• Nanoparticle-based chemotherapy is widely used but liver clearance often limits its effectiveness
  • The gut microbiome regulates how aggressively the liver clears these drugs from the bloodstream
  • A common antibiotic reshaped gut bacteria in preclinical models, significantly reducing liver clearance and doubling how long chemotherapy remained in circulation to reach tumors
  • The findings demonstrate that the microbiome itself drives the response, supporting the potential for microbiome-directed interventions

JULY 31, 2026 A new study led by researchers at The University of Texas MD Anderson Cancer Center has identified a way to reshape the gut microbiome that can enhance the delivery of certain chemotherapies to tumors, offering a potential strategy to make nanoparticle-based cancer drugs more effective.

The study, published in Nature Materials, was led by Betty Kim, M.D., Ph.D., professor of Neurosurgery, Wen Jiang, M.D., Ph.D., associate professor of Radiation Oncology, and Jennifer Wargo, M.D., professor of Surgical Oncology and Genomic Medicine. Both Kim and Wargo are core members of the James P. Allison Institute™, and this research was a collaborative project through the Platform for Innovative Microbiome and Translational Research (PRIME-TR).

In preclinical models, reshaping gut bacteria with a short course of antibiotics roughly doubled how long nanoparticle-based chemotherapy remained in circulation, increased drug accumulation in tumors and improved survival across multiple cancer types.

Notably, the effect was driven by the microbiome itself rather than the immune system, suggesting that microbiome-directed approaches could one day be leveraged to enhance delivery for this class of chemotherapy.

“For decades, scientists have tried to address how aggressively the liver filters out nanomedicine by redesigning the drugs themselves. Our research shows that the host’s biology, specifically the gut microbiome, is just as important as the particle design,” Jiang said. “This is the first study to demonstrate that the gut microbiome can directly impact chemotherapy, opening up an entirely new strategy for boosting cancer treatment.”

How do gut bacteria impact chemotherapy delivery to tumors?

Nanoparticle-based chemotherapy – drugs packaged inside microscopic carriers like liposomes or albumin particles – is used to treat a range of cancers, including breast, ovarian and pancreatic. However, most of the therapy never reaches the tumor because immune cells in the liver, called Kupffer cells, aggressively clear the drug particles from the body.

Gut bacteria send chemical signals to those liver cells through molecules called bile acids, which are natural chemicals produced when gut bacteria process bile. When a commonly used antibiotic called metronidazole was administered to selectively reduce certain gut bacteria, bile acid levels dropped, causing the Kupffer cells to shift into a “quiet” state.

As a result, the Kupffer cells cleared fewer of the nanomedicine particles, allowing for extended circulation and increased accumulation in the tumor. This translated to significantly slowed tumor growth and prolonged survival in preclinical models of colon, breast, melanoma and pancreatic cancers.

How did researchers confirm the microbiome drives this effect?

To determine whether the microbiome itself was responsible, rather than residual antibiotic, researchers performed fecal microbiota transplantation (FMT), in which they transferred gut microbial communities from antibiotic-treated donors into germ-free recipient models. Testing confirmed the transferred material carried no detectable antibiotic, yet these recipients still exhibited the same improved tumor delivery seen in the original antibiotic-treated group.

Earlier research from the Wargo Laboratory and PRIME-TR has shown that the gut microbiome can boost the effectiveness of immunotherapy by reinvigorating the immune system to attack cancer cells.

These results confirm that the beneficial effect is encoded within the microbiome and transferable between hosts. This study is the first to show that the gut microbiome can directly improve chemotherapy by changing how drugs are physically distributed in the body, positioning microbiome-targeted strategies as potential future approaches for enhancing nanoparticle cancer therapy.

What’s next for this approach?

In this study, FMT served to demonstrate that the microbiome drives the effect and can carry it between hosts – not as a proposed cancer therapy itself. The findings nonetheless present several promising avenues for clinical translation. The antibiotic metronidazole already is approved by the Food and Drug Administration and has a well-established safety profile, making short-course administration alongside nanoparticle-based chemotherapy a tractable near-term strategy for clinical investigation.

