Medicare & Medicaid Sweep · November 4, 2026

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Published November 4, 2026 · Reporting window October 25–31, 2026, Pacific. Later developments are labelled. Source coverage is incomplete; the complete reports describe the limitations.

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CMS increases the dialysis base rate and changes low-volume, home-training and quality policies for 2027

CMS set the 2027 Medicare dialysis base rate at $297.52 per treatment and revised low-volume, pediatric, home-training and quality policies. Eligible facilities seeking the 2027 low-volume adjustment face a December 31, 2026 attestation date; individual payment effects depend on facility circumstances.

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SNF quality refresh and January preview

CMS says its October skilled nursing facility quality-data refresh is available, with older Medicare Spending Per Beneficiary data remaining in place. CMS had already announced the spending-data delay in July. Separately, an October 15 notice identifies November 14 for review of January 2027 preview reports, subject to CMS's review and data-correction rules.

Medium priority · Nov 4, 2026 editionRead story →

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Exchange eligibility verification proposal

HHS and CMS proposed changes to Exchange eligibility verification, annual redeterminations and enrollment timing in a rule published October 27. The executive summary describes circumstances in which an Exchange generally could not authorize advance premium tax credits and cost-sharing reductions for an otherwise eligible applicant while specified eligibility inconsistencies remain unresolved, subject to a stated family-size special-enrollment exception; other inconsistencies are treated differently. Comments must be received by November 27, 2026, for assured consideration. This is a proposal, not a final rule; the full applicability schedule and all exceptions remain to be reviewed.

Medium priority · Nov 4, 2026 editionRead story →

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DHCS behavioral-health state plan proposal

On October 29, 2026, California DHCS issued a revised public notice for proposed Alternative Benefit Plan State Plan Amendment 26-0034. DHCS says the proposal would clarify behavioral health treatment policy, including utilization-management controls, and support program integrity. The revised notice applies only to 26-0034; DHCS says the June 30 notice for Medicaid State Plan Amendment 26-0033 remains unchanged. The notice states a July 1, 2026 proposed effective date subject to CMS approval; it does not establish approval or identify the specific utilization controls.

Medium priority · Nov 4, 2026 editionRead story →

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2027 SNF consolidated-billing update

On October 26, 2026, CMS issued Transmittal 14003 (CR 14658) for the 2027 annual skilled nursing facility consolidated-billing update. It states a January 1, 2027 effective date and January 4 implementation date, and directs contractors to use the new A/B MAC (A) and (B) SNF coding files for applicable 2027 dates of service. The transmittal alone does not establish individual code changes or actual file postings.

Medium priority · Nov 4, 2026 editionRead story →

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