The last five months have seen a wave of proposals and policies from CMS related to everything from updates to coverage of pain procedures to fraud crackdowns and claims documentation requirements.
Here are five CMS moves impacting ASCs and outpatient centers in 2026:
1. CMS proposed a mandatory bundled payment model expansion for lower extremity joint replacements under the FY 2027 Hospital Inpatient Prospective Payment System proposed rule May 12.
The proposed Comprehensive Care for Joint Replacement Expanded, or CJR-X, model would apply nationwide to Medicare fee-for-service beneficiaries undergoing hip, knee and ankle replacement procedures in inpatient and outpatient hospital settings, according to the proposal.
2. In April, CMS announced it will require all states to audit healthcare providers participating in Medicaid in an effort to address alleged fraud. Administrator Mehmet Oz, MD, unveiled the plan at Politico’s Health Care Summit. CMS will require all states to submit a plan within 30 days outlining how they will verify that healthcare providers are real, licensed and actually delivering care under Medicaid, particularly in areas flagged as high risk for fraud. The announcement comes as the White House has expanded its Medicaid fraud crackdown to Florida, following a March 17 letter from Dr. Oz to Gov. Ron DeSantis and other state leaders requesting information on how the state identifies, prevents and addresses Medicaid program integrity issues.
3. CMS finalized a rule to phase out faxing and mailing for healthcare claims documentation, which it estimates will save the healthcare industry $781 million annually. The rule takes effect May 19 and applies to HIPAA-covered entities, including health plans, healthcare clearinghouses and healthcare providers that conduct electronic transactions. Covered entities must comply by May 19, 2028.
4. The American Society of Anesthesiologists is urging CMS not to proceed with proposed policies that would end coverage of peripheral nerve blocks for chronic pain.ASA applauded 25 bipartisan members of Congress for signing a letter to CMS opposing the changes, which were introduced by five regional Medicare administrative contractors. The lawmakers warned that restricting access to non-opioid alternatives like peripheral nerve blocks could increase opioid use and misuse among Medicare beneficiaries.5. CMS plans to transition to an independent dispute resolution “gateway” during the second half of 2026. The federal agency will move away from single-use web forms, instead relying on “a secure, centralized platform” for managing disputes. Platform users can initiate or follow up with disputes, track them, or view dashboards and reports for their organizations.
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