Rather than relying on prolonged antibiotic exposure that broadly depletes the gut microbial community, future research could explore how to selectively engineer a beneficial microbiome state through short-course antibiotic modulation, defined microbial consortia or bile acid-directed therapies that reproduce the effect.

The study also suggests that gut microbiome profiles and bile acid signatures could one day serve as biomarkers to predict which patients will respond best to nanomedicine and which might benefit from microbiome-modulating co-treatment beforehand.

“Hepatic clearance is not a fixed physiological constraint but a dynamic state that can be modulated through the microbiome,” Wargo said. “By understanding how the microbiome shapes drug delivery, we can begin thinking about chemotherapy not just as a drug-tumor interaction, but as a drug-microbiome-host interaction, which changes how we might design treatment plans for patients in the future.”

 

This research was supported by the Andrew Sabin Family Recruitment and Retention Fund to the Allison Institute™, the Cancer Prevention and Research Institute of Texas (CPRIT), the National Cancer Institute (NCI), and the Texas Medical Center Digestive Diseases Center. For a full list of collaborating authors, disclosures and funding sources, see the full paper in Nature Materials.

SEE COMPLETE ARTICLE AT : https://www.mdanderson.org/newsroom/research-newsroom/reshaping-the-gut-microbiome-can-boost-chemotherapy-delivery-to-tumors.h00-159856923.html

 



On July 30, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1851-F) that would update Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2027 under existing statutory and regulatory requirements.

This final rule also highlights Medicare non-hospice spending under a hospice election, using data from the hospice service and spending variation index (SSVI). The SSVI includes a comprehensive scoring system calculated using nine claims-based measures, each representing a different aspect of hospice utilization as well as non-hospice spending. These data indicate hospice providers that might need additional targeted education and oversight. This rule also finalizes changes to the hospice election statement regulations; these regulations require hospices to provide to all Medicare beneficiaries, at the time of hospice election, an addendum to the election statement regarding coverage of non-hospice services. Additionally, this rule finalizes conforming regulation text changes that allow a physician designee and the physician member of the interdisciplinary group, in addition to the hospice medical director, to discharge a patient from hospice care, which will help improve flexibility for hospices and reduce regulatory burden.

This rule also finalizes conforming regulation text changes to the hospice telehealth face-to-face policy under the Consolidated Appropriations Act, 2026. The final rule includes a summary of comments from requests for information on enhancing community palliative care services under current Medicare benefits; developing a hospice-specific wage index using BLS data; and describing any experiences with overlap between hospice and assisted suicide or “medical aid in dying.”

FY 2027 Routine Annual Rate Setting Changes

For FY 2027, CMS updated the hospice payment rate by 2.3% (an estimated increase of $755 million in payments from FY 2026). This figure results from the finalized 3.2% inpatient hospital market basket percentage increase reduced, as required by law, by a finalized 0.9 percentage point productivity adjustment. The finalized FY 2027 rates for hospices that do not submit required quality data information include the finalized FY 2027 hospice payment update percentage of 2.3% minus four percentage points as required by law, which would result in a 1.7% reduction over the previous year’s payment rate. These finalized payment rates reflect the most accurate, updated data available on the cost of goods, services, and labor.

Hospice payments are subject to a statutory aggregate cap limiting the overall payments made to a hospice annually. The finalized hospice cap amount for FY 2027 is $36,174.75 (FY 2026 cap amount of $35,361.44 increased by the FY 2027 hospice payment update percentage of 2.3%).

Service and Spending Variation Index

Given the growing concern of fraud, waste, and abuse in hospice care, CMS has continued to monitor trends on a variety of metrics from hospice claims, including non-hospice spending during a hospice election. CMS’ internal monitoring has identified patterns of hospice care delivery and associated non-hospice spending per hospice day. The comprehensive services covered under the Medicare hospice benefit are structured so that hospice beneficiaries do not have to routinely seek items, services, or drugs beyond those provided by hospice. CMS continues to believe that it would be unusual and exceptional to see services provided outside of hospice for those individuals approaching the end of life and has reiterated since 1983 that “virtually all” care needed by the terminally ill would be provided by the hospice.

