(April 10, 2026) – MLN Connects Provider eNews from the Medicare Learning Network
The Centers for Medicare & Medicaid Services issued the following updates in the MLN Connects Provider eNews:
CMS Releases Final CY 2027 Medicare Advantage Capitation Rates
The Centers for Medicare & Medicaid Services released the Medicare Advantage capitation rates and Medicare Parts C and D payment policies for the 2027 calendar year. "The final policies in the CY 2027 Rate Announcement are projected to result in an increase of 2.48 percent or over $13 billion in payments to MA plans in CY 2027. When accounting for estimated risk score trend in MA due to factors such as population changes and coding practices, this amounts to a 4.98 percent increase."
CMS also revised the MA risk adjustment model to exclude diagnosis information obtained from unlinked chart review records, meaning diagnosis details not tied to a specific beneficiary encounter will no longer be used to calculate risk scores.
OMB Releases FY 2027 President's Budget
The Office of Management and Budget released President Donald J. Trump's fiscal year 2027 budget, which allocates $111.1 billion in discretionary budget authority for the U.S. Department of Health and Human Services — a $15.8 billion, or 12.5 percent, cut from the enacted FY 2026 budget.
The proposed budget suggests removing several programs, such as the Medicare Rural Hospital Flexibility Program, the State Offices of Rural Health, the Rural Hospital Stabilization Program and the Rural Hospital Provider Assistance Program.
The budget allocates $6.8 billion for the Centers for Medicare & Medicaid Services, representing a $1.4 billion decrease from the enacted FY 2026 budget. The proposal also suggests relocating the Office of Pharmacy Affairs from HHS to CMS, while boosting funding for the 340B Drug Pricing Program from $8 million to $20.5 million.
CMS to Reprocess Certain CAH Method II Claims
The Centers for Medicare & Medicaid Services released a notification for critical access hospitals that use Method II billing for professional services. "Certain CAH claims were incorrectly returned with Fiscal Intermediary Shared System reason codes 31006 and 31007, indicating that providers don't have a reassignment on file in PECOS. To address this issue, the Medicare Administrative Contractors stopped returning these claims with dates of service in 2025 and 2026. They will reprocess claims that were incorrectly returned since Jan. 1, 2026. Payments should be issued in about two weeks. CAHs do not need to take any action."
CMS Releases Proposed Updates for Medicare Hospice, IRF, IPF and SNF Payment and Policy Changes for FFY 2027
The Centers for Medicare & Medicaid Services published the proposed federal fiscal year 2027 Medicare payment and policy updates for the Inpatient Rehabilitation Facility, Inpatient Psychiatric Facility, Skilled Nursing Facility and Hospice Prospective Payment Systems. Comments about the rules are due Monday, June 1.
CMS Releases Final CY 2027 Medicare Advantage and Part D Final Rule
The Centers for Medicare & Medicaid Services released the calendar year 2027 Medicare Advantage and Part D final rule. Key changes include refocusing on the Star Ratings measure set, rewarding sustained high performance, reducing regulatory burden, strengthening prescription drug protections and clarifying requirements to combat waste and abuse. Key changes include refocusing on the Star Ratings measure set, rewarding sustained high performance, reducing regulatory burden, strengthening prescription drug protections and clarifying requirements to combat waste and abuse.
Before You Go ...
April is Alcohol Awareness Month, a time to highlight the important health and community impacts of alcohol use. Kansas hospitals can utilize evidence-based resources from organizations such as the the National Institute on Alcohol Abuse and Alcoholism, Substance Abuse and Mental Health Services Administration, and the Addiction Policy Forum to support prevention, screening, treatment and recovery efforts. These organizations offer data, clinical tools, and educational resources to help providers reduce stigma, improve diagnosis and care for alcohol use disorder, and expand access to support.