Medicare and Medicaid Programs: Calendar Year 2026 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program

This issue is not about special treatment—it’s about correcting an outdated, unequal system that penalizes frontline providers.

The current GPCI calculation is not only inequitable and outdated - it is factually misaligned with current economic, demographic, and healthcare realities in Arkansas.

Medicare telehealth being mostly discontinued after 9/30/25 would be a tragic disruption of the healthcare system that could be easily prevented by Congress simply passing a new law saying Medicare telehealth will be covered permanently in all settings.

Slashing reimbursements ignores manufacturing and distribution, forcing unsustainable operations.

Occupational therapy plays a vital role in helping Medicare beneficiaries maintain independence, manage chronic conditions, and reduce the risk of hospitalizations or institutional care.

CMS is not giving credit to our providers for quality/knowledgeable treatment that can give a positive outcome for the patient.

Removing patient cost-sharing would strengthen APCM’s effectiveness and better align with CMS’s goals for proactive, team-based, and equitable care.

The harsh reality is that if CMS locks in a bundled product cost at $125/cm²: Providers cannot cover their actual product acquisition costs.

This rule may be the straw that breaks our back and leaves our community without the care it needs.

This is faulty, and shifts almost all complex and high cost patients to these academic tertiary entities and away from their true primary care practices.

There are already too few infectious disease physicians and less and less are choosing this specialty every year.

Historically, CMS has appeared to favour certain companies, and this proposal also seems to reflect a continuation of that trend.

Infectious disease is already one of the least compensated specialties in the medical community and further cut backs are unwarranted and increase the risk of having poor quality care for the people that need them.

Hospital based care is intrinsically more complicated, time and resource consuming, and higher risk.

The physicians who already make the least (ID, hospitalists) getting a pay cut so that vascular surgeons (who make 2x) can get a pay bump is crazy.

Primary care is in crisis and pharmacists are available to ease the burden, but getting reimbursed 99211 rates for 99214-worthy patient care negatively impacts nearly every stakeholder in our healthcare system.

Diabetes is almost 5% of Medicare costs, thus demonstrating the importance of evidenced-based education by a certified DSMES program.

It is a serious concern that CMS is attempting to assume FDA’s role by independently determining whether a product is 'reasonable and necessary' for use.

Your proposal for the Medicare Diabetes Prevention Program is destined to become a bigger source of Medicare fraud than the many DME scams that exist.

Mississippi faces acute primary care shortages, with NPs filling critical gaps (e.g., 80% of rural health clinics rely on NPs).

We have noticed that the eligibility snapshot seems to come out later and later each year, which puts constraints on our ability to successfully participate in the program.

Reclassification would disrupt current clinical workflows without demonstrated reason.

A modest increase in per‑unit payment at the point of service can avert substantially higher expenditures associated with avoidable admissions, extended lengths of stay, sepsis management, and amputation care.

The idea that telehealth services cost less to deliver simply because the patient is at home is flawed when providers continue to bear the same infrastructure expenses.

Undervaluing ID will lead to workforce shortages, worsening patient outcomes, and increased costs due to misdiagnosis, delayed care, and rising resistance.

These are proven to actually heal chronic wounds faster and more effective than any other treatments available.

The proposed rule prioritizes cost savings over patient outcomes, undervaluing biologics that heal chronic wounds in weeks.

A 90% reimbursement cut will make it financially impossible for many of us to continue offering this care, even when it’s used ethically and appropriately.

Reclassifying these products as 'supplies' rather than maintaining their designation under Section 361 of the Public Health Service Act represents not only a semantic shift but a material threat to patient access, provider workflows, and the integrity of biologic innovation in the wound care space.

Patients use telehealth as a means to further their medical care and feel better and this would completely negate that aspect.

These changes reflect years of advocacy and align with how SGRT is used in modern clinical practice.

Biologic skin substitutes—many of which are derived from amniotic tissues and represent a breakthrough in regenerative medicine—are fundamentally different from traditional wound dressings.

These grafts are not supplies! They are not a band aide style of treatment.

Independent outpatient physical therapy generates over $13 billion in annual Medicare savings by preventing hospitalizations, reducing surgery rates, managing chronic conditions conservatively, and keeping seniors safe and mobile in their homes.

Primary care needs support and when it comes to payment ALL PHYSICIANS should be paid the same.

This is a short-sighted cut which will lead to overall greater costs and worsened patient outcomes.

These aren’t “expensive bandages.” They are advanced regenerative therapies that give people a second chance at healing.