However, CMS has seen non-hospice spending continue to rise in recent years. In response, CMS developed a service and spending variation index (SSVI), using metrics collected from claims data, that can signal potentially inappropriate utilization or concerns with quality of care or compliance. The SSVI uses a scoring system, with a higher score representing potential concerning hospice utilization and non-hospice spending.

This information provides transparency for CMS data analysis, can help beneficiaries make informed decisions, and could support program integrity efforts. CMS solicited comments on the metrics and the SSVI scoring system and summarizes those comments in this final rule. Additionally, this final rule discusses the SSVI, which includes data from FYs 2024 and 2025, displays provider-level data, and includes each hospice’s SSVI score. This final rule uses more recent claims data to update the SSVI, though no substantive changes to the methodology were made. To view the SSVI scores for FYs 2024 and 2025, additional data from claims-based measures, and related documentation on the methodology, visit: https://www.federalregister.gov/d/2026-15686.

Finalized Mandatory Hospice Election Statement Addendum

The hospice election statement addendum is a written addendum to a Medicare hospice election statement that lists and explains what conditions, items, services, or drugs the hospice has determined are not related to the beneficiary’s terminal illness and related conditions — and will therefore not be covered under the Medicare hospice benefit. In the FY 2020 Hospice Final Rule (84 FR 38484), CMS finalized the requirement that a hospice provide a hospice election statement addendum to a beneficiary upon request to increase coverage transparency and potentially help ensure that Medicare beneficiaries who elect the hospice benefit are provided comprehensive and holistic services. Hospices are also required to provide the hospice election statement addendum to requesting non-hospice providers who furnish services to a beneficiary under hospice.

Despite this addendum requirement being finalized in FY 2020, Medicare non-hospice spending for beneficiaries who have elected the hospice benefit has shown substantial and consistent growth from FY 2020 through FY 2024, with particularly dramatic increases in Part A and B spending. This may suggest that the policy requirement stipulating that hospices only provide the addendum to beneficiaries (or their representatives) that request it — rather than every beneficiary who elects the benefit — has not achieved the intended accountability objective of ensuring that hospices provide virtually all care needed by terminally ill individuals as required under the comprehensive and holistic Medicare hospice benefit. Additionally, many beneficiaries or their representatives may not realize the importance of asking for the addendum and may continue to bear more financial burden as a result.

In this final rule, CMS made the addendum mandatory for all those electing hospice and not just those who request the addendum. This change ensures that all beneficiaries have greater transparency into non-covered items, services, or drugs to make care decisions that align with their treatment preferences and goals, potentially leading to a decrease in beneficiary out-of-pocket costs. This requirement may hold hospices more accountable for the items, services, and drugs they are required to provide. The addendum also will provide needed information to non-hospice providers for claims submission.

Hospice Quality Reporting Program 

The Secretary, authorized by Section 1814(i)(5) of the Social Security Act, established the hospice quality reporting requirements for hospice programs and is also required to publicly report quality measures that relate to the care provided by hospice programs across the country on https://www.medicare.gov/care-compare/. Since FY 2014, the failure of hospices to comply with quality data reporting requirements results in a two percentage-point reduction to the annual payment update (APU) for the corresponding FY. In the FY 2022 Hospice Final Rule, CMS finalized that beginning with the FY 2024 APU and for each subsequent year, under statute, the APU penalty increased from two percentage points to four percentage points for hospices that did not comply with the Hospice Quality Reporting Program (HQRP).

Despite the doubling of the APU penalty increase in FY 2024, CMS has not seen significant improvement in the number of hospices meeting the HQRP reporting requirements. In FY 2024, the first year of the percentage points APU penalty, 22.06% of hospices were found to be non-compliant. In FY 2025, the percentage of non-compliant hospices increased to 23.53%, and in FY 2026 the percentage of non-compliant hospices was 20.37%. The consistent lack of data for approximately one-fifth of hospices limits CMS’ ability to accurately measure the quality of care provided by hospices and reduces the amount of data available to consumers.

