CMS Policy Updates: Wound Care and Chronic Disease Management Impact on Insurance

The Centers for Medicare & Medicaid Services (CMS) recently announced several policy updates significantly impacting the healthcare and insurance industries. Key among these is the modification of coverage for wound care treatments, focusing on skin substitute grafts and tissue-based products for diabetic foot ulcers and venous leg ulcers. Set to take effect on January 1, 2026, these changes involve updated Local Coverage Determinations from all seven Medicare Administrative Contractors, affecting insurance carriers and healthcare providers. Out of 66 products evaluated, 18 have met CMS's evidentiary standards to receive Medicare coverage, while others remain in review or continue under current reimbursement practices.

Advancements in Chronic Disease Management and Price Transparency

In another significant move, CMS is set to change chronic disease management funding within Medicare through the ACCESS model. Starting in July 2026, this decade-long initiative rewards healthcare providers and payers for achieving successful health outcomes in chronic care management. The approach offers both traditional and digital care options, promoting innovation and cost efficiency while aligning with industry expectations for regulatory compliance.

Furthermore, CMS, alongside the Departments of Labor and Treasury, is proposing adjustments to healthcare price transparency regulations. These aim to simplify and reorganize price data, enhancing accessibility for both providers and patients. The proposals include lower out-of-network pricing thresholds and decreased reporting frequency, addressing regulatory compliance requirements under the No Surprises Act. Insurance professionals should note these developments, anticipating shifts in coverage policies, pricing strategies, and risk management practices across the industry.