Compliance and accreditation news: week of November 7, 2026
CMS extended and modified its moratoria on new Medicare hospice and home health enrollments, published final rules for the CY 2027 Physician Fee Schedule and the Medicare Drug Price Negotiation Program, and announced second-year Rural Health Transformation Program awards. ONC and CMS announced electronic prior authorization testing events.
CMS extends and modifies nationwide freeze on new Medicare hospice and home health enrollment
Compliance: CMS said on November 12, 2026 that it "will extend its nationwide moratoria on new Medicare enrollments for hospices and home health agencies (HHAs) for an additional six months…" CMS said the extensions "will continue to cover new applications for initial Medicare enrollment and certain changes in majority ownership." The release also states: "Unlike the May 2026 moratoria, the moratoria extensions will allow currently enrolled hospices and HHAs to add new practice locations within their existing enrollment." Source: Centers for Medicare & Medicaid Services, "CMS Extends and Modifies Nationwide Freeze on New Medicare Hospice and Home Health Enrollment for Six Months to Combat Fraud", November 12, 2026. https://www.cms.gov/newsroom/press-releases/cms-extends-modifies-nationwide-freeze-new-medicare-hospice-home-health-enrollment-six-months-combat
CMS finalizes CY 2027 Physician Fee Schedule and Part B policies
CMS published the CY 2027 Physician Fee Schedule final rule in the Federal Register on November 9, 2026. The rule also covers other Part B payment and coverage policies, Medicare Shared Savings Program requirements and the Medicare Prescription Drug Inflation Rebate Program. The rule states: "These regulations are effective on January 1, 2027." Source: Centers for Medicare & Medicaid Services, "Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program (Final rule; FR Doc. 2026-22743)", November 9, 2026. https://www.govinfo.gov/content/pkg/FR-2026-11-09/html/2026-22743.htm
CMS finalizes Medicare Drug Price Negotiation Program and Part D rule
CMS published a final rule on November 9, 2026 that finalizes and codifies the Medicare Drug Price Negotiation Program. The rule also sets certain new policies for that program and for the Medicare Part D program, as required by the Inflation Reduction Act of 2022. It also finalizes a proposed policy for specific fixed combination drugs that are new formulations. The rule states: "Effective date: These regulations are effective on December 5, 2026. Applicability date: These regulations are applicable to the Negotiation Program beginning with respect to initial price applicability year 2029 and to Part D Program coverage beginning January 1, 2029." Source: Centers for Medicare & Medicaid Services, "Medicare Drug Price Negotiation Program and Medicare Prescription Drug Benefit Program (Final rule; FR Doc. 2026-22792)", November 9, 2026. https://www.govinfo.gov/content/pkg/FR-2026-11-09/html/2026-22792.htm
CMS issues CY 2027 home infusion therapy services payment rates
CMS issued transmittal R14029CP (Change Request 14671) on November 10, 2026. It covers CY 2027 Home Infusion Therapy services payment rates and has an implementation date of January 4, 2027. Source: Centers for Medicare & Medicaid Services, "Calendar Year (CY) 2027 Home Infusion Therapy (HIT) Services Payment Rates and Instructions for Retrieving the January 2027 HIT Services Payment Rates Through the CMS Mainframe Telecommunications System (Transmittal R14029CP)", November 10, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r14029cp
CMS issues home health PPS rate update for CY 2027
CMS issued transmittal R14031CP (Change Request 14668), the Home Health Prospective Payment System rate update for CY 2027, on November 10, 2026. It has an implementation date of January 4, 2027. Source: Centers for Medicare & Medicaid Services, "Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2027 (Transmittal R14031CP)", November 10, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r14031cp
CMS implements CY 2027 ESRD PPS and AKI dialysis payment changes
CMS issued transmittal R14043BP (Change Request 14638) on November 12, 2026. It covers CY 2027 changes in the End-Stage Renal Disease Prospective Payment System and payment for dialysis furnished for acute kidney injury in ESRD facilities, and it has an implementation date of January 4, 2027. Source: Centers for Medicare & Medicaid Services, "Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2027 (Transmittal R14043BP)", November 12, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r14043bp
CMS issues CY 2027 ESRD PPS and AKI system changes
CMS issued transmittal R13909CP (Change Request 14551) on November 12, 2026. It covers CY 2027 system changes for the End Stage Renal Disease Prospective Payment System and payment for renal dialysis services furnished to individuals with acute kidney injury, and it has an implementation date of January 4, 2027. Source: Centers for Medicare & Medicaid Services, "Implementation of System Changes for the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury (AKI) for Calendar Year (CY) 2027 (Transmittal R13909CP)", November 12, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13909cp
ONC and CMS launch electronic prior authorization testing initiative
ONC, in partnership with CMS, announced on November 12, 2026 "…a series of industry testing events in production-like environments to advance end-to-end electronic prior authorization (ePA)." The announcement says payers, providers, EHR developers and intermediaries are invited to test prior authorization workflows together ahead of 2027 requirements. Source: Office of the National Coordinator for Health IT (ONC), U.S. Department of Health and Human Services, "ONC and CMS Launch Industry Electronic Prior Authorization Testing Initiative", November 12, 2026. https://healthit.gov/news/onc-and-cms-launch-industry-electronic-prior-authorization-testing-initiative/
Inpatient psychiatric facility payment panel nominations due November 30
CMS reported on November 12, 2026 that its contractor is seeking nominations for a technical expert panel on an alternative wage index methodology for the Inpatient Psychiatric Facility Prospective Payment System. The contractor seeks feedback from people with expertise in IPF operations and finance, psychiatric workforce and compensation practices, or Medicare wage index policy. Nominations are due November 30, and the panel "…will meet virtually in mid-January 2027." Source: Centers for Medicare & Medicaid Services, "Inpatient Psychiatric Facilities Prospective Payment System: Submit Technical Expert Panel Nominations by November 30", November 12, 2026. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-november-12-2026
CMS announces second-year Rural Health Transformation Program awards to states
Program development: HHS, through CMS, announced on November 9, 2026 "…$10 billion in awards to all 50 states for the second year of the Rural Health Transformation Program (RHTP)…" The release says this year's awards "…reflect, in part, states' progress implementing their approved RHTP plans." The CMS fact sheet says RHTP "…provides $50 billion over five years to help states improve healthcare access, quality, and outcomes in rural communities." Source: Centers for Medicare & Medicaid Services, "Trump Administration Announces $10 Billion in Second Year of Rural Health Transformation Awards to All 50 States", November 9, 2026. https://www.cms.gov/newsroom/press-releases/trump-administration-announces-10-billion-second-year-rural-health-transformation-awards-all-50 Source: Centers for Medicare & Medicaid Services, "Rural Health Transformation Program: Year 2 Awards", November 9, 2026. https://www.cms.gov/newsroom/fact-sheets/rural-health-transformation-program-year-2-awards
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