Top News
2027 Medicare Physician Fee Schedule Proposes Major Changes to MIPS
The Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule on July 16, 2026. The MPFS is the primary method of payment for traditional Medicare covering professional services of physicians and other health care providers in private practice, services covered incident to physicians’ services other than certain drugs, diagnostic tests other than clinical laboratory tests, and radiology services. Every year since 1992, CMS updates the MPFS through the notice-and-comment rulemaking process.
For CY2027, CMS proposed an update to the conversion factor for qualifying alternative payment model (APM) participants of +0.75% ($33.17) and non-qualifying APM participants of +0.25% ($32.84). The One Big Beautiful Bill Act (H.R.1) included a one-year increase in the MPFS conversion factor of 2.50% for CY2026. As a result, the CY2027 conversion factor represents a projected payment decrease of $0.40 (-1.19%) for qualifying participants and a projected payment decrease of $0.56 (-1.68%) for non-qualifying participants compared to CY2026.
H.R.1 also included language restricting Medicare eligibility to individuals who are a citizen or national of the U.S., an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act, an alien who has been granted the status of Cuban and Haitian entrant, or an individual who lawfully resides in the U.S. in accordance with the Compact of Free Association. In alignment with the policy, CMS proposed amendments to incorporate newly specified groups of individuals who may be eligible for Medicare, procedures for termination and appeal rights for individuals found ineligible for Medicare, and enrollment options for individuals who later gain or regain eligibility.
Last year, the CY2026 MPFS Proposed Rule solicited comments on how CMS could enhance its support of the prevention and management of chronic disease, including lifestyle and behavioral changes. Based on commenters feedback, CMS proposed to establish new billing codes for shared medical appointments, appointments where beneficiaries receive clinical guidance in a group-based setting with peers facing similar health challenges. This proposed change for behavioral and lifestyle factors mirrors group-billing codes for mental and behavioral health conditions.
Additionally, the rule includes provisions that would advance Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr’s Make America Healthy Again (MAHA) initiative. CMS requested comments on how it can reconsider primary care service valuation to better support the administration’s objectives of shifting the health care system towards preventative medicine. CMS proposes to establish a billing code for Accountable Care Organizations (ACOs) providing longitudinal care and care coordination to append to evaluation and management codes to compensate them for the additional resource costs of these activities.
The Roundtable is conducting a comprehensive review of the CY2027 MPFS and will identify advocacy opportunities.
WISeR Model Saved in Senate Vote
On July 16, the Senate voted to preserve the Centers for Medicare and Medicaid Services’ (CMS) Wasteful and Inappropriate Service Reduction (WISeR) Model. The model was originally implemented in July 2025 and leverages artificial intelligence (AI) and machine learning to adjudicate prior authorization claims for Medicare patients across six states: Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington. Senate Finance Committee Ranking Member Ron Wyden (D-OR) along with other Senate Democrats introduced a resolution in May to block further implementation of the model because they were concerned the WISER Model would exacerbate delays in seniors’ access to care. Led by Senator Mike Crapo (R-ID), Republicans argued that Medicare’s reimbursement structure rewards providing high-volume care, not high-value care, and that the model is a useful tool to curb wasteful and fraudulent spending. While implementation is set to continue, last month a House Appropriations panel voted unanimously to block funding for the model in the Department of Health and Human Services’ 2027 spending bill. This positions both chambers of Congress to revisit their support for the program later this year.
Judge Stays Multiple ACA Rule Provisions
A federal judge in Maryland temporarily blocked eight provisions of the Trump administration’s latest Affordable Care Act (ACA) Marketplace Integrity and Affordability rule from taking effect, delaying an estimated 1.2 to 2 million people from losing health insurance coverage. Led by Baltimore, Chicago, Columbus, and Pima County along with Doctors for America and Main Street Alliance, the plaintiffs argued the eight provisions violated the ACA’s original intent and the Administrative Procedures Act, the law governing the federal rulemaking process. Judge Brendan Hurson ruled that the plaintiffs were likely to succeed in their lawsuit and blocked provision that intended to expand catastrophic plan eligibility, higher out-of-pocket limits for bronze plans, new verification requirements for low-income enrollees, and loosen network adequacy standards.