In this rule, CMS will add an icon to the Medicare.gov Care Compare tool to identify hospices that fail to submit any quality data, or submit less than the required 90%, within a given year — effective no earlier than FY 2028. To comply, hospices must submit quality data through the Hospice Outcomes and Patient Evaluation (HOPE) tool within 30 days of the patient’s HOPE admission, HOPE Update Visit (HUV), and HOPE discharge dates.



On July 31, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for inpatient and long-term care hospitals under the Medicare hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) for fiscal year (FY) 2027. The final rule also includes changes, clarifications, and codifications for Organ Acquisition and Reasonable Cost Payment Policies, and Reimbursement Appeals for Independent Organ Procurement Organizations and Histocompatibility Laboratories.

The final rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2027. CMS is publishing this final rule to meet the legal requirements to update Medicare payment policies for IPPS hospitals and LTCHs on an annual basis. This fact sheet discusses major provisions of the final rule, which can be downloaded from the Federal Register at: https://www.federalregister.gov/d/2026-15833.

The final rule expands the Comprehensive Care for Joint Replacement (CJR) Model, which produced strong evidence of cost savings while maintaining quality of care. The expanded model, called CJR-X, is designed to improve care for Original Medicare patients undergoing hip, knee, and ankle replacements (also called lower extremity joint replacements) performed in inpatient and hospital outpatient settings. CJR-X will be mandatory nationwide and begin on January 1, 2028.

Background on the IPPS and LTCH PPS 

CMS pays acute care hospitals (with a few exceptions specified in the law) for inpatient stays under the IPPS. LTCHs are paid under the LTCH PPS. Under these two payment systems, CMS sets base payment rates prospectively for inpatient stays, generally based on the patient’s diagnosis, the services or treatment provided, and the severity of illness. Subject to certain adjustments, a hospital receives a single payment for each case depending on the payment classification assigned at discharge. The classification systems are for: IPPS, Medicare Severity Diagnosis-Related Groups (MS-DRGs), and for LTCH PPS, Medicare Severity Long-Term Care Diagnosis-Related Groups (MS-LTC-DRGs).

The law requires CMS to update payment rates for IPPS hospitals annually and to account for changes in the prices of goods and services these hospitals use when treating Medicare patients, as well as for other factors. The index used to do this is known as the hospital “market basket.” The IPPS pays hospitals for services provided to Medicare beneficiaries using a national base payment rate, adjusted for a number of factors that affect hospitals’ costs, including the patient’s condition and the cost of hospital labor in the hospital’s geographic area. CMS updates LTCHs’ payment rates annually according to a separate market basket based on LTCH-specific goods and services.

Changes to IPPS Payment Rates 

The finalized increase in the IPPS payment rates is 2.3%. This reflects a projected FY 2027 hospital market basket percentage increase of 3.2%, reduced by a 0.9 percentage point productivity adjustment. IPPS-participating hospitals must successfully participate in the Hospital Inpatient Quality Reporting (IQR) program and be meaningful electronic health record (EHR) users to earn the full rate update.

Overall, for FY 2027, CMS expects the final changes in IPPS payment rates — in addition to other changes — will generally increase hospital payments by approximately $2.1 billion. CMS also estimates that additional payments for inpatient cases involving new medical technologies will increase by approximately $779 million in FY 2027, primarily driven by new approvals for new technology add-on payments. Under current law, additional payments for Medicare-Dependent Hospitals (MDHs) and the temporary change in payments for low-volume hospitals will expire December 31, 2026. In the past, legislation has extended these payments, and if they were to be extended through the end of FY 2027, CMS estimates that these hospitals would receive additional payments of approximately $0.3 billion in FY 2027.

