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Medicare & Medicaid · Oct 4, 2026

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Medi-Cal & Medicaid policyMedicare & MedicaidNew in this edition

Medi-Cal youth gender-affirming services: October 13 reimbursement and continuity requirements

DHCS’s September 30 letter sets October 13 reimbursement limits for specified youth gender-affirming services, with an existing-hormone transition and continuing ancillary-care duties. Managed care plans must address member notices, care coordination and policy updates; the guidance does not permit blanket cancellation of care.

High priority · Oct 4, 2026 editionRead story →

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Provider operationsMedicare & MedicaidNew in this edition

Hospice election addendum is mandatory for every new election starting October 1

Every new hospice election from October 1 requires a written election-statement addendum, furnished within five calendar days. CMS also requires timely updates and a valid signed record. October–December enforcement discretion concerns claim denials for missing or incomplete addenda; it does not make the document optional.

High priority · Oct 4, 2026 editionRead story →

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Audits & program integrityMedicare & MedicaidNew in this edition

OIG finds $72 million in MA and Part D payments tied to excluded or felony-convicted providers

OIG identified $72 million in Medicare Advantage and Part D payments associated with 249 revoked NPIs absent from the Preclusion List. The brief describes timing, ownership and pharmacy-related gaps. It issues no specific recommendations and does not classify every payment as proven fraud.

High priority · Oct 4, 2026 editionRead story →

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Coverage & clinical policyMedicare & MedicaidContinuing

CMS revises the October NCD coding update and moves stem-cell changes to April 2027

CMS’s revised October NCD coding instructions remove the stem-cell changes for a later April 2027 request. October 5 implementation remains scheduled for the retained coding updates, including some earlier effective dates. CMS distinguishes these maintenance changes from new coverage policy.

High priority · Oct 4, 2026 editionRead story →

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