The Regulator

Medicare’s 2027 physician fee schedule is now final in the Federal Register, and the conversion factor for most doctors drops 2.31% to $32.63 on January 1. The Centers for Medicare & Medicaid Services (CMS) rule was published today at 91 FR 70992, a 1,029-page document with a January 1, 2027 effective date, five days after CMS issued its fact sheet. Who it hits: physicians and other practitioners paid under the physician fee schedule, the rate list Medicare uses for office and professional services. So what: the conversion factor, the dollar amount multiplied against each service’s relative value units, falls $0.77 from $33.40 for clinicians who are not in a qualifying advanced alternative payment model, and $0.62 (1.83%) to $32.95 from $33.57 for those who are. Statutory updates of 0.25% and 0.75% and an estimated 0.12% work-value adjustment are swamped by the expiry of a one-year 2.50% increase Congress gave for 2026, which CMS says means current law effectively requires a 2.50% reduction. The same rule carries the Medicare Shared Savings Program, rural health clinic, ambulance and clinical laboratory changes. Confidence: High; the figures come from CMS and the Federal Register entry. Sources: Federal Register final rule 2026-22743, CMS fact sheet, CY 2027 Medicare Physician Fee Schedule final rule.

The drug price negotiation final rule and the 2027 home health final rule also reached the Federal Register today. The negotiation rule (2026-22792, 91 FR 72176, 215 pages) lists an effective date of December 5, 2026, and its summary says it codifies the Medicare Drug Price Negotiation Program and new Medicare Part D policies required by the Inflation Reduction Act, plus a policy for fixed combination drugs that are new formulations. The home health rule (2026-22750, 91 FR 72022, 152 pages) sets routine payment updates, a temporary behavior adjustment, recalibrated case-mix weights, low-utilization payment adjustment thresholds, quality reporting changes, and provider enrollment and durable medical equipment supplier policies. Who it hits: drugmakers with selected drugs, Part D plans, and home health agencies and equipment suppliers enrolled in Medicare. So what: the December 5 date starts the clock on the negotiation rulebook, and home health agencies now have the formal text behind CMS’s earlier payment announcement. Confidence: High on the document numbers and summaries; Low on the home health effective date, because the Federal Register’s date field reads January 4, 2026, which cannot be right for a 2027 rule, so confirm it in the document. Sources: Federal Register negotiation final rule 2026-22792, Federal Register home health final rule 2026-22750.

UPDATE: CMS corrected its October proposed rule on pharmacy benefit manager accountability, low-income Part D copays and Medicare Advantage provider directories, and comments are due December 15. A Federal Register correction published today fixes a typographical error in proposed rule CMS-4214-P, which implements three sections of the Consolidated Appropriations Act, 2026: section 6219 on Part D cost-sharing for low-income enrollees, section 6220, the Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act, and section 6224 on pharmacy benefit manager accountability. Who it hits: about 6 million low-income Part D enrollees, per CMS’s estimate, Medicare Advantage organizations that publish provider directories, and Part D pharmacy benefit managers. So what: CMS estimates the cost-sharing change at a net $1.337 billion in federal spending over 2028 to 2037, and proposes that Medicare Advantage organizations estimate a directory accuracy score from a random sample using verification methods CMS specifies. The correction notice does not say which text changed. Confidence: High on the figures, which come from the proposed rule text. Sources: Federal Register correction 2026-22807, Federal Register proposed rule 2026-21420, Regulations.gov docket CMS-2026-2533.

A federal ruling that struck down CMS’s strict “medically frail” test does not protect Missouri, where attorneys say 100,000 to 140,000 people face the January 1 Medicaid work rule. KCUR reported today that U.S. District Judge Richard Stearns in Boston blocked CMS’s added requirement that people prove a condition significantly impairs their ability to work, but upheld other limits, including rejecting frailty proof based on a diagnosis more than a year old. Who it hits: Medicaid expansion enrollees aged 19 to 64 in states that were not plaintiffs; Missouri was not, so it has until January 1, 2027 to adapt, while the plaintiff states got six months to rebuild their systems. So what: enrollees must show 80 hours a month of work, community service, job training or education, and a separate Missouri suit by Legal Aid of Western Missouri and Kansas City resident Emily Byrd is still pending. The administration has said it wants to appeal, but KCUR says the timing is unclear. Confidence: Med. KCUR names no case number and links no order, and we have not read the opinion. Sources: KCUR report, November 9. Supplemental: Georgetown Center for Children and Families analysis of the ruling.

Quiet Monday note: CMS posted no new press releases or fact sheets after November 5, and the Federal Register’s other health notices today were routine meeting and paperwork notices.