In brief: Catheter code change, Part B premium increase, AdaptHealth debt reduction

WASHINGTON – Documentation of any spinal cord injury diagnosis is sufficient to establish Medicare coverage for sterile catheter kits (A4297 and A4353) starting Jan. 1, according to a new local coverage determination (LCD) and policy article from the Durable Medical Equipment Medicare Administrative Contractors (DME MACs). 

The expanded coverage, which better aligns with current clinical evidence, will help to reduce serious urinary tract infections (UTIs), AAHomecare stated in a bulletin. 

“The clarification streamlines coverage by allowing documentation of SCI alone to automatically qualify a beneficiary as immunocompromised for sterile catheter kits, allowing patients access to sterile kits without requiring them to have two UTIs,” the association stated. 

The new LCD incorporates the new and revised HCPCS codes for intermittent catheters, including separate codes for hydrophilic catheters. 

AAHomecare called out the Intermittent Catheter Coding Reform Coalition (ICCRC) for its collaborative approach and continued advocacy to improve coverage for beneficiaries. 

You can find the new LCD and policy article at the links below: 

Final LCD: Urological Supplies (L33803) 

Policy Article: Urological Supplies (A52521) 

Related reading: 

• Countdown to coding change: CMS to update HCPCS for hydrophilic caths 
• AAHomecare launches resource for new cath codes 
• CMS proposes coding changes for intermittent urinary catheters 

Medicaid enrollment dropped in 2025, according to KFF 

WASHINGTON – Medicaid enrollment declined by 7.6% in FY 2025, driven primarily by the unwinding of the continuous enrollment provision, according to a new issue brief from Kaiser Family Foundation. The completion of unwinding renewals, as well as competing upward and downward enrollment pressures, are expected to result in flat Medicaid enrollment growth (0.2%) in FY 2026. Other findings from the issue brief: 

• Total Medicaid spending growth was 8.6% in FY 2025 and is expected to slow slightly (7.9%) in FY 2026. States are experiencing several significant upward expenditure pressures that outweigh the downward pressure from Medicaid enrollment trends, including rate increases, higher health care needs among enrollees post-unwinding, and increasing long-term care, pharmacy, and behavioral health care costs. 
• State Medicaid spending growth was 12.2% in FY 2025 and is projected to slow to 8.5% in FY 2026, similar to total spending growth levels and marking the end of shifts caused by pandemic-era enhanced federal funding. While most of the state (or non-federal) share of Medicaid spending comes from state general funds, there is considerable variation in how much states rely on other non-federal share funding sources and how they account for those other funding sources. 
• Almost two-thirds of responding states at the time of the survey thought the chance of a Medicaid budget shortfall in FY 2026 was “50-50”, “likely”, or “almost certain.” A few states are implementing Medicaid spending cuts to address recent budget challenges, and other states may follow as they contend with potential Medicaid budget gaps and look ahead to the implementation of the Medicaid changes in H.R.1. 

Go here to read the full issue brief. 

CMS announces nearly 10% increase for Medicare Part B premium 

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has announced that the standard monthly premium for Medicare Part B will be $202.90 for 2026, an increase of $17.90 from $185 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025. CMS says the increase in the 2026 Part B standard premium and deductible is mainly due to projected price changes and assumed utilization increases that are consistent with historical experience. The agency noted: “If the Trump Administration had not taken action to address unprecedented spending on skin substitutes, the Part B premium increase would have been about $11 more a month. However, due to changes finalized in the 2026 Physician Fee Schedule Final Rule, spending on skin substitutes is expected to drop by 90% without affecting patient care.”  

• Related: CMS moves skin substitutes under physician fee scheduled as incident-to-supplies 

ACHC launches rebrand focusing on meaningful quality improvement 

CARY, N.C. - The Accreditation Commission for Health Care (ACHC) has launched a new brand campaign supported by a new video “THE Choice” and a refreshed digital presence at www.achc.org. “Accreditation should empower, not encumber,” said José Domingos, president and CEO of ACHC. “While others market simplification as innovation, ACHC has always focused on meaningful quality improvement. We’ve never imposed the unnecessary burdens that others are now trying to undo.” ACHC says the campaign underscores its commitment to: 

• Meaningful standards: CMS-aligned and patient-centered with no duplicative or non-essential requirements. 
• True partnership: Collaborative, respectful surveys led by accessible experts and account advisors. 
• Education-first support: Resources and guidance that build confidence, not confusion. 
• Consistency and clarity: A process rooted in transparency and continuous improvement. 

