As published in the CY2026 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) requests feedback on their proposal to update how they calculate the Overall Hospital Quality Star Rating, which summarizes a variety of quality measures across five areas into a single star rating for each hospital.

The five areas of quality are Safety of Care, Mortality, Readmission, Patient Experience, and Timely and Effective Care.  CMS proposes to emphasize the contribution of the Safety of Care measure group in hospitals’ ratings by limiting the total number of stars that hospitals with the lowest Safety of Care scores can earn.  They also propose that this change, if finalized, would only apply to hospitals and Critical Access Hospitals with at least 3 Safety of Care measures.

CMS estimates that about 830 rural hospitals with star ratings had at least 3 Safety of Care measures in 2024.

Comments are due by September 15.

On July 31, the Centers for Medicare & Medicaid Services (CMS) issued updates to the Transforming Episode Accountability Model (TEAM) as part of the Medicare Inpatient Prospective Payment System (IPPS) final rule. TEAM is a mandatory model for hospitals in selected geographic areas. Participating hospitals will receive bundled payments for selected surgical procedures for traditional Medicare patients. The 2026 IPPS final rule updates several policies for TEAM, including the removal of hospital health equity plans and Health Related Social Needs screening and reporting.

The TEAM model starts on January 1, 2026.

Aetna plans to discontinue nearly 90 Medicare Advantage plans across 34 states in 2026 including Pennsylvania. The decision is part of a larger trend of insurers reducing their presence in the Medicare Advantage market due to rising costs and a focus on profitability. Most of the affected plans are PPOs, and Aetna will stop paying commissions to brokers for enrolling new members in these plans starting in September.

According to the Society for Human Resources Management (SHRM), more than half of workers feel pressured to prioritize their organization over their personal wellbeing. To protect their own wellbeing in the face of this pressure, at least 1 in 5 workers reported they have taken a lower-paying job, pursued a different career or left a job without having another one lined up.

View the National Council for Mental Wellness blog post to learn how workplace mental health training can help.

On August 12, CMS released its 2025-2026 Medicaid Managed Care Rate Development Guide, which provides states and their actuaries with guidance for the development of Medicaid managed care capitation rates for rating periods starting between July 1, 2025, and June 30, 2026. States are expected to abide by the provisions in 42 CFR § 438 to ensure actuarial soundness.

The current version does not intend to replace prior versions but builds on the prior year’s guide and the rate certification experiences of both the agency and states. The rate development guide speaks to Medicaid managed care rates in general, for long-term care services, and new adult group capitation rates.

The Pennsylvania Department of Human Services (DHS) posted the following statement on their website.

“In July 2025, Congress passed a bill that will change programs run by the Pennsylvania Department of Human Services (DHS). President Trump signed that bill into law. The law makes changes to Medicaid (Medical Assistance) and the Supplemental Nutrition Assistance Program (SNAP). For some SNAP recipients, these changes will begin Sept. 1, 2025. PA DHS is waiting for information on how states must implement these changes. Your benefits have not changed at this time and will not change without notice from DHS. You will have the opportunity to update your case information. Be on the lookout for more information from DHS. Keep your address and other contact information up-to-date with DHS and the US Postal Service. We will help you prepare for these changes as they come.”

Learn more.

The President issued a new Executive Order (EO) that, if implemented as written, would dramatically increase political involvement in the Federal grant making process. Under the EO, senior political appointee will have the final say over all steps in the grant process, including which applications to fund (the Objective Review Committee [ORC] decisions would be merely “advisory”) and whether/when to terminate any grant “for convenience, including when the award no longer advances agency priorities.” The EO states that senior appointees may not “routinely defer to the recommendations of others” regarding grants decisions, “but shall instead use their independent judgment.”

For more information, see this summary