CMS Proposes CY 2027 Physician Fee Schedule with Part B Payment and Quality Program Updates
CMS published a proposed rule updating the physician fee schedule for calendar year 2027, along with changes to Medicare Part B payment policies, Quality Payment Program requirements, and Medicare Shared Savings Program rules. The proposal also codifies the Medicare Prescription Drug Inflation Rebate Program established under the Inflation Reduction Act of 2022 and updates policies for rural health clinics, federally qualified health centers, ambulance services, and clinical laboratory fee schedules. While primarily Medicare-focused, the rule affects providers participating in both Medicare and Medicaid managed care networks, potentially impacting provider contracting, rate negotiations, and network adequacy for dual-eligible populations. Comments are due 60 days after Federal Register publication.
Changes to Medicare physician payment rates and quality requirements directly affect Medicaid managed care organizations' ability to contract with providers serving dual-eligible beneficiaries and may influence Medicaid rate-setting methodologies in states that benchmark to Medicare fee schedules.
Managed Care · Finance
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