CMS Health Policy
Material regulatory developments from Centers for Medicare & Medicaid Services are tracked daily by Cresthaven Analytics. Over the last 90 days, 20 material briefs relevant to professionals operating in the healthcare & life sciences sector have been published below. Each brief is sourced directly from the primary regulatory feed, summarized for institutional readers, and scored for materiality.
Recent material activity
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CMS renews NCQA deeming authority for Medicare Advantage HMOs and PPOs for six years
On July 27, 2026, CMS approved NCQA's renewal application for Medicare Advantage deeming authority, covering Health Maintenance Organizations and Preferred Provider Organizations. The six-year term allows NCQA-accredited…
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CMS proposes to codify WFTC-mandated Medicaid provider tax thresholds with phased reductions beginning October 2026
CMS published a proposed rule on July 23, 2026 to revise the indirect hold harmless threshold for state health care-related taxes under Medicaid. The proposal implements statutory changes from the One Big Beautiful Bill …
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CMS releases draft guidance on manufacturer effectuation of maximum fair prices for 2028 Medicare drug price negotiations
CMS published draft guidance on July 20, 2026 on how drug manufacturers must effectuate maximum fair prices under the Medicare Drug Price Negotiation Program for 2028. The release opens a public comment period on operati…
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CMS proposes CY 2027 Physician Fee Schedule rule covering payment rates, drug inflation rebates, and shared savings updates
CMS published a proposed rule on July 16, 2026 addressing calendar year 2027 payment policies under the Physician Fee Schedule, Medicare Part B, the Medicare Shared Savings Program, and the Medicare Prescription Drug Inf…
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CMS Health Policy release pending Cresthaven Analytics full analysis: Request for Information; Clinical Laboratory Improvement Amendments of 1988 (CLIA) Regulations
CMS Health Policy published a regulatory release titled 'Request for Information; Clinical Laboratory Improvement Amendments of 1988 (CLIA) Regulations'. Cresthaven Analytics' full intelligence brief is pending re-analys…
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CMS opens public comment on The Joint Commission's renewal application for home health agency accreditation authority
CMS published a Federal Register notice on July 10, 2026 soliciting public comments on The Joint Commission's application for continued approval to accredit Medicare- and Medicaid-participating home health agencies. The …
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CMS proposes 2027 Medicare outpatient and ASC payment system updates with quality reporting revisions
On July 7, 2026, the Centers for Medicare and Medicaid Services issued a proposed rule updating the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System for calendar year 2027. The…
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CMS Health Policy release pending Cresthaven Analytics full analysis: Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasi
CMS Health Policy published a regulatory release titled 'Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based P…
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CMS Health Policy release pending Cresthaven Analytics full analysis: Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality Incentive
CMS Health Policy published a regulatory release titled 'Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality In…
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CMS issues RFI on PBM compensation restrictions and data reporting requirements effective 2028
On June 18, 2026, the Centers for Medicare and Medicaid Services published a Request for Information seeking technical input on pharmacy benefit manager services, business practices, and affiliate compensation structures…
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CMS final rule tightens Medicare accrediting organization oversight, conflict-of-interest rules, and reentry limits for terminated providers
CMS issued a final rule with comment period on June 16, 2026, restructuring oversight of Medicare national accrediting organizations. The rule mandates conflict-of-interest controls, standardizes validation and performan…
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CMS proposes to codify Medicare drug price negotiation program with new Inflation Reduction Act policies
The Centers for Medicare and Medicaid Services published a proposed rule on June 16, 2026 to codify the Medicare Drug Price Negotiation Program and establish new program policies under the Inflation Reduction Act of 2022…
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CMS grants COLA deeming authority for Histocompatibility specialty under CLIA for five years
CMS published Federal Register Doc. 2026-11618 on June 10, 2026, granting the Commission on Laboratory Accreditation (COLA) deeming authority under the Clinical Laboratory Improvement Amendments of 1988 for the specialty…
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CMS interim final rule mandates Medicaid community engagement requirements for certain beneficiaries by January 1, 2027
CMS published an interim final rule with comment period on June 3, 2026, under Federal Register Doc. 2026-11094, implementing the community engagement requirement in Medicaid under section 1902(xx) of the Social Security…
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HHS publishes notice that federal court vacated gender-identity provisions of the 2024 Section 1557 nondiscrimination rule
HHS issued Federal Register Doc. 2026-11015 on June 2, 2026, notifying the public that the U.S. District Court for the Southern District of Mississippi vacated the gender-identity provisions of the 2024 Section 1557 fina…
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CMS issues final rule updating IOTA Model payment parameters for Performance Year 2
CMS published Federal Register Doc. 2026-10890 on June 1, 2026, finalizing updates to the Increasing Organ Transplant Access (IOTA) Model for Performance Year 2 under the Medicare Alternative Payment Model framework. The…
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CMS proposes new payment rate limits for Medicaid managed care directed payments and fee-for-service targeted practitioner payments
CMS published a proposed rule on May 22, 2026 under Federal Register Doc. 2026-10292, proposing modifications to the total payment rate limit for State directed payments in Medicaid managed care and establishing a new li…
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CMS Health Policy release pending Cresthaven Analytics full analysis: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program
CMS Health Policy published a regulatory release titled 'Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program'. Cresthaven Analytics' full intelligen…
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CMS imposes 6-month nationwide Medicare enrollment moratorium on home health agencies effective May 2026
CMS published Federal Register Doc. 2026-09717 on May 15, 2026, announcing a 6-month nationwide temporary moratorium on Medicare enrollment of home health agencies (HHAs). The moratorium applies across Medicare, Medicaid…
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CMS imposes 6-month nationwide moratorium on Medicare enrollment of new hospice providers
CMS published Federal Register Document 2026-09718 on May 15, 2026, announcing a 6-month nationwide temporary moratorium on Medicare enrollment of hospices under authority granted by the Affordable Care Act Section 6401(…
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