WASHINGTON, D.C. — Federal health officials are rolling out a sweeping set of Medicare and health policy changes that will reshape wound care coverage, accelerate technology-supported treatment for chronic disease, clamp down on pediatric medical practices, and overhaul how Americans see and compare health care prices.
The Centers for Medicare & Medicaid Services announced that all seven Medicare Administrative Contractors will issue updated Local Coverage Determinations for skin substitute grafts and cellular and tissue-based products used to treat diabetic foot ulcers and venous leg ulcers. The updated policies take effect January 1, 2026, and apply only to those indications.
CMS said it reviewed clinical evidence submitted by manufacturers for 66 products after delaying the original coverage date to allow for additional research. Eighteen products met the agency’s evidence threshold and will be covered by Medicare, including Grafix Prime, which was added after publication of a randomized controlled trial earlier this year. Products lacking sufficient evidence were deemed non-covered, while others were placed into a 12-month “status quo” category allowing continued payment while additional studies are completed.
Officials said the approach balances patient access with evidence-based standards and reduces market disruption while clearly signaling what outcomes Medicare expects to see. Contractors will reconsider coverage in early 2027 after reviewing evidence submitted through the end of 2026.
Beyond coverage decisions, CMS is preparing to bar hospitals that participate in Medicare and Medicaid from performing sex-rejecting procedures on children under 18, following an executive order directing federal agencies to halt practices deemed to cause irreversible harm. The agency is also proposing to prohibit Medicaid and Children’s Health Insurance Program funding for such procedures. Federal health officials said the proposals are grounded in patient safety authority and would apply to nearly all U.S. hospitals.
At the same time, CMS is advancing a major shift in how Medicare pays for chronic care. The agency’s Innovation Center announced the ACCESS model, a voluntary 10-year program beginning in July 2026 that will reward outcomes rather than activity. Under ACCESS, organizations managing chronic conditions such as diabetes, hypertension, chronic pain, and depression will receive predictable payments tied to measurable health improvements, with care delivered in person, virtually, or asynchronously.
CMS officials said the model is designed to expand access to digital tools, remote monitoring, and technology-enabled care for people with Original Medicare, while giving clinicians more flexibility to innovate and reduce costs.
The agency also joined the Departments of Labor and Treasury in proposing major updates to federal health care price transparency rules first issued in 2020. The proposed changes aim to make pricing data smaller, clearer, and easier to use by reorganizing machine-readable files by provider network, cutting duplicative data, lowering reporting thresholds for out-of-network prices, and reducing reporting frequency from monthly to quarterly.
New requirements would also make price information easier to locate and require insurers to provide the same cost-sharing details by phone as they do online, aligning transparency rules with consumer protections under the No Surprises Act.
Federal officials said the combined actions reflect an effort to modernize Medicare and the broader health system by tightening evidence standards, improving oversight, expanding technology-supported care, and finally making health care prices understandable to ordinary Americans.
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