Administrative Action
HHS Office of the Inspector General Releases Summary Report on Oversight of Federal Health Programs
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Spring 2026 Semiannual Report to Congress, highlighting oversight and enforcement activities conducted between October 2025 and March 2026. During the reporting period, OIG reported a total monetary impact of $5.56 billion, including 317 criminal actions, 287 civil actions, and the exclusion of 1,212 individuals and entities from participation in federal health care programs for a variety of reasons, including fraud convictions. OIG noted that Medicaid Fraud Control Units secured 1,185 convictions and recovered more than $2 billion during fiscal year 2025. They also stated that oversight of Medicare Advantage resulted in two False Claims Act settlements totaling $674 million after plans allegedly submitted documentation with unsupported diagnoses that increased federal payments. Additionally, OIG audited and evaluated nursing homes, behavioral health provider networks, cybersecurity at hospitals, National Institutes of Health grants, foster care systems, and federal grant management. The report highlights OIG’s continued emphasis on strengthening program integrity through both enforcement actions and recommendations intended to improve oversight and address misuse across HHS programs.
HHS and VA Announce Partnership To Advance Mental Health Treatments For Veterans
On July 13, the U.S. Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA) entered a Memorandum of Understanding (MOU) to coordinate on research, clinical development, and eventual deployment of psychedelic drug products for veterans with serious mental health conditions, contingent on future Food and Drug Administration (FDA) approval. The agreement implements the Executive Order Accelerating Medical Treatments for Serious Mental Illness, which directed HHS and the VA to coordinate on clinical trial participation and data-sharing with the FDA. HHS Secretary Kennedy stated the effort reflects a commitment to move promising treatments from research into care rather than leaving veterans to “sit on the sidelines.” The MOU commits the departments to workforce training, evidence-based clinical protocols, and real-world data collection over a five-year term.
In parallel, federal agencies are continuing to advance information sharing and research on the clinical use of psychedelic drugs. The FDA issued final guidance on clinical investigations of psychedelic drugs while announcing plans for a public hearing on their therapeutic use. The National Institute on Drug Abuse (NIDA), subdivision of the National Institutes of Health (NIH), also revived historical ibogaine study data and funded new research on an Investigational New Drug application to address previously identified cardiac risks associated with ibogaine. The Advanced Research Projects Agency for Health (ARPA-H) opened competitive funding for ibogaine research targeting opioid use disorder, and the Health Resources and Services Administration (HRSA) is issuing a Request for Information on workforce and care-delivery readiness for future approved products. While agencies continue to collaborate and improve the evidence-base for psychedelic drugs, none of the products being advanced are approved by the FDA.
Congressional Action
House GOP Aims to Launch Third Reconciliation Bill
On July 16, the House Budget Committee passed the budget resolution by a vote of 20-14, after a request from Speaker Mike Johnson (R-LA). This is the first procedural step toward a party-line reconciliation package that would allow the Senate to vote on the package by a simple majority, bypassing the filibuster. Speaker Johnson does not have the votes to pass the package today but is moving the resolution forward due to pressure from White House officials to advance the package before the midterm elections and as funding for the war in Iran runs out. The framework under discussion would include $67 billion for defense, $20 billion for farm aid and agriculture funding, and elements of the Safeguard American Voter Eligibility (SAVE America) Act, which would incentivize states to adopt voter ID and citizenship verification requirements.
Judicial Action
Multi-State Lawsuit Against Department of Education Challenges Planned Termination of School Mental Health Grants
A coalition of 14 states filed a lawsuit against the Department of Education (DOE), challenging the agency’s plans to terminate federal school mental health grants that support the recruitment, training, and retention of school counselors, psychologists, and other mental health professionals. These grants were authorized by Congress and awarded for five-year project periods, with funding distributed through annual continuation awards. The states argue that DOE’s planned action would unlawfully discontinue funding that has already been approved and relied upon by school districts and higher education institutions participating in the programs.
The lawsuit follows an earlier court victory for the states after a federal district court permanently stopped DOE’s April 2025 directive to discontinue the grants, finding the policy “arbitrary and capricious” under federal law. However, the department has since indicated that it might still seek to terminate some or all of the grants at the end of July, prompting the states to file a new action to ensure funding remains in place while the legal dispute continues. The states are seeking emergency relief, including a preliminary injunction or temporary restraining order, and have requested a court hearing on July 24. The case represents the latest dispute over the administration’s efforts to reshape federally funded education programs and the extent of agency authority to modify congressionally appropriated initiatives.
Save the Date: 2026 Annual Conference
HealthCare Roundtable 22nd Annual Conference
November 4-6, 2026
The Mayflower Hotel
Washington, D.C.