Changes to LTCH PPS Payment Rates

For FY 2027, CMS finalized an annual update of 2.3% to the LTCH standard payment rate, which reflects a projected LTCH PPS market basket percentage increase of 3.2%, reduced by a 0.9 percentage point productivity adjustment. CMS expects LTCH PPS payments for discharges paid the LTCH standard payment rate to increase by approximately 2.2%, or $54 million, due primarily to the 2.3% annual update. For FY 2027, CMS is finalizing the proposal to maintain the LTCH PPS outlier threshold at its FY 2026 value. We estimate that this threshold will result in estimated outlier payments approximating 8% of estimated total payments, as required by statute, considering information currently available regarding possible LTCH charging practices and other information.

Graduate Medical Education (GME) Payments

To further strengthen the protections against unlawful discrimination finalized in the calendar year (CY) 2026 Outpatient Prospective Payment System (OPPS) Final Rule, we are finalizing the proposal to require that, in addition to meeting other applicable requirements, an approved medical residency training program must not discriminate, or promote or encourage discrimination, on the basis of race, color, national origin, sex, age, disability, or religion, including the use of those characteristics or intentional proxies for those characteristics as a selection criterion for employment, program participation, resource allocation, or similar activities, opportunities, or benefits. Similar requirements will also apply to approved nursing and allied health education programs and accreditors.

Organ Acquisition and Reasonable Cost Payment Policies, and Reimbursement Appeals for Independent Organ Procurement Organizations and Histocompatibility Laboratories

As part of broader efforts to strengthen Medicare cost reimbursement and appeals policies to ensure payment accuracy and reduce inappropriate spending, this rule finalizes the proposal that Medicare reconcile organ acquisition costs for non-renal organs for Independent Organ Procurement Organizations (IOPOs) and Histocompatibility Laboratories (HCLs) with a modification for a 2-year delayed implementation date for cost reporting periods beginning on or after October 1, 2028. This rule also finalizes the proposal to clarify and codify certain longstanding policies on allowable costs under Medicare’s reasonable cost principles for all provider types, including public education for Organ Procurement Organizations. This rule also finalizes the proposal to clarify and codify Medicare’s longstanding policies for allocating overhead costs across all provider types. Additionally, this final rule codifies the Administrator’s discretionary review of reimbursement appeals for IOPOs and HCLs.

Hospital Inpatient Quality Reporting Program

The Hospital Inpatient Quality Reporting Program is a pay-for-reporting quality program that reduces payments to hospitals that do not meet program requirements. Hospitals that do not submit quality data or do not meet all Hospital Inpatient Quality Reporting Program requirements are subject to a one-fourth reduction in their Annual Payment Update under the IPPS.

In the FY 2027 IPPS/LTCH PPS final rule, CMS is finalizing the adoption of three new measures:

  • Excess Days in Acute Care After Hospitalization for Diabetes measure beginning with the FY 2029 payment determination.
  • Hospital Harm-Postoperative Venous Thromboembolism electronic clinical quality measure (eCQM) beginning with the FY 2030 payment determination.
  • Advance Care Planning eCQM beginning with the FY 2030 payment determination.

CMS is finalizing the removal of three measures beginning with the FY 2030 payment determination:

  • Venous Thromboembolism Prophylaxis eCQM.
  • Intensive Care Unit Venous Thromboembolism Prophylaxis eCQM.
  • Discharged on Antithrombotic Therapy eCQM.

CMS is finalizing modifications to three measures beginning with the FY 2028 payment determination. Modifications include adding Medicare Advantage patients and shortening the performance period from 3 years to 2 years:

  • Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction.
  • Excess Days in Acute Care after Hospitalization for Heart Failure.
  • Excess Days in Acute Care after Hospitalization for Pneumonia.

CMS is finalizing the adoption of five modified mortality measures, beginning with the FY 2028 payment determination, before moving the modified versions to the Hospital Value-Based Purchasing Program. Modifications include adding Medicare Advantage patients and shortening the performance period from 3 years to 2 years:

  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Acute Myocardial Infarction Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Heart Failure Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Pneumonia Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Chronic Obstructive Pulmonary Disease Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Coronary Artery Bypass Graft Surgery measure.

