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Medicare & Medicaid · Oct 18, 2026

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Billing & paymentMedicare & MedicaidNew in this edition

DHCS seeks feedback on draft removal of mandatory PSC-35 assessment and reporting

DHCS’s October 15 draft proposes ending mandatory PSC-35 administration and corresponding FAST submissions, while preserving assessment-tool choices. Feedback is requested by November 3. The file retains draft markings, notice-number inconsistencies and an unspecified effective date, so current workflows should not be stopped on this evidence.

Medium priority · Oct 18, 2026 editionRead story →

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Provider operationsMedicare & MedicaidNew in this edition

Treasury proposes phased premium tax credit eligibility changes

The October 15 Treasury proposal addresses premium tax credit verification, eligibility and reconciliation across different effective periods. Its Medicaid community-engagement provision has a narrow sole-basis condition and timing exceptions. Comments are due November 30; the December 8 hearing depends on submitted outlines.

Medium priority · Oct 18, 2026 editionRead story →

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Medicare Advantage & Part DMedicare & MedicaidNew in this edition

CMS proposes phased Part D PBM and MA directory implementation

CMS’s October 16 public-inspection proposal implements CAA 2026 provisions on low-income Part D cost sharing, MA directories and PBM contracts. It preserves distinct 2028/2029 phases and proposes detailed remuneration, reporting and enrollee protections. The posted text requests comments by December 15, 5 p.m. EST.

Medium priority · Oct 18, 2026 editionRead story →

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Provider operationsMedicare & MedicaidNew in this edition

DHCS posts Phase II IP-CANS alignment timetable; notice version needs confirmation

The October 13 CANS alignment file describes a January 2027 Phase II start, age-specific IP-CANS use, administrator training transitions and reporting through 2029. Its notice numbers and appendix dates conflict. Confirm the authoritative issued version before using the stated timetable for implementation.

Medium priority · Oct 18, 2026 editionRead story →

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Billing & paymentMedicare & MedicaidNew in this edition

Medi-Cal sets February 2027 attending and referring NPI requirements for LTC claims

Long-term-care providers face separate attending and referring NPI requirements from February 1, 2027. Initial, discharge and transfer claims need both; ongoing claims still need the attending NPI. Submitted identifiers must be valid individual NPIs for the billed service date.

Medium priority · Oct 18, 2026 editionRead story →

More leading stories

Medi-Cal & Medicaid policyMedicare & MedicaidNew in this edition

Medi-Cal phases DME and clinical-lab ordering NPI requirements into February and May 2027

Medium priority · Oct 18, 2026 editionRead story →

Provider operationsMedicare & MedicaidNew in this edition

CMS restores nursing-home complaint investigation and reporting instructions

Medium priority · Oct 18, 2026 editionRead story →

Provider operationsMedicare & MedicaidNew in this edition

HHS declares Hurricane Isaias public health emergencies in Florida and Alabama

Medium priority · Oct 18, 2026 editionRead story →

Coverage & clinical policyMedicare & MedicaidNew in this edition

CMS reports duplicate-coverage and deceased-enrollee subsidy removals

Medium priority · Oct 18, 2026 editionRead story →

Provider operationsMedicare & MedicaidNew in this edition

DHCS replaces the English LTC eligibility notice to reflect reinstated non-MAGI asset limits

Medium priority · Oct 18, 2026 editionRead story →

Medi-Cal & Medicaid policyMedicare & MedicaidNew in this edition

Medi-Cal directs DRG resubmissions after the October 1 Mapper 44.0 change

Medium priority · Oct 18, 2026 editionRead story →

Billing & paymentMedicare & MedicaidNew in this edition

DDS denies a transportation-rate benchmark petition; no new reimbursement floor takes effect

Lower priority · Oct 18, 2026 editionRead story →

Provider operationsMedicare & MedicaidNew in this editionNice to Know

Nice to Know: DHCS announces a monthly Justice-Involved Reentry newsletter

Watch · Oct 18, 2026 editionRead story →

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Coverage note

Limited coverage: Compliance Sweep, Enforcement Briefing, Medicare & Medicaid

Coverage limitation for 2026-10-11 through 2026-10-17: California regulator source review (https://www.cdph.ca.gov/Programs/OPA/Pages/NR26-NewsReleases.aspx): Actual complete 2026 News MainContent index read at 2026-10-20T08:59:13.710Z at https://www.cdph.ca.gov/Programs/OPA/Pages/News-Releases-2026.aspx. The latest displayed release is September 18 and Page Last Updated is September 23, 2026. No October 11-17 row is displayed, but authoritative coverage through the required week is unproved. A complete read of this stale page does not establish complete current-week discovery or zero activity. Preserve the original NR26-NewsReleases.aspx failure and exact alternative URL. Missing requirement: an authoritative adequately current dated result/archive or supported limitation for October 11-17. No failed new request is invented. DHCS audit and program-integrity publications (https://www.dhcs.ca.gov/individuals/audits-and-investigations-auditsinvestigations/): Earlier actual mission/navigation and program-integrity material remain retained, without a dated October11-17 result inventory. Exact original source response at 2026-10-21T20:22:11.637Z is HTTP200, complete945-byte Incapsula unsuccessful-request iframe, not audit results. A new official alternative Medical Audits index request also returned a212-byte shell. A supported web reader exposes report-year rows, but report year, file metadata and audit period do not establish posting within October11-17. Preserve the dated publication/query hold and original observations; no zero activity, new human request or source completion is inferred. DHCS audit and investigation actions (https://www.dhcs.ca.gov/individuals/audits-and-investigations-auditsinvestigations/): Earlier actual mission/navigation and program-integrity material remain retained, without a dated October11-17 result inventory. Exact original source response at 2026-10-21T20:22:11.637Z is HTTP200, complete945-byte Incapsula unsuccessful-request iframe, not audit results. A new official alternative Medical Audits index request also returned a212-byte shell. A supported web reader exposes report-year rows, but report year, file metadata and audit period do not establish posting within October11-17. Preserve the dated publication/query hold and original observations; no zero activity, new human request or source completion is inferred. This edition contains supported selected findings; it does not establish complete activity for the named missing authorities or unresolved candidates.