Congress has passed a FY 2026 “minibus” appropriations package that includes funding for the Department of Health and Human Services (HHS) along with several important healthcare policy updates. While the bill does not extend enhanced ACA premium subsidies, it delivers meaningful changes that directly impact providers, billing teams, and revenue cycle management (RCM) organizations.
Rather than sweeping reform, this package focuses on extending key Medicare policies, tightening compliance requirements, and preparing the system for more oversight-driven healthcare delivery. Here’s what matters most — and why it should be on every provider and RCM leader’s radar.
Medicare Stability in the Short Term
Several temporary Medicare provisions that were nearing expiration have been extended, offering short-term predictability for providers and billing teams.
Work GPCI Floor Extended
The 1.0 Work Geographic Practice Cost Index (GPCI) floor has been extended through January 1, 2027. This protects physician reimbursement, especially for providers operating in rural and lower-cost geographic areas.
RCM impact: Payment stability reduces short-term reimbursement volatility but should not delay long-term financial planning.
Telehealth Flexibilities Continue — With New Compliance Expectations
Medicare telehealth flexibilities have been extended through December 31, 2027, reaffirming virtual care as a permanent component of healthcare delivery.
However, the bill also signals increased oversight:
- CMS must implement new codes or modifiers by 2027 to identify telehealth services delivered via third-party virtual platforms.
- HHS must issue guidance on delivering telehealth services to patients with limited English proficiency.
Provider takeaway: Telehealth remains viable, but documentation and coding accuracy will be under closer scrutiny.
RCM takeaway: Expect updates to coding workflows, claim edits, and audit readiness requirements.
Medicare Advantage Directory Accuracy Gets Tighter
Beginning with the 2028 plan year, Medicare Advantage (MA) plans must maintain accurate, publicly available provider directories, updated at least every 90 days.
Key highlights:
- CMS will introduce a directory accuracy scoring system
- Scores will be publicly posted starting in 2029
- Beneficiaries misled by inaccurate directories will have cost-sharing protections
Why this matters:
Inaccurate MA directories are a frequent source of patient dissatisfaction, claim disputes, and denied payments. This change should improve transparency — but also increase plan and provider accountability.
Payment and Compliance Changes Providers Should Watch
Several provisions affect reimbursement, identification, and long-term financial planning:
- Super-rural ambulance bonus payments extended through January 1, 2028
- Advanced APM bonus set at 3.1% for 2028
- 2% Medicare sequestration extended through February 2033
- Unique NPIs required for off-campus hospital outpatient departments beginning January 1, 2028
RCM impact: Claim submission accuracy and provider identification will become even more critical as CMS increases visibility into site-of-service billing.
Increased Prepayment Reviews for DMEPOS
Starting January 1, 2029, CMS will expand prepayment reviews for DMEPOS claims when:
- A provider is furnishing an item to a beneficiary for the first time within a defined period
- The item appears on CMS’s Master List but is not already subject to prior authorization
RCM takeaway: DME suppliers should prepare for tighter cash flow, heavier documentation requirements, and increased denial risk.
New Focus on Quality, Technology, and Preventive Care
The package also includes forward-looking provisions that point to CMS’s evolving priorities:
- Provider education on screening for medication-induced movement disorders by 2028
- A GAO study on wearable medical devices used in clinical decision-making
- Medicare coverage for multi-cancer early detection tests beginning January 1, 2029
These changes highlight growing interest in preventive care, digital health, and clinical data integrity.
Medicare Part D and Medicaid Enrollment Simplification
Additional updates include:
- “Any willing pharmacy” access for Medicare Part D networks starting in 2029
- Simplified Medicaid enrollment for out-of-state providers, with five-year enrollment periods
RCM takeaway: These policies may reduce administrative burden but will require payer system updates and enrollment workflow adjustments.
Increased Funding for No Surprises Act Enforcement
CMS funding for implementing the No Surprises Act will increase from $14 million to $42.1 million in 2026 — a strong signal that enforcement, dispute resolution, and compliance oversight will continue to intensify.
What This Means for Providers and RCM Companies
This health package delivers temporary stability, but it also sets the stage for:
- Greater transparency
- More documentation-driven audits
- Increased compliance expectations
- Tighter alignment between clinical care and billing accuracy
For providers and RCM organizations, the message is clear:
now is the time to strengthen workflows, update coding strategies, and prepare for a more compliance-driven Medicare environment.