RISE summarizes recent regulatory-related headlines and reports.
CMS data: 14.3M Medicare beneficiaries enroll in ACOs in 2026
The Centers for Medicare & Medicaid Services (CMS) reports an increase in the number of Medicare enrollees in accountable care organizations for 2026. As of January 2026, CMS estimates that 14.3 million Medicare beneficiaries will receive care coordinated by accountable care organizations (ACOs), up from 13.7 million in 2025, representing a 4.4 percent increase. The figure includes patients whose health care providers are in Medicare Shared Savings Program (Shared Savings Program) ACOs and entities participating in Center for Medicare and Medicaid Innovation (CMS Innovation Center) accountable care models, as well as other CMS Innovation Center models focused on total cost of care, advanced primary care, and specialty care.
ACOs, which are groups of doctors, hospitals, and other health care providers who collaborate and provide coordinated, high-quality care to people with Medicare, have saved Medicare billions of dollars by focusing on delivering the right care at the right time while avoiding unnecessary services and medical errors.
- For the 2026 performance year, CMS approved 134 applications for the Shared Savings Program, including 72 new ACOs and 62 renewing or reentering ACOs. This brings the total number of ACOs participating in the Shared Savings Program for Performance Year 2026 to 511, up from 476 ACOs participating in 2025. These Shared Savings Program ACOs, with more than 700,000 health care providers and organizations, will serve 12.6 million people with traditional Medicare, a 12.3 percent increase from 2025 and the largest number ever served by the program.
- The ACO REACH Model has 74 ACOs with 125,909 health care providers and organizations providing care to an estimated 1.7 million people with traditional Medicare. This model has 614 federally qualified health centers, rural health clinics, and critical access hospitals participating in 2026.
- The Kidney Care Choices (KCC) Model includes 74 kidney contracting entities (KCEs) which are accountable for the quality and care of their aligned people with traditional Medicare. The KCC Model has 7,534 participating health care providers and organizations, serving 237,000 people with traditional Medicare who have chronic kidney disease and end-stage renal disease in 2026.
- The ACO PC Flex Model includes 23 ACOs serving 359,720rpeople with Traditional Medicare and tests a new payment model for primary care within the Shared Savings Program. ACOs jointly participate in the model and the Shared Savings Program.
SAMHSA distributes nearly $800M in block grants
The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services (HHS) has distributed $794 million in block grant funding across the United States and territories for community mental health services and substance abuse treatment and prevention.
The allocations include $319 million for SAMHSA's Community Mental Health Services Block Grant (MHBG), which provides comprehensive community mental health services for adults with serious mental illness and children with serious emotional disturbance, and $475 million for the agency’s Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG) program to prevent and treat substance abuse. This funding represents the first allocation for the annual block grant awards.
Former NFL player convicted of $197M Medicare fraud
A federal jury in the Middle District of Florida convicted the owner of a marketing company, and former NFL player, for his role in a yearslong scheme to deceive Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) out of nearly $200 million by selling patient information and fake doctors’ orders for orthotic braces that patients did not want or need.
According to court documents and evidence presented at trial, Joel Rufus French, 47, of Amory, Miss., worked with overseas call centers that pressured elderly Americans to provide their personal and health insurance information and agree to accept medically unnecessary orthotic braces. Some of the individuals who agreed to the braces suffered from Alzheimer’s and dementia. In certain instances, the call centers altered call recordings to make it seem like Medicare patients agreed to the braces when they did not.
French paid fake telemedicine companies to obtain signed orders from doctors and nurse practitioners who never examined, and often never even spoke to, the patients. He sold the orders to marketers and medical supply companies, which then submitted claims to Medicare. French also defrauded Medicare and CHAMPVA, the health care program for spouses and children of veterans who have or had a permanent and total service-connected disability or who died from a service-connected condition, by billing the programs for orthotic braces through eight durable medical equipment supply companies that he owned and managed, using false documents to hide his connection to the companies from Medicare.
The jury convicted French of conspiracy to commit health care fraud and wire fraud, conspiracy to commit money laundering, and conspiracy to offer, pay, solicit, and receive kickbacks. French faces a maximum penalty of 20 years in prison for conspiracy to commit health care fraud and wire fraud, 10 years in prison for conspiracy to commit money laundering, and five years in prison for conspiracy to defraud the United States.
AHIP-CMS release findings from 2025 APM adoption survey
AHIP, in collaboration with CMS, released the results of the 2025 Alternative Payment Model (APM) Adoption Survey. The findings, AHIP said, reaffirm the commitment of the federal government and private health plans to advance value-based care and APM models that shift payment from fee-for-service models toward arrangements that reward quality, efficiency, and improved patient outcomes.
The 2025 survey analyzed data across commercial, Medicaid, Medicare Advantage (MA), and original Medicare based on payments made to providers in 2024 or the most recent 12 months of data available. CMS provided original Medicare payment data, while participating states submitted their own Medicaid data; all other data were reported by responding health plans.
Participants in the 2025 survey represent over 271 million people nationwide, or 87.5 percent of covered lives across all lines of business, based on 2024 enrollment figures.
Key findings:
- 44.9 percent of all health care payments across all lines of business were tied to APMs that hold providers accountable for quality and cost of care in 2024 compared to 45.2 percent in 2023.
- 28.7 percent of health care payments across all lines of business were tied to APMs with downside risk in 2024 compared to 28.5 percent in 2023.
- Seventy percent of health plan respondents expect APM activity to increase over the next 24 months, citing provider readiness, health plan engagement, and health plans’ ability to operationalize such models as key facilitators.
- Fifty-five percent of health plans believe the category that will grow the most in the future is 3B—shared risk/procedure-based episode payments.
Humana report: Value-based care improves outcomes in MA
Medicare Advantage members in value-based care arrangements had 24.3 percent fewer inpatient hospital admissions that those in original Medicare in 2024, according to a Humana report on value-based care. Humana reports that its Medicare Advantage members who receive value-based care had 13.4 percent fewer emergency department visits and 7.6 percents fewer hospital admissions than members in non-value-based care arrangements. In addition, these Medicare Advantage members report higher satisfaction with their care, including a 13-point higher Net Promoter Score than those using fee-for-service.
Medicaid tech companies pledge $600M to support community engagement
CMS announced that 10 health technology companies that have existing Medicaid eligibility and enrollment contracts with states have voluntarily pledged to help states successfully prepare for and implement Medicaid community engagement requirements.
Companies that currently support state Medicaid systems have informed CMS that they intend to offer states more than $600 million in no-cost and significantly discounted technology products and services to support community engagement implementation while accelerating broader modernization of Medicaid systems. These voluntary commitments are expected to generate significant savings over the coming years for states and taxpayers and improve beneficiary experience.
The community engagement requirements apply to certain adults enrolled in Medicaid and have the potential to empower these beneficiaries through employment, education, volunteering, or job training opportunities. CMS issued guidance to states in late 2025 providing an overview of these requirements.
Companies voluntarily participating include Accenture, Acentra Health, Conduent, GDIT, Deloitte, Gainwell, Maximus, Curam by Merative, Optum, and RedMane.
States must implement community engagement requirements by January 1, 2027, and may choose to implement earlier.