Lawmakers Praise APMs at Congressional Hearing. Reps. Brian Fitzpatrick (R-PA) and Claudia Tenney (R-NY) highlighted the success of Alternative Payment Models (APMs) and ACOs in incentivizing early identification of chronic disease, thereby improving health outcomes while mitigating costs at a House Ways and Means Subcommittee on Health hearing on modernizing care coordination last week. Subcommittee Chairman Vern Buchanan (R-FL) questioned whether physicians should continue to be paid under fee-for-service (FFS) “is the way we should go, or should we be looking at alternatives?… The right incentive is to treat people, treat their health, their conditions, get them better, so they don’t need to be running to the doctor every couple of weeks.” Lawmakers from both parties also expressed support for extending Medicare telehealth flexibilities to enhance care coordination.

Why It Matters. Themes echoed at the hearing, such as care coordination, chronic disease management, and moving away from FFS, mirror A4H’s core policy goals. We are pleased that such issues received positive attention. A4H routinely makes the case for these tools and will continue to work with policymakers to address payment reform and accelerate the transition to accountable care.

Congress Asks CMS to Shield ACOs from Fraud. House Ways and Means Health Subcommittee Chair Vern Buchanan (R-FL), along with Reps. Claudia Tenney (R-NY) and Greg Murphy (R-NC), urged CMS Administrator Mehmet Oz in a letter to take stronger actions to protect ACOs from the financial harm caused by fraud in Medicare—particularly recent spikes in skin substitute spending. While CMS has previously excluded anomalous claims from catheters from ACO calculations, current methodologies don’t adequately address broader fraud, abuse, or future schemes, leaving ACOs unfairly liable for millions in illegitimate spending.

The lawmakers emphasize that unchecked fraud distorts benchmarks, erodes shared savings, discourages participation in risk models, and threatens the financial stability of accountable care providers. The letter asks CMS to create a mechanism to exclude verified fraud or improper claims from ACO financial calculations and to strengthen fraud-detection criteria to preserve the integrity of accountable care.

A4H Leadership. A4H has been working with Congress and the administration on the need for reform around skin substitutes, including the need to protect CMMI model participants and Medicare Shared Savings Program ACOs from spending outside of their control. Our Health Affairs Forefront article from last month goes deeper on suggested policy solutions. For additional resources or background on all matters related to skin substitutes, visit our landing page on the issue.

Skin Substitutes Victory Prevents Larger Premium Increase. CMS announced the 2026 premiums and deductibles for Medicare Parts A and B. Part A deductibles are expected to rise by $60 (3.5 percent). Part B’s standard monthly premium will increase by $17.90 (9.7 percent), and its annual deductible will increase by $26 (10.1 percent).

A4H’s Fight Kept Increases Lower. Part B premiums would have been $11 per month higher, CMS noted, if not for recent actions taken to address “unprecedented” spending on skin substitutes. A4H is a leading voice in the fight against improper use of skin substitutes. We look forward to continued work with policymakers to ensure payments eliminate incentives that invite fraud, waste, and abuse on wound care.

CMS Increases Payment for ESRD Facilities, Hospital Outpatient Departments, and ASCs.

CMS issued the final payment rules for end-stage renal disease (ESRD) facilities, hospital outpatient departments (HOPDs), and ambulatory surgical centers (ASCs).

CMS finalized a 2.6 percent increase to payment rates for both HOPDs and ASCs, changes to how skin substitutes will be paid for, and requirements for hospital price transparency. For skin substitutes, CMS unpackaged payment for the products from the procedures they are associated with and established three new payment codes based on the FDA approval pathway. For CY2026, the payment rate for all three codes will be $127.14, but CMS anticipates setting separate payment rates for each of the three codes in the future.

Under the ESRD payment rule, facilities will see a 2.2 percent rate increase. CMS also finalized the termination of the ESRD Treatment Choices Model on December 31, 2025, 18 months earlier than initially scheduled.

CMMI Applies Evidence to Protect Patients, Providers and Taxpayers. CMS Innovation Center (CMMI) Director Abe Sutton and CMS Senior Advisor & Chief of Staff Gita Deo authored an article in Health Affairs Forefront discussing how CMMI is applying evidence across programs to improve efficiency and reduce costs. The authors provide three examples:

• Highlighting CMS’s efforts to reduce unnecessary care, including actions to curb the improper use of skin substitutes and the Centers’ new WISeR model.
• Demonstrating how CMMI is implementing evidence in support of downside risk in increased two-sided risk arrangements for ACO REACH and the Transforming Episode Accountability Model.
• Explaining efforts to refine and simplify benchmark methodology in CMMI models, including in the new Ambulatory Specialty Model.

Mirroring A4H Message. Their message on supporting two-sided risk for models reflects A4H’s work, recognizing that holding providers accountable for outcomes consistently delivers better value for patients and taxpayers.

A4H Institute and West Health Convening, Dec 9. Join industry experts, stakeholders, and government leaders in-person while they take a closer look at ways to strengthen accountable care for seniors and opportunities to advance accountable care in Medicare Advantage and Traditional Medicare. The convening will be held at the Marriott Marquis in Washington, DC.

Congressional Briefing on Kidney Care, Jan. 14. Join A4H, the Coalition to Transform Advanced Care, and the National Kidney Foundation for a Capitol Hill briefing on “Improving Kidney Care with Innovative Payment and Delivery Models.” This session will include conversations about CMMI and the Comprehensive Kidney Care Contracting model to improve health outcomes and lower costs. The briefing will be held at the Rayburn House Office Building, Room 2060 from 12pm to 1pm.