Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

Latest Resources

• Advancing Chronic Care With Effective, Scalable Solutions (ACCESS) Model Payment Amounts & Performance Targets Effective Period: July 5, 2026 – December 31, 2027
• When The Rate Doesn’t Work
• Limbic Becomes First AI-Led Mental Health Care Company Selected For FDA TEMPO Pilot
• West Virginia To Launch PACE-Aligned Programs As Part Of Rural Health Transformation Program
• Medicare Removes Homelessness & Housing Instability Codes From Higher-Payment Hospital Classification
• CMS To Require SNFs To Report Quality Data For Skilled Care Across All Payers
• Final Rule: Medicare Program; Prospective Payment System and Consolidated Billing For Skilled Nursing Facilities; Updates To The Quality Reporting Program For Federal Fiscal Year 2027
• Providence Health Plan To Exit Most Health Insurance Business Lines Starting In 2027
• New Verana Health AI Agent Boosts Efficiency & Compliance In MIPS Submissions
• Out-Of-Pocket Health Care Costs For People Retiring In 2026 Estimated At $185,500, Up 7.5% From 2025
• Medicare Launches Post-Payment Review Of Home Health Stays Lasting 361 Days Or Longer
• Costco & SCAN Health Plan Launching Medicare Advantage Plans In 3 Markets
• July 2026 Data Book: Health Care Spending & The Medicare Program
• Cityblock Health Raises $116 Million, Acquires Rural Medicare Provider Organization Homeward Health In An All-Stock Transaction
• Health Plans Deny Between 12% & 18% Of Prior Authorization Requests

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Medicare Removes Homelessness & Housing Instability Codes From Higher-Payment Hospital Classification

Beginning October 1, 2026, Medicare will no longer classify 10 diagnosis codes for homelessness, inadequate housing, and housing instability as complications or comorbidities (CCs) when determining payment for inpatient hospital stays. The change means documenting one of these housing circumstances will no longer provide the CC severity designation that can affect Medicare Severity Diagnosis Related Group (MS-DRG) assignment and increase payment for an inpatient stay. The Centers for Medicare & Medicaid Services (CMS) elevated homelessness… Read

• 2026 PACE Rural Memo
• Programs Of All-Inclusive Care For The Elderly (PACE) Marketing Guidelines
• Program Of All-Inclusive Care For The Elderly
• Amazon Pharmacy Starts $50 GLP-1 Delivery For Medicare Beneficiaries
• State Medicaid & Children’s Health Insurance Program Applied Behavior Analysis Toolkit

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