Decreasing payments to physicians are driving experienced physicians to early retirement and intimidating potential 'new' physicians from considering the field.

The significant cuts on outpatient or inpatient higher level procedures, including data-supported BPH intervention will push us further into crisis driving many urologists away from performing these essential procedures.

The proposed efficiency adjustment can negate the proposed physician payment increases, particularly in certain specialties such as radiology, pathology, critical care, and surgical disciplines.

The difference CGM made in his care has been truly life changing.

Applying an efficiency adjustment before any real-world utilization data exists undermines the integrity of the valuation process and devalues innovation.

This policy change will significantly enhance continuity of care and provide greater flexibility for clinicians—especially advanced practice providers like nurse practitioners—who manage complex and chronically ill patient populations.

An earlier diagnosis within the AAP guidelines would help children access needed therapy and services sooner and, in turn, avoid missing developmental milestones.

This obviously creates a great disparity in how clinical studies are recognized by CMS compared to the same process by the FDA, which absolutely requires completion of submission through ClinicalTrials.gov.

Independent offices lack the economies of scale and administrative overhead subsidies enjoyed by health systems, placing them at a structural disadvantage.

It has becoming increasingly hard to care for Medicare patients because of continued yearly CMS cuts as well as the added 2% sequester.

These certified outpatient settings not only meet high clinical standards but also provide significant cost savings to the healthcare system.

If all children with a diagnosis of autism had access to this type of test sooner, they could receive treatment sooner and potentially reduce the severity of their symptoms.

We believe it would be unduly burdensome to report measures that are not addressed by these specialists.

Aquablation is a complex, multi-step procedure that typically takes 1–1.5 hours for larger glands—longer than TURP and comparable to HoLEP.

Amniotic grafts are currently regulated as Section 361 HCT/Ps under the FDA and reimbursed through HCPCS Q-codes, allowing patients access to these evidence-supported, advanced wound care options.

CMS wrongly believes that many procedures automatically become more efficient over time. This is patently false.

Eliminating this service would cause significant suffering to these patients.

I recommend CMS request Congress change the law to allow no more than a reasonable MAXIMUM ALLOWANCE to acquire, store, and bill for a Part B covered drug.

Wholesale reductions in RVUs are simply pay cuts.

We are deeply concerned about the unintended yet significant negative impact the proposed CY 2026 GPCI adjustments will have on healthcare providers and Medicare beneficiaries statewide in Texas.

We respectfully urge CMS to adopt a more comprehensive and forward-looking approach when making technical assessments that determine product reimbursement levels, to ensure decisions are grounded in long-term value and innovation.

If my family had access to this type of test sooner, we could have acted sooner to get treatment, instead of struggling just for a diagnosis.

The people we serve are not statistics. They are mothers, veterans, students, survivors of trafficking, and individuals rebuilding after trauma.

Not being able to know what your child is asking for is frustrating; watching them hurt themselves in frustration is heartbreaking.

These dressings are ridiculously OVER priced & NO proof they work!!

If you pressure the specialist by the pocketbook then the patient pays the price.

The Centers for Medicare & Medicaid Services (CMS) is proposing updates to the Medicare Physician Fee Schedule and other Part B payment policies for calendar year 2026. The rule includes payment rate adjustments, implementation of the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act, and changes to programs including the Medicare Shared Savings Program, Diabetes Prevention Program, and Quality Payment Program. It also addresses rural health center policies, ambulance fee schedules, and electronic interoperability. Public comments may focus on reimbursement fairness, drug pricing, provider incentives, and access to care.

Medicare Physician Fee Schedule and Drug Pricing Updates for 2026

Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency

The proposal to remove the inpatient only list is an extremely bad idea.

A system should be created in which hospitals/healthcare entities are rewarded/incentivized for the behavior and outcomes that we wish to see.

The removal of the Inpatient Only List will have significant negative effects on hospitals due to Medicare Advantage plans ignoring the 2 midnight rule.

The true injustice would be to deny patients access to therapies that can save limbs, prevent infection, and restore lives, all in the name of fiscal efficiency.

Financially doing that extra procedure means the hospital gets paid less than if the procedure was not done.

A patient having a surgery at a hospital in an inpatient setting and an outpatient setting have EXACTLY the same care.

For an urban academic medical center that gets $10,000 IME per inpatient surgery... that $10,000 per surgery loss in IME means at some point fewer residents can be trained, exacerbating the physician shortage.

It is a symptom of our dysfunctional health care finance structure.

