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Medicare Advantage and Part D Drug Benefit Changes

CMS issued a final rule effective June 1, 2026 (applicable to coverage beginning January 1, 2027) implementing Medicare Advantage (Part C), Medicare Part D, and Medicare cost plan changes. The rule codifies Inflation Reduction Act section 11201 changes to Part D benefit design, including new coverage phases, out-of-pocket thresholds, and the Manufacturer Discount Program replacing the Coverage Gap Discount Program.

WISeR Prior Authorization Implementation Delay

CMS issued a notice delaying implementation of prior authorization requirements for two services under the Wasteful and Inappropriate Services Reduction (WISeR) model: Deep Brain Stimulation for Essential Tremor and Parkinson's Disease (NCD 160.24) and Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13). The original January 1, 2026 implementation date is postponed until a future date to be announced. This is a routine administrative delay to allow additional time for operational readiness.

WISeR Model Prior Authorization Technical Correction

CMS issued a correction notice correcting typographical and technical errors in the July 1, 2025 Federal Register notice regarding the WISeR (Wasteful and Inappropriate Services Reduction) Model prior authorization requirements. The corrections refine the lists of Local Coverage Determination (LCD) codes for specific services including Epidural Steroid Injections, Vertebral Compression Fracture procedures, Fusion surgeries, and Sleep Apnea treatments. The corrections are effective April 6, 2026, with applicability to WISeR items and services implemented on January 1, 2026.

PRA Notice - Skilled Nursing Facility Physician Certification Information Collection

CMS published a 60-day notice under the Paperwork Reduction Act requesting public comment on an information collection related to physician certifications and recertifications in skilled nursing facilities under Section 1814(a) of the Social Security Act. The notice includes burden estimates and invites comments on the necessity, utility, and accuracy of the proposed information collection. Comments must be received by June 5, 2026.

CMS PRA Information Collection Request - Annual EPSDT Participation Report

The Centers for Medicare & Medicaid Services (CMS) published a Paperwork Reduction Act (PRA) notice inviting public comment on the revision of Form CMS-416, the Annual Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Participation Report. The notice summarizes the proposed data collection to assess state effectiveness in providing child health screening and treatment services to Medicaid-eligible children. Comments must be submitted to the OMB desk officer by May 6, 2026.

Public Data Asset Release Under OPEN Government Data Act

CMS announced the release of seven public data assets containing Original Medicare utilization and payment data aggregated by provider and service, including physician services, inpatient/outpatient hospitals, Part D prescribers, DMEPOS, and Medicaid provider spending. The datasets are released in open, machine-readable formats under an open license pursuant to the OPEN Government Data Act. CMS evaluated privacy protections under HIPAA, 21st Century Cures Act, and 42 CFR Part 2, determining the data has been de-identified and appropriately limited to mitigate re-identification risk.

Delayed Implementation of Prior Authorization for Medicare WISeR Services

CMS issued a notice delaying the implementation of prior authorization requirements for two services under the WISeR (Wasteful and Inappropriate Services Reduction) Model: Deep Brain Stimulation for Essential Tremor and Parkinson's Disease (NCD 160.24) and Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13). The original January 1, 2026 implementation date for these services has been postponed. The new implementation date will be announced in a future Federal Register notice.

WISeR Model Prior Authorization Requirements Correction

CMS issued a correction notice to fix typographical and technical errors in the WISeR Model prior authorization requirements originally published July 1, 2025. The corrections revise the list of covered service codes for epidural steroid injections, vertebral compression fracture procedures, fusion procedures, and sleep apnea services, reducing the number of applicable codes in each category. The notice also clarifies that Skin and Tissue Substitutes prior authorization applies only to selected WISeR MAC jurisdictions with active LCDs during performance years starting January 1, 2026.

Center for Scientific Review Notice of Closed Meetings

The NIH Center for Scientific Review published a Federal Register notice announcing four closed meetings scheduled for April 29 through May 1, 2026. The meetings will review grant applications for research in communication/language, biocontainment laboratories, biomaterials/nanoscience, clinical care interventions, and oncology fellowships. All meetings will be held virtually and closed to the public under exemptions for confidential trade secrets and personal privacy.

Center for Scientific Review Closed Meeting Notices

The National Institutes of Health Center for Scientific Review announced five closed meetings scheduled for April 28-29, 2026, pursuant to the Federal Advisory Committee Act. The meetings will review grant applications for topics including health services research, basic and translational cancer research, medical technology partnerships, mentored career development awards, and shared-use biomedical research equipment. All meetings will be held virtually.