Long-term care stakeholders found bright spots in the CY2026 Physician Payment Rule released Monday afternoon by the Centers for Medicare & Medicaid Services. 

Encouraging signs included proposed payment updates and expanded telehealth provisions, although key players said they were reserving final judgment until complete details could be discerned.

Cynthia Morton, the CEO of ADVION, said she was heartened by an update for services provided in nursing homes that appears to net out at 3.3%.

“The payment update is good and it takes into consideration two parts — the 0.25% update under MACRA [the Medicare Access and CHIP Reauthorization Act] that we are moving to in 2026 and the increase included in the One Big Beautiful Bill Act of 2.5%,” Morton said in an email to McKnight’s Long-Term Care News. “There also appears to be a positive budget neutrality adjustment of 0.55%, which is good news because it’s usually a negative.”

Last year’s physician payment update was a negative 2.93%.

On Monday, Morton also was among those expressing caution over a proposed “productivity adjustment” to some of the payment codes. “This could remove resources needed for patient care,” she noted.

Another concern is a CMS proposal that would make an “efficiency adjustment” of -2.5% to certain work relative value units. The value is to be based on a lookback of five years of the Medicare Economic Index.

Stakeholders were unified in their praise of new language on telehealth, which includes the continuation of some COVID-era allowances.

“The permanent removal of telehealth limitations on nursing home subsequent care codes stands out as a win,” said Alex Bardakh, senior director of advocacy and partnerships for PALTmed, the association for long-term care medical directors. He added, however, that the legislation’s expiration in September still needs to be addressed.

The agency is proposing to permanently remove frequency limitations for ensuing nursing facility and inpatient visits, as well as critical care consultations.

CMS also said in Monday’s release it wants to “streamline” the process for adding services to the Medicare Telehealth Services List. 

“There is some good simplification in here that they are simplifying how they choose which codes can be provided utilizing telehealth,” added Morton. “That is great.”

CMS said it was “proposing to simplify our review process by removing the distinction between provisional and permanent services and limiting our review on whether the service can be furnished using an interactive, two-way audio-video telecommunications system.” 

In keeping with Health and Human Services Secretary Robert F. Kennedy Jr.’s emphasis on chronic care management, CMS also included in its proposed rule multiple requests for information about how to better support prevention and management of long-term conditions. 

In addition, the proposed rule marks a continuation of the new administration’s asking for ideas from providers to do things such as simplify the regulatory rubric, as it did in the proposed SNF PPS in April.

CMS acknowledged it is shifting the general focus from prevention to wellness. It proposes removing 10 quality measures that, it said, did not directly improve patient health outcomes and adding five new outcome measures that focus on the prevention of chronic disease, including prescreening for diabetes.

In addition, the agency said it hopes to move away from what it called typically low-response rate surveys of practitioners to what it calls “value surveys,” or toward using observable/experienced information.

CMS also proposed big changes to how Medicare pays for skin substitutes in order to save an estimated 90% by designating it as billable by incident-to supplies rather than biologialsa. The agency said that from 2019 to 2024, the amount spent on skin substances rose fortyfold, due to “abusive pricing practices in the sector” and questionable prescribing practices.

Comments on the rule will be accepted through Sept. 12.