Amputation of leg in an ASC? Really? Many go well but what if there is uncontrolled bleeding?

If CMS' goal is increasing patient access and rights, then this significant financial issue facing beneficiaries needs to be addressed either by capping the out-of-pocket costs or requiring written informed consent that includes delineation of actual costs.

If you had recognized the value of physician expertise years ago and allowed physician payments to increase to match inflation and the increased regulatory burden, physicians would not have been forced to transition to being employees of hospitals and health care systems.

The proposed changes to the ASC CPL endanger the health and safety of Medicare beneficiaries.

I encourage the proposed 2.4% increase in OPPS and ASC payment rates, acknowledging the continued financial burdens faced by outpatient and surgical providers.

Work with the administration to allow private practice physicians to deduct the costs of any uncompensated care from their personal taxes.

It's truly reprehensible that taxpayer dollars are being spent on a race to the bottom to implement even more stringent regulations on hospitals while completely ignoring the fraud, waste, and abuse of commercial insurance companies.

The only ones who benefit from price transparency are the major insurers who can now see what their competitors pay providers and they can then collude to increase their profits.

I urge the agency to address this discrepancy and to implement the NOPAIN Act as Congress intended by ensuring that all qualifying non-opioid drugs and devices are eligible for separate payment.

We wholeheartedly support CMS efforts to allow additional procedures to be performed in the outpatient setting.

Patients should be able to access that data in a patient-friendly form to make an informed decision on the site of their care prior to allowing any procedure at an ASC.

How does removing 'burdensome health equity and COVID vaccine reporting requirements' support public health measures and make us healthier again?

As you know the 3 day rule from 1965 is obsolete but requires an act of Congress to change as part of the SSA.

My patients consistently rate the ASC higher than the hospital - no emergencies coming from the ED - more relaxed and cleaner environment for patient and physician - cost effective way to provide higher quality of care.

The term 'immediate' could represent instantaneous, meaning that there must be a live audio and video connection with the supervising physician at all times.

Patients enjoying the ability to get care in locations where they have easy access to high quality providers at a manageable cost.

The ASC is not place to gather SDOH information- the primary care setting is.

Having done more than 5000 cases over the past 3 years in the ASC, I can certify that not only that it is safe (no death) but also very cost effective compared to the hospital (50percent less expensive).

The Centers for Medicare & Medicaid Services (CMS) is proposing updates to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment system for calendar year 2026. The rule would revise payment formulas, adjust quality reporting requirements, and strengthen hospital price transparency enforcement. It also seeks public input on future quality measures related to well-being and nutrition, and explores refinements to how services are paid when performed in outpatient clinics or physician offices.

Medicare Hospital Outpatient and Ambulatory Surgical Center Payment Updates for 2026

Deep Seabed Mining: Exploration License and Commercial Recovery Permit Applications

There is nowhere on Earth with less life than the abyssal plains of the deep sea, and such little disruption is required to pick these important nodules off the sea floor.

I oppose it due to potential harm to the ocean's carbon sink, sea floor, and Islander livelihoods.

Opposing these efforts, I believe they pose a threat to vital carbon sinks, marine life, and Coastal communities.

Mining in these areas disrupts the critical carbon sink, harms ocean floors, endangers unknown species, and jeopardizes Islander livelihoods.

I'm strongly opposed to these measures, as they threaten the ocean's biodiversity, disturb carbon sinks, and endanger Islander livelihoods.

Such activities threaten the critical carbon sink of our oceans, damage seabeds, harm unknown marine life, and jeopardize Island livelihoods.

I'm opposed to these actions as they jeopardize the ocean's role as a carbon sink, damage the sea floor, threaten species, and endanger Islander communities.

This plan threatens essential carbon sinks, harms the sea floor, risks undiscovered marine species, and jeopardizes Islander livelihoods.

I oppose deep sea exploration and exploitation, as it jeopardizes the world's largest carbon sink, harms the sea floor, threatens undiscovered species, and endangers Islander communities.

I'm against it due to its risks to carbon storage, sea floors, species, and Islander livelihoods.

Regulating doesn't protect fragile ecosystems, overlooks sediment plumes, and ignores cumulative impacts.

I oppose the proposed deep sea mining rules due to threats to carbon sinks, marine life, and Islander livelihoods.

The rules lack safeguards for biodiversity, misjudge sediment impact, and ignore cumulative effects.

The proposed deep sea mining regulations alarmingly overlook significant ecological threats.

I oppose it due to risks to carbon sinks, sea floors, species and island communities’ livelihoods.

