicare Physicians Fee Schedule proposed rule, where it outlined planned changes to reimbursement for skin substitutes and quality reporting requirements for accountable care organizations. It also proposed a mandatory model for beneficiaries with heart failure and lower back pain.

The sprawling 1800-page proposal (RIN 0938-AV50) also aims to reduce payment differences for physicians between care environments. In addition, certain Covid-era payment flexibilities would be made permanent, simplifying the process for making services available via telehealth.

“This move reflects our continued shift toward smarter, data-informed policymaking,” said Chris Klomp, deputy administrator and director of the Center for Medicare at CMS.

“We’re advancing technical improvements that reward high-quality, efficient care; addressing the root causes of unique health challenges; and aligning health care spending with value so that new innovations help to deliver better quality at a lower price,” Klomp said.

The CMS said in a release that it was proposing to boost payments in the 2026 calendar year for physicians who reach a certain threshold of participation in advanced alternative payment models.

The CMS said the conversion factor for those doctors is projected to increase by $1.24 or 3.83% from the current conversion factor of $32.35, totaling $33.59.

For other physicians, a second conversion factor is projected to increase by $1.17 or 3.62% from the current conversion factor of $32.35, for a total of $33.42.

The 60-day comment period for the proposed rule ends Sept. 12.


To contact the reporter on this story: Ganny Belloni at gbelloni@bloombergindustry.com

To contact the editor responsible for this story: Brent Bierman at bbierman@bloomberglaw.com

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