As part of the campaign, ACHC also embraces its identity as proud “Accreditation Nerds” – a confident, customer-obsessed culture that celebrates expertise, collaboration and passion for quality patient care. The organization’s “Accreditation Nerds” platform showcases its approachable, education-driven personality through relatable storytelling, social media engagement and thought leadership, it says. To learn more, visit www.achc.org. 

Big Sky AMES welcomes Utah providers 

JAMESTOWN, N.D. - The board of directors of the Big Sky Association of Medical Equipment Suppliers (Big Sky AMES) has voted to welcome all durable medical equipment (DME) providers in Utah. The regional association already represents providers in Montana, Wyoming and Idaho. “We are excited to welcome Utah into Big Sky and look forward to working together to support patient access, strengthen providers, and advance the home medical equipment community across the region,” the association stated. Utah will have a designated state representative/director to ensure strong representation and a clear voice within the association. Members in the state will be fully represented in all activities, initiatives and communications. When legislative or regulatory issues arise in the state, the association will engage directly and, when necessary, travel to the state to support providers and advocate on their behalf. The Big Sky AMES annual conference will continue to be held in Montana. 

AdaptHealth’s debt reduction efforts lead to upgrade 

CONSHOHOCKEN, Pa. - AdaptHealth has announced that S&P Global Ratings has recently upgraded the issue-level rating on the company’s senior unsecured debt to “BB-” from “B+” and revised its recovery rating to “4” from “5.” S&P highlighted that the upgrade follows $225 million of year-to-date prepayment of its senior secured term loan A due in 2029. This, S&P said, increases recovery prospects for AdaptHealth’s unsecured notes in the rating agency’s hypothetical default scenario. “S&P Global Rating’s upgrade is an important recognition of the deliberate actions we are taking to strengthen our balance sheet, improve our risk profile, and increase our financial flexibility,” said Suzanne Foster, CEO of AdaptHealth. “Since the end of the third quarter of 2024, we have reduced the balance of our term loan A by $275 million, funded by our strong free cash flow generation and by proceeds from dispositions of non-core assets to sharpen our strategic focus. Debt reduction remains among our highest capital allocation priorities, as we believe a strong balance sheet is essential to unlocking and sustaining value for shareholders.” AdaptHealth recently announced that it has signed a new capitated agreement with a major health insurer, a move that CFO Jason Clemens said reflects the company’s broader strategy to expand its business through these contracts. In the third quarter, AdaptHealth reported net revenue of $820.3 million compared to $805.9 million, a 1.8% increase year over year. 

GEM SLEEP issues ‘Wake-Up Call’ to increase awareness of OSA 

MINNEAPOLIS – GEM SLEEP, a provider of fully virtual sleep apnea care from at-home testing and diagnosis through treatment set up and ongoing support, has launched a national campaign to increase public awareness of obstructive sleep apnea (OSA). “A Wake-Up Call: Restoring Sleep, Reimaging Care” is designed to reach people during the holidays as they begin thinking about their New Year’s resolutions. "OSA is the most common – and most treatable – sleep disorder," said Dr. Michael Howell, MD, chief medical officer of GEM SLEEP and professor of neurology at the University of Minnesota. "When diagnosed correctly, most patients experience life-changing improvement in their energy, mood and overall health in just weeks. The challenge isn't treatment. It's recognition. Too many people simply don't realize their poor sleep has a medical solution." The campaign features a new OSA Education Hub, a free, comprehensive online resource that offers: 

• Basics: Understand what OSA is, its symptoms and key risk factors. 
• Diagnosis: Learn how at-home testing compares to in-lab sleep studies. 
• Therapy: Explore evidence-based treatments, including therapy, mask selection and adherence support. 
• Coaching: Discover how personalized coaching improves comfort and long-term therapy success. 
• FAQs: Access practical guidance on testing, insurance and lifestyle considerations. 
• Educational articles: Read curated content for men, women and athletes. 