Deep seafloor mining could devastate carbon sinks, damage undiscovered species, and harm Islander communities.

The current proposal is inadequate, risking precious marine ecosystems.

Such mining disrupts vital carbon sinks, destroys sea floors, endangers species, and jeopardizes island livelihoods.

Such activities threaten massive carbon storage areas, harm sea floors, risk species extinction, and jeopardize Islander livelihoods.

The practice is destructive to fragile marine ecosystems, coral reefs, and essential fisheries.

Deep sea mining is our country's best option for critical minerals self-sufficiency.

DSM will not kill animals, contaminate rivers/seas, destroy rain forests, harm indigenous communities, and contaminate our air.

The proposed deep sea mining regulations endanger marine ecosystems, insufficiently addressing major environmental impacts.

The proposal overlooks significant environmental threats, risking marine life and local communities.

How does NOAA’s current regulatory framework both support responsible innovation in deep-sea mining — for example by companies like TMC — and ensure that environmental protections are effectively enforced?

Such mining risks disrupting vital carbon sinks, damaging sea beds, imperiling species, and affecting island communities.

Supporting polymetallic nodule collection is not an additive impact, it is a substitutional shift.

I oppose the proposed deep sea mining regulations due to their potential to harm marine ecosystems.

Let’s show the world what responsible resource development actually looks like — instead of letting the dirtiest players define the rules.

The regulation, as it stands, is inadequate in safeguarding our marine ecosystems.

The current upside to seabed metal gathering appears to be environmentally less impactful on the ecosystem.

The sooner the United States starts focusing more in the maritime space, including deep sea mineral harvesting, the sooner we can restore our shipbuilding focus and increase our ability to protect the Pacific Ocean from IUU fishing.

Waiting for perfect regulation before action only deepens our environmental crisis.

Deep seabed mining offers us an alternative that is safe, clean, and provides the United States with an abundant source of minerals critical to our security and energy independence.

This is a comparatively minimally invasive way to gather critical resources needed for our economic future and national security.

Deep sea mining poses unprecedented environmental risks to fragile and poorly understood ecosystems in international waters, with potentially irreversible impacts on marine biodiversity and ocean health.

Destroying habitats will indirectly affect our own for the negative.

The proposed measures reflect a thoughtful approach to balancing environmental conservation with sustainable development.

Conservatives understand that stewardship over God’s creation is not a progressive concept—it is a biblical and moral responsibility.

We are currently in a climate and ecological crisis.

Deep sea mining should not continue in North America or anywhere else because it causes irreversible damage to fragile marine ecosystems already suffering from anthropogenic destruction.

As a species whose own actions threatens our survival, we cannot afford to irrevocably damage and destroy an important biological system that we don’t understand.

Deep sea mining will cause damage that will take millennia to recover, if ever at all.

This is not innovation—it is irreversible destruction of our home.

No amount of money can bring back what is lost once it's gone or damaged beyond the chance for restoration.

The deep ocean is Earth’s final frontier — a fragile, ancient ecosystem that sustains biodiversity, regulates climate, and offers insight into our planet’s origins.

Deep Sea Mining has the potential to do irreversible damage to the sea floor.

Scientists warn that deep sea mining risks causing severe and potentially irreversible damage to the deep ocean and to the marine life that calls it home.

I strongly believe that the United States and NOAA should proceed expeditiously and completely to secure material independence and lead the way for deep sea mining.

National security and cleaner than land based mines.

From the benefits to small businesses alone this seems like a no-brainer.

It would cause horrific damage to the ocean and to the marine life.

It makes no sense to rob us all of our future to make a quick buck.

Don’t let a handful of short-lived, greedy fools destroy the future of life on Earth.

life isn't about profits or resources, nature is the base on which all of our industries and our possibility for life stands.

Something like this could ruin the date of humanity forever.

The National Oceanic and Atmospheric Administration (NOAA) is proposing updates to its regulations governing exploration licenses and commercial recovery permits for deep seabed mining under the Deep Seabed Hard Mineral Resources Act. The changes aim to modernize outdated 1980s-era rules by streamlining application procedures and reflecting current technology and international standards. The proposal has drawn both support for improving regulatory clarity and concern over potential environmental impacts to ocean ecosystems.

Deep Seabed Mining: License and Permit Updates

Endangered and Threatened Wildlife and Plants; Endangered Species Status for Seven Species of Pangolin

I fully support listing all pangolins as endangered species, with all of the protections provided with that designation.

