From Becker’s Hospital Review

CMS introduced several new care and payment models in 2025, many focused on drug pricing, chronic disease management and prevention:

1. CMS published plans Dec. 23 for its voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model. Under the model, CMS will negotiate reduced prices with GLP-1 manufacturers for state Medicaid programs and Medicare Part D plans. Eligible manufacturers must have a product that is any combination of GIP, GLP‐1 and glucagon receptor agonist with an FDA-approved active ingredient for weight management. The drug must be proven to reduce body weight by at least 10% on average.

2 and 3. CMS on Dec. 19 proposed two new models aimed at curbing Medicare drug spending by linking payments to international benchmarks. The GUARD model applies to prescription drugs covered under Medicare Part D, while GLOBE targets drugs reimbursed under Medicare Part B, such as injectables administered in physician offices. Both models would benchmark U.S. Medicare payments to prices paid in economically comparable countries, aiming to reduce inflated domestic costs for high-expenditure drugs.

4. CMS on Dec. 11 unveiled the “Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence,” or Elevate, model, a voluntary initiative that will fund up to 30 chronic disease prevention and health promotion pilot projects aimed at integrating lifestyle and evidence-based functional medicine into original Medicare. The model will test interventions like physical activity, nutrition and other wellness-focused strategies that are not currently covered by Medicare, with the goal of slowing or preventing chronic disease. Organizations that participate will receive around $3 million over three years to collect cost, quality and health outcome data.

5. On Oct. 31, CMS finalized a new Ambulatory Specialty Model, a mandatory payment model focused on specialty care for beneficiaries with heart failure and low back pain. The program is set to begin in 2027 and will run through 2031.

6. CMS plans to launch the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model on Jul 1, 2026. ACCESS will test whether tying payments to clinical outcomes can expand the use of digital tools in chronic disease management. The model targets conditions common among Medicare beneficiaries, such as high blood pressure, diabetes, chronic musculoskeletal pain and depression. Participants will receive recurring payments to manage patients’ conditions, with payment tied to achieving specific health outcomes.

From Becker’s Hospital Review

CMS has formally established the Office of Rural Health Transformation within the Center for Medicaid and CHIP Services, creating a permanent home for the federal government’s $50 billion Rural Health Transformation Program.

The move follows the launch of the program earlier this year under President Donald Trump’s Working Families Tax Cuts legislation and comes as CMS begins distributing funding to all 50 states. The five-year initiative is one of the largest federal investments ever aimed at stabilizing and modernizing rural healthcare delivery.

CMS said the new office is designed to strengthen oversight, coordination and accountability as states begin implementing ambitious plans to expand access, modernize infrastructure and support rural providers through Sept. 30, 2031.

Eight things to know:

1. The office will oversee a $50B, five-year rural health initiative. The Office of Rural Health Transformation will continue leading implementation of the Rural Health Transformation Program, which allocates $50 billion from 2026 through 2030 to strengthen rural health systems and expand access to care nationwide. The office sits within the Center for Medicaid and CHIP Services, signaling CMS’ intent to closely align rural health transformation with Medicaid policy, state partnerships and delivery system reform.
2. All 50 states have been approved for funding. CMS announced Dec. 29 that every state will receive awards under the program. First-year funding in 2026 averages about $200 million per state, with awards ranging from roughly $147 million to $281 million. Each state will be assigned a CMS project officer. States must submit yearly progress reports, and CMS will convene an annual rural health summit beginning in 2026 to share best practices.
3. Funding flows to states, not directly to hospitals. Unlike past relief programs, funds are distributed to states, which design and implement rural health transformation plans subject to CMS approval. States are not required to direct dollars specifically to rural hospitals.
4. Half of the funding is distributed equally. Fifty percent of the $50 billion is divided evenly among approved states, providing a baseline level of funding regardless of state size or rural population, according to CMS. The other 50% is distributed based on metrics such as rurality, health system needs and the scale and potential impact of state proposals, as outlined in the notice of funding opportunity.
5. Investments target workforce, infrastructure and care delivery. State plans focus on strengthening the rural clinical workforce, modernizing facilities and technology, expanding telehealth and remote monitoring, improving emergency services and testing new primary care and value-based models. CMS said many states are deploying evidence-based, outcomes-driven strategies — such as physical fitness and nutrition programs, food-as-medicine initiatives and chronic disease prevention models — to address the root causes of illness and better manage chronic conditions.
6. Investments also aim to strengthen rural emergency care through improved emergency medical services communication, expanded treat-in-place options and better coordination for patient transfers. In addition, states plan to modernize rural facilities and equipment, bolster cybersecurity and interoperability and adopt digital tools — including AI scribes and clinical workflow technologies — to reduce administrative burden and support clinicians.
7. ORHT will provide technical assistance and federal coordination. The office will guide states through implementation, provide technical assistance, coordinate federal and state partnerships and assign CMS project officers to each state. States must submit regular progress updates, allowing CMS to track performance, identify best practices and intervene when implementation challenges arise over the five-year program.
8. CMS is positioning the office for long-term transformation. By formally establishing ORHT, CMS aims to create lasting infrastructure for rural health policy beyond the life of the program. States will convene annually at a CMS Rural Health Summit to share lessons learned and accelerate innovation across regions.
9. Policy experts raise concerns. Despite the program’s $50 billion headline investment, policy experts and rural hospital leaders have raised concerns about whether the program will deliver meaningful benefits to rural providers, according to a study published July 23 in Health Affairs. Because funds flow to states, which are not required to allocate dollars to rural hospitals, critics worry money could be diverted to broader initiatives, vendors or administrative efforts with limited on-the-ground impact.

The program also grants the CMS administrator broad discretion over half of the funding and does not tie continued payments to performance or rural health outcomes. Compounding those concerns, the five-year program coincides with permanent Medicaid cuts expected to disproportionately affect rural areas, while tight timelines and potential clawbacks could limit states’ ability to plan and execute effective, provider-focused investments.

The Centers for Medicare & Medicaid Services (CMS) today announced that all 50 states will receive awards under the Rural Health Transformation Program, a $50 billion initiative established under President Trump’s Working Families Tax Cuts legislation (Public Law 119-21) to strengthen and modernize health care in rural communities across the country. In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million. This unprecedented federal investment will help states expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home.

“More than 60 million Americans living in rural areas have the right to equal access to quality care,” said Health and Human Services Secretary Robert F. Kennedy, Jr. “This historic investment puts local hospitals, clinics, and health workers in control of their communities’ healthcare. Thanks to President Trump’s leadership, rural Americans will now have affordable healthcare close to home, free from bureaucratic obstacles.”

“Today marks an extraordinary milestone for rural health in America,” said CMS Administrator Dr. Mehmet Oz. “Thanks to Congress establishing this investment and President Trump for his leadership, states are stepping forward with bold, creative plans to expand rural access, strengthen their workforces, modernize care, and support the communities that keep our nation running. CMS is proud to partner with every state to turn their ideas into lasting improvements for rural families.”

A Nationwide Commitment to Strengthen Rural Health Care

The Rural Health Transformation Program is a national commitment to improving the health and well-being of rural communities across the country. With this funding, states will implement comprehensive strategies to improve care delivery, support providers, and advance new approaches to coordinating health care services across rural communities. Across the country, many states are planning efforts that will:

• Bring More Care Within Reach

States will advance Make Rural America Healthy Again goals by expanding preventive, primary, maternal, and behavioral health services and creating new access points that bring care closer to home and help preserve strong local health systems. Many states are implementing evidence-based, outcomes-driven strategies—such as physical fitness and nutrition programs, food-as-medicine initiatives, and chronic disease prevention models—to address root causes of diseases and manage chronic conditions. States will also strengthen rural emergency care through improved emergency medical services (EMS) communication, treat-in-place options, and coordinated transfers.

• Strengthen and Sustain the Rural Clinical Workforce

States will support clinical workforce training, residencies, recruitment and retention incentives, and new pathways that help students begin health care careers in their own communities. States are also investing in programs to train and support the existing clinical workforce and build futures close to home.

• Modernize Rural Health Infrastructure and Technology

Investments will modernize rural facilities and equipment; strengthen cybersecurity and interoperability; and expand telehealth, remote patient monitoring, and digital tools that enable timely access to care. States are also exploring the use of technology such as AI scribes and clinical workflow improvement tools to reduce burdens on clinicians.