CMS is also finalizing changes to the data reporting and submission requirements for some eCQMs and structural measures, specifically:

  • Mandatory reporting for the Malnutrition Care Score eCQM beginning with the FY 2030 payment determination.
  • Establishing a mandatory reporting policy to make hospital harm eCQMs mandatory after 2 years of reporting beginning with the FY 2030 payment determination. We note that the proposed policy has been modified such that the data will be publicly reported on the Provider Data Catalog for the first year of mandatory reporting before publicly reporting on the Care Compare tool at Medicare.gov, including Hospital Star Ratings, beginning with the second year of mandatory reporting.
  • An update to the reporting of the Maternal Morbidity Structural measure beginning with the FY 2028 payment determination to identify which perinatal quality collaborative the hospital participates in.

Hospital Readmissions Reduction Program

The Hospital Readmissions Reduction Program is a value-based purchasing program that reduces payments to hospitals with excess readmissions. The program supports improving quality of care and care coordination for patients. In the FY 2027 IPPS/LTCH PPS final rule, CMS is finalizing the proposal to adopt the Hospital 30-Day, All-Cause, Risk-Standardized Readmission Rate Following Sepsis Hospitalization measure, with modifications. Hospitals will have 2 years of confidential early look reports that will include estimated Hospital Readmissions Reduction Program payment adjustments with the sepsis readmission measure added during the FY 2028 and FY 2029 program years. The measure will be used in payment reduction calculations beginning with the FY 2030 program year.

Hospital-Acquired Condition Reduction Program

The Hospital-Acquired Condition Reduction Program creates an incentive for hospitals to improve patient safety and reduce the rate of hospital-acquired conditions. Hospitals in the worst-performing quartile receive a payment reduction of 1% on overall Medicare fee-for-service payments. CMS is not making any changes to this program in the FY 2027 IPPS/LTCH PPS final rule.

Hospital Value-Based Purchasing Program

The Hospital Value-Based Purchasing Program is a budget-neutral program funded by reducing participating hospitals’ base operating DRG payments each fiscal year by 2% and redistributing the entire amount back to the hospitals as value-based incentive payments. In the FY 2027 IPPS/LTCH PPS final rule, CMS is finalizing modifications to five condition-specific and procedure-specific mortality measures beginning with the FY 2032 program year. Modifications include adding Medicare Advantage patients and shortening the performance period:

  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Acute Myocardial Infarction Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Heart Failure Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Pneumonia Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Chronic Obstructive Pulmonary Disease Hospitalization measure.
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Coronary Artery Bypass Graft Surgery Acute Ischemic Stroke measure.

We note that several proposals across our Quality Reporting and Value-Based Purchasing Programs include the addition of Medicare Advantage data for purposes of calculating claims-based measures. With the increase in Medicare Advantage beneficiaries to more than half of all Medicare beneficiaries, these modifications will better reflect overall patient care coordination among a broader population of patients, improving measure reliability. Shortening the reporting period will also allow measure results to reflect more recent hospital performance and provide more actionable insights for quality improvement.

PPS-Exempt Cancer Hospital (PCH) Quality Reporting Program

The PCH Quality Reporting Program is a quality reporting program for eleven cancer hospitals that are statutorily exempt from the IPPS. CMS collects and publishes data from PCHs on applicable quality measures. In the FY 2027 IPPS/LTCH PPS final rule, CMS is adopting the Advance Care Planning eCQM and the Malnutrition Care Score eCQM, with a modification to offer an initial voluntary reporting period for the FY 2030 program year and mandatory reporting beginning with the FY 2031 program year. CMS is also finalizing removal of the COVID–19 Vaccination Coverage Among Healthcare Personnel measure beginning with the FY 2028 program year. Finally, CMS is finalizing the reporting and submission requirements for eCQMs in the PCH setting.

