Care Management Blog

The CMS Brief (July 2026): Tracking Rulemaking Seasons, Margin Pressures, and Strategic Shifts

The Rural Health Transformation (RHT) Program, backed by $50 billion in federal funding, offers US states an opportunity to address healthcare for rural populations. This includes strategically investing in infrastructure and innovative models that deliver measurable, sustainable improvements.

What You'll Learn in This Article

Every month, CMS releases dozens of announcements, policy updates, proposed rules, and operational guidance documents. Some generate headlines. Others quietly signal where healthcare policy, payment reform, and value-based care may be heading next.

Many Medicare billing guides focus on reimbursement requirements but often lack clear steps on how to successfully and accurately bill Medicare for Remote Patient Monitoring (RPM) services. In 2026, CMS significantly updated the program, introducing new "short-duration" codes that make it easier to bill for acute care and intermittent patient engagement.

Chronic disease is one of the most significant challenges in Medicare today. Patients are living longer with conditions that require ongoing support and providers are balancing the realities of limited time, fragmented systems, and growing expectations in value-based care. Against this backdrop, CMS has released the ACCESS Model, short for Advancing Chronic Care with Effective, Scalable Solutions.

In the face of growing calls for value-based care, reduced reimbursement, and increasing costs, providers are launching care management programs to help counteract these pressures.

According to an announcement from the Centers for Medicare & Medicaid Services (CMS), the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule includes suggested changes to the Medicare Shared Savings Program. The goal is to make timely improvements to program policies and operations.

Over a decade, the Centers for Medicare & Medicaid Services (CMS) tested various value-based innovation models focused on improving primary care. Models like CPC, CPC+, and Primary Care First demonstrated that “comprehensive primary care can lead to reductions in emergency department and hospital visits while better meeting patient needs.”

Medicare’s new program, Advanced Primary Care Management (APCM), moves away from time-based tracking and focuses on reimbursement based on a patient’s risk level. The highest risk level is covered under CPT code GPCM3 and focused solely on any patient who is a Qualified Medicare Beneficiary (QMB).