CMS targets chronic disease management 

WASHINGTON – CMS is proposing changing the Medicare Diabetes Prevention Program to allow more people to access coaching and peer support, as well as practical training in dietary change, physical activity and behavior change strategies, to delay or prevent the onset of Type 2 diabetes for those with prediabetes. 

In a new proposed rule, the agency also seeks to remove 10 quality measures that it says did not improve health outcomes and add five new measures that focus on the prevention of chronic disease, including prescreening for diabetes. 

“We are taking meaningful steps to modernize Medicare, cut waste, and improve patient care,” said CMS Administrator Dr. Mehmet Oz. “We’re making it easier for seniors to access preventive services, incentivizing health care providers to deliver real results, and cracking down on abuse that drives up costs. This is how we protect Medicare for the next generation while helping Americans live longer, healthier lives. 

Additionally, CMS is issuing a request for information (RFI) to gather recommendations on improving wellness, prevention and chronic disease management. 

Through the physician fee schedule (PFS) proposed rule, CMS also seeks to: 

• Pay for skin substitutes as incident-to supplies, a change that it expects to reduce spending on these products by nearly 90%, saving billions of dollars. Skin substitutes are also part of a new Wasteful and Inappropriate Service Reduction (WISeR) model, an initiative aimed at improving and expediting the prior authorization process for original Medicare. 
• Create a new Ambulatory Specialty Model, a mandatory payment model focused on specialty care for beneficiaries with heart failure and low back pain, significant areas of Medicare spending. Participants will be held accountable for their performance, generating savings. 
• Reduce payment differentials for physicians across settings of care by leveraging hospital data to calculate more accurate payment rates for certain services and better accounting for increased efficiencies in procedures and tests. 

“This move reflects our continued shift toward smarter, data-informed policymaking,” said Chris Klomp, deputy administrator and director of the Center for Medicare at CMS. “We’re advancing technical improvements that reward high-quality, efficient care; addressing the root causes of unique health challenges; and aligning health care spending with value so that new innovations help to deliver better quality at a lower price.” 

The 60-day comment period for the CY 2026 PFS proposed rule (CMS-1832 P) ends on Sept. 12, 2025.  

For a fact sheet on the CY 2026 Physician Fee Schedule proposed rule, please visit https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-pfs-proposed-rule-cms-1832-p.  

To view the CY 2026 PFS proposed rule, please visit: https://www.federalregister.gov/public-inspection/current.