The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule aimed at enhancing the quality of care for Medicare recipients while reducing unnecessary spending. The proposed rule, set to take effect in calendar year 2026, seeks to advance primary care management through new quality measures and a payment model focused on chronic disease management.
U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. said, "For the last four years, powerful interests have targeted independent medical practices." He credited Dr. Oz's leadership for modernizing CMS payment systems and improving care for patients with chronic diseases.
CMS Administrator Dr. Mehmet Oz highlighted efforts to modernize Medicare, cut waste, and improve patient care by making preventive services more accessible and incentivizing healthcare providers to deliver better results.
A significant focus is on reducing spending on skin substitutes, which saw costs rise from $256 million in 2019 to over $10 billion in 2024 due to abusive pricing practices. CMS proposes treating skin substitutes as incident-to supplies, potentially reducing spending by nearly 90%.
The proposal also aims to shift healthcare towards prevention and wellness by integrating behavioral health treatment into primary care management and updating quality measures. If finalized, changes will allow more access to programs like the Medicare Diabetes Prevention Program at no cost.
Additionally, CMS is proposing a new Ambulatory Specialty Model (ASM) targeting specialty care for heart failure and low back pain. This model intends to enhance care quality while holding participants accountable for performance.
CMS plans to improve payment accuracy by leveraging hospital data and simplifying telehealth service processes. It also proposes broadening digital mental health treatment device policies.
Chris Klomp of CMS emphasized the shift toward data-informed policymaking that rewards high-quality care while aligning healthcare spending with value.
The comment period for this proposed rule ends on September 12, 2025.
Information from this article can be found here.