• Driving Structural Efficiency & Empowering the Community Providers

States will prioritize streamlining operations, empowering providers to enhance coordination of care and resources, and building partnerships across the state with the goal of keeping care local. This includes establishing specialized hub-and-spoke models, rural regional centers of excellence, comprehensive data-sharing platforms, and rural clinically integrated networks.

• Advance Innovative Care Models and Payment Reform

States will test new primary care and value-based care models, strengthen partnerships among rural and other providers, and promote regional collaboration that improves health sustainability and patient outcomes.

Awardees and Funding Amounts

The Rural Health Transformation Program’s $50 billion in funds will be allocated to approved states over five years, with $10 billion available each year from 2026 through 2030. As directed by Public Law 119-21:

• 50% of the funding is distributed equally among all approved states. This provides states with a strong foundation to begin implementing their Rural Health Transformation Plans; and
• 50% is allocated based on a variety of factors. As described in the Notice of Funding Opportunity, those factors include individual state metrics around rurality and a state’s rural health system, current or proposed state policy actions that enhance access and quality of care in rural communities, and application initiatives or activities that reflect the greatest potential for, and scale of, impact on the health of rural communities. All scoring factors are outlined further in the Notice of Funding Opportunity.

CMS made funding awards to all 50 states.

State Award List (Alphabetical)

With today’s announcement, CMS launches a new phase of collaboration with every state to accomplish their transformative visions. CMS project officers dedicated to each state will convene program kickoff meetings and provide ongoing guidance and technical assistance during implementation. States will submit regular updates so CMS can track progress, identify proven approaches, support successful execution of their plans, and ensure strong oversight throughout the program.

States will also convene annually at the CMS Rural Health Summit—to be held during the CMS Quality Conference in 2026—to share lessons learned, highlight effective models, and accelerate innovation across regions.

Additional Background

CMS evaluated applications through a rigorous merit review process, consistent with standard HHS grantmaking procedures, that incorporated assessments from federal and non-federal subject matter experts with unique perspectives relevant to rural health. These individuals represented expertise across clinical, operational, workforce, technology, and payment mechanism disciplines. Reviewers were screened for conflicts of interest and did not assess applications from states with which they had personal or professional ties. Applications were evaluated using a structured scoring framework outlined in the Notice of Funding Opportunity and aligned with statutory goals, ensuring a fair and consistent process across all 50 states.

The program follows standard HHS grants policy, including protections that ensure the integrity of the merit review process, consistent with longstanding HHS practices for competitive grant and cooperative agreement programs. Additional information on the Rural Health Transformation Program, including the Notice of Funding Opportunity, is available at: http://www.cms.gov/RHTProgram.

To view the Rural Health Transformation Program State Project Abstracts visit https://www.cms.gov/files/document/rht-program-state-provided-abstracts.pdf

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on X @CMSgov

The Centers for Medicare & Medicaid Services (CMS) provided additional guidance outlining how states should implement landmark community engagement requirements created by the Working Families Tax Cut (WFTC) legislation (Public Law 119-21). The reforms—among the most significant Medicaid eligibility and financing changes in more than a decade—aim to connect able-bodied, working-age adults with work and community engagement opportunities, reduce improper enrollment, and strengthen the long-term sustainability of Medicaid and the Children’s Health Insurance Program (CHIP).

States must implement these requirements by January 1, 2027, but may choose to do so earlier.

KFF has published an Implementation Tracker for the 2025 Reconciliation Law focused on Medicaid Work Requirements. State and national data along with current state policies related to Medicaid Enrollments, renewal and application processing times are available for view.

Several states have submitted Section 1115 Work Requirements waivers since January 2025. Seven states are pending approval while Georgia’s “Pathways to Coverage” waiver was implement in July 2023. The waiver was approved for a temporary extension that included changes such as allowing parents or caretakers of children up to age 6 (in households at or below 100% FPL) to receive Medicaid without work requirements and eliminating the requirement of monthly reporting of work activities (in exchange for annual reporting). Georgia’s waiver is now set to expire December 2026. Georgia will likely need to comply with federal work requirements beginning January 1, 2027.

