CMS Under Dr. Oz: 15 Key Actions

Posted on by lad3

From Becker’s Hospital Review

CMS Administrator Mehmet Oz, MD, is charting an ambitious path to reshape federal healthcare policy in line with President Donald Trump’s “Make America Healthy Again” agenda. His vision comes as President Trump on July 4 signed The One Big Beautiful Bill Act, a sweeping package of reforms targeting Medicaid, Medicare, and the ACA marketplace.

From plans to close a Medicaid funding “loophole” to probing hospitals over gender care for minors and clamping down on states using federal Medicaid funds to treat undocumented migrants, here are 15 key actions CMS has taken since Dr. Oz was confirmed as administrator:

  1. CMS plans to add prior authorization for some traditional fee-for-service Medicare services as part of its newly launched Wasteful and Inappropriate Service Reduction model.
  2. CMS is enacting a final rule that will shorten the open enrollment period on the ACA exchange and create stricter eligibility verifications for enrollees. The changes will lower individual premiums by about 5% on average, and save around $12 billion in 2026 by clamping down on improper enrollments, according to the agency, which estimates as many as 5 million people may have improperly enrolled in ACA plans “enabled by weakened verification process and expanded premium subsidies.”
  3. CMS proposed a rule to close what it describes as a Medicaid tax “loophole” that some states have used to increase federal payments while limiting their own financial contributions. The proposed rule aims to ensure that federal Medicaid dollars are used to support vulnerable populations rather than being redirected to fund other state programs, including healthcare coverage for undocumented immigrants.
  4. CMS is ramping up federal oversight to prevent states from “misusing” Medicaid funds to cover care for undocumented immigrants. While federal Medicaid dollars are generally limited to emergency services for “noncitizens with unsatisfactory immigration status” who meet specific eligibility criteria, CMS argues that some states have expanded benefits beyond what is permitted — shifting additional costs to federal taxpayers.
  5. CMS proposed a 2.4% payment increase in 2026 for hospitals and ambulatory surgery centers that meet quality reporting requirements. In a major shift, the agency plans to phase out the inpatient-only list over three years, beginning with 285 mostly musculoskeletal procedures, offering physicians greater flexibility to determine care sites. The proposed rule also adds 276 procedures to the ASC covered-procedures list and significantly adjusts 340B repayment timelines by increasing the pay cut to 2% to accelerate debt recoupment through 2031 .
  6. CMS unveiled its 2026 Medicare Physician Fee Schedule proposal, which includes two separate conversion factors — 3.83% for qualifying alternative payment model participants and 3.62% for others. The agency is also prioritizing time-based services in RVU adjustments, removing frequency limits on key visit types, and simplifying the telehealth services list by removing distinctions between provisional and permanent status. CMS also plans to roll back pandemic-era flexibility for virtual supervision of residents in urban settings .
  7. The agency has proposed key changes to the Medicare Shared Savings Program aimed at encouraging accountable care organizations to transition more quickly to two-sided risk models. The updates, which take effect for agreement periods beginning Jan. 1, 2027, would shorten the time ACOs can participate in one-sided risk from seven to five years. The proposals also refine quality scoring and beneficiary assignment rules, including removing the health equity adjustment and changing the definition of primary care services. Additionally, ACOs affected by events like ransomware attacks may be eligible for extended relief under extreme and uncontrollable circumstances policies starting in 2025.
  8. CMS on June 3 withdrew a 2022 guidance issued under the Biden administration that reinforced hospitals’ obligations to provide emergency abortion care under the Emergency Medical Treatment and Labor Act. The move effectively removes federal protections for clinicians who offer such care in states where abortion is restricted or banned.
  9. CMS is investigating an undisclosed number of hospitals that provide gender-confirming care to minors.
  10. On May 22, CMS issued updated price transparency requiring hospitals to publicly post actual prices for items and services — not estimates. The update follows an executive order  from President Trump aimed at increasing transparency in healthcare pricing.
  11. On April 4, CMS published its final rule for Medicare Advantage and Part D in 2026. While the final rule solidifies several changes — including measures to streamline prior authorization, tighten oversight of supplemental benefits and codify provisions from the Inflation Reduction Act — CMS stopped short of addressing two of the most closely watched issues: expanding coverage for GLP-1s under Medicare and Medicaid, and regulating the use of AI in prior authorization. Those decisions have been deferred to future rulemaking.
  12. CMS plans to increase payments to MA plans by more than $25 billion in 2026. MA plans can expect a payment increase of 5.03% in 2026, more than double what the Biden administration proposed. The agency will continue the final year of the phase-in of risk-adjustment changes, shifting MA’s diagnosing coding from ICD-9 to ICD-10 and remove certain codes from the hierarchical condition categories model.
  13. CMS plans to audit every MA plan annually as part of what it calls an “aggressive” effort to strengthen oversight and address potential overpayments. The agency currently audits about 60 plans each year but intends to expand that to all 500-plus MA plans moving forward.
  14. On April 10, CMS said it is halting federal matching funds for state expenditures on designated state health programs and designated state investment programs “to preserve the core mission of the Medicaid program.”
  15. In early April, CMS proposed a series of payment updates across multiple care settings for fiscal 2026, including a 2.4% payment increase for inpatient hospitals, equating to a $4 billion funding increase.