This magnificent species is an exact example of why the Endangered Species Act exists.

It should not be necessary to justify protecting the most trafficked animal in the world by granting endangered species status under the EPA act.

The pangolin is one of the most trafficked animals on the planet and is certainly the most trafficked mammal.

These species are under severe threat from relentless illegal trafficking and habitat loss, compounded by climate change.

Pangolins should receive protection under the Endangered Species Act.

Pangolins, arguably the most trafficked mammal in the world, need further protection as described in this proposed rule to prevent probable extinction.

These gentle creatures deserve to be protected in their habitat.

Pangolins are sadly the most heavily trafficked mammals in the world, driven by demand for their scales and meat.

Pangolins, the most heavily trafficked mammals in the world, have experienced sharp population decreases driven by illegal wildlife trade, habitat fragmentation, and environmental degradation.

Pangolins are the most frequently trafficked mammal in the world.

We owe it to posterity to provide this living proof of God's love and creativity its place in our world for all time.

To lose such a miraculous creature would be unforgivable.

I am in full support of adding endangered status to Pangolin to prevent its decline.

Pangolins are among the most heavily trafficked mammals in the world, and this listing is a crucial step toward curbing illegal trade and protecting these unique animals from extinction.

Mankind simply must do more to protect other species that share the planet with us.

Pangolins are the most trafficked animals in the world, it only makes sense to do as much as we can to help them.

This trafficked animal needs the Act's protections—awareness and help on a global scale are essential before it’s too late.

Pangolins are the world’s most trafficked mammals, cruelly hunted and smuggled for use in traditional medicine, despite having no proven health benefit.

Ban the horrific trade and trafficking of pangolins - a gentle animal being commodified for no reason other than ignorance.

We have to stop the merciless killing and protect this species before they disappear.

Pangolins play a vital role in tropical ecosystems and are being removed at an alarming rate.

Pangolins are the most trafficked mammals on Earth.

Protecting pangolins by law is essential to prevent their extinction and to preserve biodiversity.

Time is running out for them as the world’s most trafficked animal.

These remarkable and ancient animals are the most heavily trafficked mammals in the world—hunted and poached to the brink of extinction for their scales and meat.

It would be totally irresponsible to NOT list them as endangered.

I support USFWS listing seven species of pangolin, the most trafficked animal in the world, under the Endangered Species Act

They are the world’s most trafficked mammal, making up as much as 20% of all illegal wildlife trade and are sought after for their scales.

Hopefully, this will help curtail some of the egregious trade in pangolin scales.

Pangolins make up as much as 20% of all illegal wildlife trade and are sought after for their scales.

Pangolins are the most trafficked mammal on Earth.

I support the proposal to list seven species of pangolin under the Endangered Species Act!

The less value we place on animal parts, the more we protect the animals themselves!

Pangolins are in vital need of protection.

Pangolins are the world’s most trafficked mammal, making up as much as 20% of all illegal wildlife trade.

These poor little critters need our help more than ever before.

The science is clear - animals have cognitive, social and emotional lives.

Every species we loose is a world lost and a disruption to our valuable eco systems.

Please list seven species of pangolin under the Endangered Species Act to close loopholes to effectively end the legal sale of pangolin products within the United States.

The demand for pangolin parts is driving them to extinction.

I WHOLEHEARTEDLY ENDORSE THIS PROTECTIVE MEASURE, WHICH IS REALLY LONG OVERDUE.

ANYTHING and EVERYTHING that can be done to stop this from happening should ALWAYS be done.

Species extinction is a real problem for the pangolin, and this should help us avoid that.

I strongly support the USFWS listing these little seven species of pangolin under the Endangered Species Act.

I strongly support USFWS listing seven species of pangolin under the Endangered Species Act.

The U.S. Fish and Wildlife Service (FWS) is proposing to list seven species of pangolins—native to Asia and Africa—as endangered under the Endangered Species Act. The listing would provide protections against U.S. trade in pangolins or their parts, which are heavily trafficked for meat and scales. The proposal aims to support global conservation efforts by strengthening legal safeguards and limiting U.S. market demand.

What’s the Public Really Saying?

Current Rules

Medicare Physician Fee Schedule and Drug Pricing Updates for 2026

Medicare Hospital Outpatient and Ambulatory Surgical Center Payment Updates for 2026

Deep Seabed Mining: License and Permit Updates

Endangered Species Status for Seven Pangolins

BLM Rule to Repeal 2024 Protections in Alaska’s Petroleum Reserve