Overall, work requirements are estimated to reduce federal Medicaid spending by $326 Billion over 10 years. Capital Link analyzed the impact of potential policy changes on patient volume and health center revenues. They estimated percentage that 72% of Medicaid adults subject to reporting requirements may drop coverage because they are unable to verify either compliance with work requirements or an exemption. The total projected loss from annual revenue shortfalls from 2029 to 2032 could be almost $900 million.

Telehealth policy updates for recent legislation authorized an extension of many of the Medicare telehealth flexibilities including waiving geographic and originating site restrictions through January 30, 2026. In support of the extensions, the Centers for Medicare & Medicaid Services (CMS) published a related FAQ document for calendar year 2026. To support access to care in rural communities, telehealth policies allow:

• Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can serve as Medicare distant site providers for non-behavioral/mental telehealth services through Jan. 30, 2026.
• Non-behavioral/mental telehealth services in Medicare can be delivered using audio-only communication platforms through Jan. 30, 2026, and
• FQHCs and RHCs can permanently serve as a Medicare distant site provider for behavioral/mental telehealth services and the in-person visit requirement for mental health services furnished via communication technology to beneficiaries in their homes is not required through Jan. 1, 2026.

As part of the Pennsylvania Department of Health’s (DOH) efforts to increase surveillance for illnesses related to harmful algal bloom (HAB) throughout Pennsylvania, the Division of Environmental Health Epidemiology at DOH has developed a short survey to gauge health care provider awareness of HABs and HAB-related illness. This survey is anonymous and voluntary.

All medical professionals are eligible to complete the survey, which will be open until April 2026. Please reach out to the Division of Environmental Health Epidemiology at dehe@pa.gov with any questions.

The Pennsylvania Trauma Systems Foundation (PTSF) announced the revised list of trauma centers. A trauma center is a hospital capable of providing continuous specialized services and resources to patients suffering from traumatic injuries. Appropriate treatment by specially trained staff has been shown to reduce the likelihood of death and permanent disability. In Pennsylvania, there are four levels of trauma centers. Learn more at: What is a Trauma Center?

Adult Level IV Trauma Center Accreditation has been granted to five additional hospitals in Pennsylvania effective January 1, 2026.

1. Geisinger Medical Center Muncy – Muncy, PA
2. Indiana Regional Medical Center – Indiana, PA
3. Mount Nittany Medical Center – State College, PA
4. St. Luke’s Hospital – Easton Campus – Easton, PA
5. Wellspan Gettysburg Hospital – Gettysburg, PA

Effective January 1, 2026, there will be 57 accredited trauma centers in Pennsylvania.
Combined Adult Level I/Pediatric Level I Trauma Centers

1. Hershey — PennState Health Milton S. Hershey Medical Center/PennState Health Children’s Hospital

Combined Adult Level I/Pediatric Level II Trauma Centers

1. Allentown — Lehigh Valley Health Network — Lehigh Valley Hospital-Cedar Crest/Lehigh Valley Reilly Children’s Hospital
2. Danville — Geisinger Medical Center/Geisinger Janet Weis Children’s Hospital
   Adult Level I Trauma Centers
3. Bethlehem — St. Luke’s University Health Network — St. Luke’s University Hospital
4. Johnstown — Conemaugh Health System — Conemaugh Memorial Medical Center
5. Lancaster — Penn Medicine — Penn Medicine Lancaster General Health
6. Philadelphia — Jefferson Health — Jefferson Einstein Hospital
7. Philadelphia — Jefferson Health — Thomas Jefferson University Hospital
8. Philadelphia — Penn Medicine — Penn Presbyterian Medical Center
9. Philadelphia — Temple Health — Temple University Hospital
10. Pittsburgh — Allegheny Health Network — AHN Allegheny General Hospital
11. Pittsburgh — University of Pittsburgh Medical Center — UPMC Mercy
12. Pittsburgh — University of Pittsburgh Medical Center — UPMC Presbyterian
13. Sayre — Guthrie Robert Packer Hospital
14. West Reading — Tower Health — Reading Hospital
15. Wilkes-Barre — Geisinger Wyoming Valley Medical Center
16. York — WellSpan Health – WellSpan York Hospital

