What’s new: State Medicaid agencies and Medicare Part D plan sponsors are now encouraged to apply to participate in the BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model, which will lower the cost and expand coverage of select GLP-1 medications for weight management in Medicare Part D and Medicaid.
As the end date for the Accountable Care Organizations Realizing Equity Access and Community Health Model draws near, CMS is developing its next total cost of care model. NAACOS has shared insights and suggestions with colleagues from CMS to draw inspiration from past success and lessons learned to build a new model that helps advance the transition to value-based care in Medicare.
By Steven Posnack – In July our colleagues at CMS launched an ambitious Health Technology Ecosystem pledge program. The groundswell of energy and enthusiasm for the program has been remarkable, and we’re glad to be their partner. CMS established several pledge categories associated with aspirational criteria included within its CMS Interoperability Framework.
Beginning with the 2024 performance period/2026 MIPS payment year, the targeted review period closes 30 days following the release of MIPS payment adjustments (refer to 42 CFR 414.1385(a)(2)).
On July 31, 2025, the Centers for Medicare & Medicaid Services issued a final rule for updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System for fiscal year 2026.
The CMS Making Health Tech Great Again initiative is announced. “Let’s stop waiting and let’s definitely stop faxing. Let’s start building. The right data at the right time can mean the difference between loss and hope. The time is now. Are you in?”
CMS 2026 Physician Fee Schedule Proposed Rule. The 60-day comment period for the CY 2026 PFS proposed rule (CMS-1832 P) ends on September 12, 2025.
CMS announced that 33 states, plus the District of Columbia and Puerto Rico, will participate in the Cell and Gene Therapy Access Model, a bold new approach to delivering cutting-edge treatments for people on Medicaid living with sickle cell disease.
Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars.
CMS is expanding access to vital care for American Indian and Alaska Native communities by approving Medicaid State Plan Amendments in several states. Indian Health Service and Tribal clinics in Minnesota, New Mexico, Oregon, South Dakota, Washington, and Wyoming are now authorized to provide Medicaid clinic services beyond the physical clinic site, including in homes, schools, and other appropriate community locations.
The Centers for Medicare & Medicaid Services announced that agreements have been signed with manufacturers of the 15 drugs covered under Medicare Part D selected for the second cycle of the Medicare Drug Price Negotiation Program.
HHS announces 15 additional drugs selected for Medicare Drug Price Negotiations in continued effort to lower prescription drug costs for seniors. Building on the success of the first round of negotiations, the aim is to lower prices for some more of the costliest prescription drugs.
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