Earlier this month, Mehmet Oz, MD laid out his vision for CMS. It includes eight notable junctions along this journey that he believes will comport with the president’s call to “make America healthy again.” Here is a summary of Dr. Oz’s priorities for CMS over the next four years, as reported, in part, by Becker’s Hospital Review:
- Implement the president’s executive order to boost price transparency in the healthcare marketplace. The February order directs the U.S. Departments of Health and Human Services (HHS), Labor and Treasury to “rapidly implement and enforce” healthcare price transparency enforcement regulations that the president introduced during his first term.
- Streamline access to life-saving treatments by “equipping providers with better patient information versus unnecessary paperwork.” We will have to wait to find out how CMS proposes to effectuate this goal.
- Identify and eliminate fraud, waste and abuse. I think we are all aware of the work already undertaken by the so-called Department of Government Efficiency (DOGE), and this same focus to root out unnecessary spending will be brought to the Medicare and Medicaid programs. During his confirmation hearing, Dr. Oz promised a renewed scrutiny of the Medicare Advantage (MA) program amid allegations of widespread fraud and expressed concerns about MA sales and brokers encouraging seniors to switch to MA policies for financial gain.
- Focus on prevention, wellness and chronic disease management. HHS Secretary Robert F. Kennedy Jr. has targeted the reduction and eradication of chronic disease epidemic we have been witnessing in America over the last few decades. He has specifically linked obesity and diabetes to the influence of the pharmaceutical and food industries, as well as government dietary guidelines. Kennedy has called for reforms targeting food additives, pesticides and other environmental health risks, to include fluoridated drinking water. Effective May 7, Utah will become the first state to enact a fluoride ban.
- Prioritize artificial intelligence (AI) avatars. Oz has indicated that technologies such as machine learning and AI can help scale “good ideas” quickly and affordably.
- Preserve the core mission of the Medicaid program by “putting an end to spending that duplicates resources available through other federal and state programs or isn’t directly tied to healthcare services.” A few examples of Medicaid expenditures to be cut are as follows:
- $241M for a program in New York for non-medical in-home services, such as housekeeping
- $17M for a California student loan repayment program
- $20M in grants to high-speed internet for rural healthcare providers in North Carolina
- On April 4, CMS published its final rule for Medicare Advantage (MA) and Part D in 2026. The rule contains several changes, such as measures to (a) streamline prior authorization, (b) tighten oversight of supplemental benefits, and (c) codify provisions from the Inflation Reduction Act. However, the rule stopped short of addressing two of the most closely watched issues: expanding coverage for GLP-1s under Medicare and Medicaid, as well as regulating the use of AI in prior authorization. Those decisions have been deferred to future rulemaking.
- On April 7, CMS announced it would increase payments to MA plans by more than $25 billion in 2026. MA plans can expect a payment increase of 5.03 percent in 2026, more than double what the Biden administration proposed. The agency will also be shifting diagnosis coding from ICD-9 to ICD-10 and remove certain codes from the hierarchical condition categories model.
So, this is the road we’re going down in terms of CMS’s priorities for the foreseeable future. It may not be paved with yellow bricks, but it is overseen by a man named Oz.