"Untreated OSA affects every aspect of life, from cardiovascular and metabolic health to mood, memory and safety," said Brian Sauer, founder and CEO of GEM SLEEP. "Our mission at GEM SLEEP is to make sleep care accessible, convenient and empowering. Through this educational campaign, we're breaking down the barriers that prevent people from getting the care they need and showing how better sleep can transform health, performance and quality of life." 

The hub is available at https://www.mygemsleep.com/welcome-to-gem-sleep/. 

CMS issues guidance on health care-related taxes in Medicaid 

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has issued preliminary guidance for states on how to implement new federal requirements on health care-related taxes in Medicaid. In line with changes made under the Working Families Tax Cuts legislation, the agency will generally prohibit new or increased health care-related taxes and end financing practices that previously allowed certain states to inappropriately draw down federal matching funds. These provisions are projected to save taxpayers more than $200 billion over the next 10 years, CMS says. “CMS is restoring the federal-state partnership by ensuring that Medicaid dollars are spent responsibly, transparently, and in service of the beneficiaries who depend on this program for their health and dignity,” said CMS Administrator Dr. Mehmet Oz. “While closing a loophole that some states were taking advantage of to shift billions in costs onto federal taxpayers, we have crafted policy that gives states time to transition as the new tax limits are implemented.” 

For more information, visit: https://www.medicaid.gov/medicaid/downloads/providertax_dcl_11142025.pdf 

embecta partners with Direct Relief to extend humanitarian mission  

PARSIPPANY, N.J. - embecta Corp., a large manufacturer of insulin injection devices, has expanded its partnership with Direct Relief, a leading humanitarian aid organization and large charitable insulin provider in the United States. Through 2026, embecta's diabetes products, including syringes, pen needles, and diabetes management supplies, will reach patients who cannot afford insurance and do not qualify for Medicaid, ensuring they have consistent, uninterrupted access to the tools essential for managing their diabetes. "As we mark World Diabetes Day, embecta is proud to deepen our commitment to ensuring that everyone living with diabetes—regardless of their ability to pay or where they live—has access to the supplies they need," said Dev Kurdikar, CEO, embecta. "Since becoming an independent company, we have focused on empowering people with diabetes while paving the way for a life unlimited for all. This partnership with Direct Relief helps extend that mission to those who need it most." After embecta spun off from BD in 2022, BD-branded pen needles and insulin syringes became part of its portfolio. In 2025, embecta rebranded packaging in North America and donated about 15 million units of the previous BD-branded devices to Direct Relief. Direct Relief partners with more than 1,600 community health centers and free and charitable clinics across all 50 states, the District of Columbia and Puerto Rico, serving more than 36 million patients, including one in five of America’s uninsured. 

Orpyx, NIH put digital foot monitoring to the test 

CALGARY, Alberta – Orpyx Medical Technologies has announced that its sensory insoles, analytics platform and remote monitoring program will be used in a new clinical trial funded by the National Institutes of Health (NIH). The randomized controlled trial, “WIREDUP: Wearable Insoles for Recurrent Diabetic Ulcer Prevention,” will enroll 400 participants to test whether integrating digital foot monitoring into routine care can help reduce the incidence of diabetic foot ulcers, one of the most costly and serious complications of diabetes. “Supporting independent, peer-reviewed research is central to advancing care for people with diabetes,” said Dr. Breanne Everett, CEO and founder of Orpyx Medical Technologies. “We are honored that our platform has been selected for use in this NIH-funded trial, which will generate high-quality evidence to inform the role of digital tools in diabetic foot ulcer prevention.” The $5 million trial will be led by Johns Hopkins University School of Medicine, with collaborators from Keck Medicine of USC and the University of Utah Spencer Fox Eccles School of Medicine. Orpyx says it partners with VA Medical Centers, health systems and payers across North America to deliver clinically validated outcomes and cost savings at scale.