Long-Term Care Hospital Quality Reporting Program (LTCH QRP)

The LTCH QRP is a pay-for-reporting program, which requires LTCHs to submit quality data to CMS. Any LTCHs that do not meet reporting requirements may be subject to a 2-percentage point (2%) reduction in their Annual Payment Update. Additionally, measures adopted into the LTCH QRP are publicly reported on the Care Compare tool at Medicare.gov. In the FY 2027 IPPS/LTCH PPS final rule, CMS is finalizing the following:

  • Removal of two measures from the LTCH QRP:
    • COVID-19 Vaccination Coverage Among Healthcare Personnel measure beginning with the FY 2028 LTCH QRP.
    • COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date measure beginning with the FY 2028 LTCH QRP.
  • Revision of the data submission deadline.
  • CMS summarized public comment received on one future measure concept: advance care planning for the LTCH QRP.

Medicare Promoting Interoperability Program

The Medicare Promoting Interoperability Program encourages eligible hospitals and critical access hospitals to adopt, implement, upgrade, and demonstrate meaningful use of certified electronic health record technology (CEHRT).

In the FY 2027 IPPS/LTCH PPS final rule, CMS is finalizing policies to:

  • Remove and revise certification criteria required for the Medicare Promoting Interoperability Program in alignment with proposals made by the Office of the National Coordinator for Health IT (ONC) in the Health Data, Technology, and Interoperability: Assistant Secretary for Technology Policy (ASTP)/ONC Deregulatory Actions to Unleash Prosperity proposed rule (HTI-5 proposed rule).
  • Remove ONC Direct Review and ONC-Authorized Certification Body (ONC-ACB) Surveillance attestations beginning with the EHR reporting period in CY 2026.
  • Remove, with modification to delay removal an additional year, the Support Electronic Referral Loops by Sending Health Information and Support Electronic Referral Loops by Receiving and Reconciling Health Information measures beginning with the EHR reporting period in CY 2029.
  • Modify the Electronic Prior Authorization measure as an optional bonus measure for the EHR reporting period in CY 2027 and mandatory beginning with the EHR reporting period in CY 2028.
  • Add the Unique Device Identifiers for Implantable Medical Devices measure to the Public Health and Clinical Data Exchange objective beginning with the EHR reporting period in CY 2027.
  • Adopt two new eCQMs beginning with the FY 2030 payment determination in alignment with the Hospital Inpatient Quality Reporting Program (the Hospital Harm-Postoperative Venous Thromboembolism and the Advance Care Planning eCQMs).
  • Remove three eCQMs beginning with the FY 2030 payment determination in alignment with the Hospital Inpatient Quality Reporting Program (Venous Thromboembolism Prophylaxis, Intensive Care Unit Venous Thromboembolism Prophylaxis, and Discharged on Antithrombotic Therapy eCQMs).


JULY 31, 2026 – The Centers for Medicare & Medicaid Services (CMS) is expanding an initiative to improve care coordination for hip, knee, and ankle replacements, ensuring providers work together from pre-surgery education through post-op recovery to promote a seamless patient care experience and optimal health outcomes.

Beginning in January 2028, most hospitals will be required to participate in the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, which is part of the FY 2027 Inpatient and Long-Term Care Hospital Prospective Payment System Final Rule released today.

“Knee, hip, and ankle replacements are important for helping seniors preserve their mobility and overall well-being,” said CMS Administrator Dr. Mehmet Oz. “Expanding the joint replacement pilot program to support more of our seniors will help match financial incentives in Medicare with improved health outcomes, safeguard taxpayer resources, and ensure patients experience a positive, comprehensive care journey throughout the surgical process.”

The CJR-X Model will be the first expanded mandatory test of an episode-based payment model. Hospitals will be accountable for Medicare expenditures related to joint replacement surgery, hospitalization, and the initial 90 days of recovery following hospital discharge, including follow-up treatments like physical therapy. Episode-based payments motivate hospitals, surgeons, and post-acute providers to collaborate to help patients recover while reducing avoidable hospitalizations, complications, and unnecessary costs for Medicare and taxpayers.

The CMS Innovation Center tested CJR-X’s predecessor, the Comprehensive Care for Joint Replacement (CJR) Model, from April 2016 through December 2024 to similarly improve care for Medicare patients undergoing joint replacement procedures. The model saved Medicare more than $100 million while maintaining quality of care for patients.