Pediatric Level I Trauma Centers

1. Philadelphia — Children’s Hospital of Philadelphia
2. Philadelphia — Tower Health — St. Christopher’s Hospital for Children
3. Pittsburgh — University of Pittsburgh Medical Center — UPMC Children’s Hospital of Pittsburgh

Adult Level II Trauma Centers

1. Abington — Jefferson Health — Jefferson Abington Hospital
2. Bethlehem — Lehigh Valley Health Network — Lehigh Valley Hospital-Muhlenberg
3. Camp Hill — PennState Health Holy Spirit Medical Center
4. DuBois — Penn Highlands DuBois — Penn Highlands Healthcare
5. Easton — St. Luke’s University Health Network — St. Luke’s Hospital Anderson Campus
6. Erie — University of Pittsburgh Medical Center — UPMC Hamot
7. Langhorne — Trinity Health Mid-Atlantic — St. Mary Medical Center
8. Monroeville — Allegheny Health Network — AHN Forbes
9. Paoli — Main Line Health — Paoli Hospital
10. Philadelphia — Jefferson Health — Jefferson Torresdale Hospital
11. Scranton — Geisinger Community Medical Center
12. Sellersville — Grand View Health — Grand View Campus
13. Williamsport — University of Pittsburgh Medical Center — UPMC Williamsport
14. Wynnewood — Main Line Health — Lankenau Medical Center

Level III Trauma Centers

1. Altoona — University of Pittsburgh Medical Center — UPMC Altoona
2. East Stroudsburg — Lehigh Valley Health Network — Lehigh Valley Hospital-Pocono
   Level IV Trauma Centers
3. Coaldale — St. Luke’s University Health Network — St. Luke’s Hospital – Miners Campus
4. Easton — Lehigh Valley Health Network — Lehigh Valley Hospital-Hecktown Oaks
5. Easton – St. Luke’s University Health Network – St. Luke’s Hospital – Easton Campus
6. Gettysburg – Wellspan Gettysburg Hospital
7. Grove City — Allegheny Health Network — AHN Grove City
8. 42. Hastings — Conemaugh Health System — Conemaugh Miners Medical Center
9. Hazleton — Lehigh Valley Health Network — Lehigh Valley Hospital-Hazleton
10. Honesdale — Wayne Memorial Hospital
11. Indiana – Indiana Regional Medical Center
12. Jersey Shore — Geisinger Jersey Shore Hospital
13. Lehighton — St. Luke’s University Health Network — St. Luke’s Hospital -Carbon Campus
14. Lewistown — Geisinger Lewistown Hospital
15. McConnellsburg — Fulton County Medical Center
16. Muncy – Geisinger Medical Center Muncy
17. Orwigsburg — St. Luke’s University Health Network — Geisinger St. Luke’s Hospital
18. Pottsville — Lehigh Valley Health Network — Lehigh Valley Hospital-Schuylkill
19. Quakertown — St. Luke’s University Health Network — St. Luke’s Hospital-Upper Bucks Campus
20. Roaring Spring —Conemaugh Health System — Conemaugh Nason Medical Center
21. State College – Mount Nittany Medical Center
22. Stroudsburg — St. Luke’s University Health Network — St. Luke’s Hospital-Monroe Campus
23. Troy — Guthrie Troy Community Hospital

The Pennsylvania Trauma Systems Foundation (PTSF) is a nonprofit corporation recognized under the Emergency Medical Services Act (Act 1985.45) and serves as the accrediting body for trauma centers throughout Pennsylvania.

Contact: Amy Kempinski, PTSF President. Akempinski@ptsf.org or 717-857-7383

The Centers for Medicare & Medicaid Services (CMS) through the Centers for Medicare and Medicaid Innovation (CMMI) announced a new payment model titled Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE).

The model aims to supports chronic disease initiatives for fee-for-service Medicare beneficiaries. A total of $100 million dollars will fund up to 30 proposals for three years. The proposals will include evidence-based whole-person care approaches currently not covered by original Medicare.

CMMI will release a Notice of Funding Opportunity (NOFO) in early 2026 for the first cohort, and the voluntary model will launch on September 1, 2026.