“We look forward to building on the success of the CJR model. CJR-X gives more patients the opportunity for a better care experience when undergoing joint replacement surgery, because hospitals are given the right financial incentives to enhance care coordination, reduce unnecessary services, such as preventable readmissions and emergency visits, and prioritize patient outcomes with post-acute care providers supporting recovery,” said CMS Innovation Center Director Abe Sutton.

Under the CJR-X Model, patients across the country will still choose their own doctors and will not face added complexity in how they receive care. While most hospitals paid under the Inpatient Prospective Payment System (IPPS) will be required to participate in CJR-X, certain hospitals may be exempt, including those participating in the Transforming Episode Accountability Model, those located in Maryland, and those not paid under both the IPPS and Outpatient Prospective Payment System.

Additionally, for FY 2027, CMS, through the IPPS rule, has finalized the payment rate for inpatient and long-term care hospitals (LTCHs) under this final rule to increase by 2.3%, reflecting more recent available data on hospital costs.

For additional information about the finalized payment policies and the Quality Reporting Program changes in the FY 2027 IPPS and LTCH PPS final rule, visit: https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-long-term-care-hospital-prospective-payment

To learn more about the CJR-X Model, visit: https://www.cms.gov/priorities/innovation/innovation-models/cjr-x

CMS is partnering with the Office of the National Coordinator for Health Information Technology (ONC) to finalize a series of health information technology (health IT) standards and specifications. Learn more at https://healthit.gov/resources/onc-finalizes-the-adoption-of-certain-health-it-standards-in-the-fy2027-cms-ipps-final-rule/

The FY 2027 IPPS and LTCH PPS final rule (CMS-1849-F) can be viewed on the Federal Register at: https://www.federalregister.gov/d/2026-15833.



JULY  31, 2026 – The Substance Abuse and Mental Health Services Administration (SAMHSA), a division within the U.S. Department of Health and Human Services (HHS), announced today that it has awarded $73.2 million in grants to strengthen children’s mental health services, suicide prevention programs, and to expand assisted outpatient treatment (AOT) to those with serious mental illness.

“Americans deserve a mental health system that delivers results. These investments will expand access to effective treatment, strengthen suicide prevention, and help communities care for people before a crisis becomes a tragedy,” said HHS Secretary Robert F. Kennedy, Jr. “We will continue to support programs that are accountable, evidence-based, and focused on restoring health.”

“Far too many Americans, including children, are affected by mental illness and the risk of suicide, but we also know that getting better is possible and that effective treatments and proven programs can change lives,” said SAMHSA Principal Deputy Assistant Secretary Christopher D. Carroll. “At SAMHSA, we are committed to equipping communities with the resources they need to expand access to care, improve mental health outcomes, and help more people build healthier, more hopeful futures.”

Today’s awards will support evidence-based, community-driven programs that expand access to mental health services, strengthen suicide prevention efforts, and improve treatment for individuals with serious mental illness. Through these investments, SAMHSA is advancing its mission to reduce the impact of mental illness and substance use disorders on America’s communities by supporting proven approaches that promote recovery, improve outcomes, and increase access to quality behavioral healthcare.

The $73.2 million in awards includes:

  • Children’s Mental Health Initiative (CMHI) – ($44.3 million) – The purpose of this initiative is to provide comprehensive community mental health services to children, youth, and young adults, birth through age 21 with a serious emotional disturbance, which may include efforts to identify and serve children at risk, and their families.
  • Implement Zero Suicide in Health Systems – ($17.6 million) – The purpose of this program is to provide resources to healthcare systems to implement the Zero Suicide framework for adults at risk of suicide.
  • Assisted Outpatient Treatment – ($11.2 million) – The purpose of this program is to facilitate implementation of AOT programs for adults with serious mental illness. This funding advances the President’s Executive Order Ending Crime and Disorder on America’s Streets.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To locate a treatment facility or provider, visit FindTreatment.gov.