TEAM Proposed Changes FY26 IPPS
- APMConnect
- Apr 13
- 2 min read
Updated: 6 days ago
Transforming Episode Accountability Model (TEAM): Key Proposed Changes for 2026 and Beyond
In the recently released proposed rule, CMS outlines several significant changes to the Transforming Episode Accountability Model (TEAM), set to launch on January 1, 2026. TEAM is a 5-year, mandatory episode-based payment model designed to improve cost and quality accountability across acute care episodes.
To help you navigate these proposed changes more efficiently, we’ve created a streamlined PDF document that includes only the TEAM-specific proposed regulations, complete with bookmarked sections for each major policy update. Whether you're looking for quick reference or a deeper dive, this PDF makes it easy to find exactly what you need—without sifting through the entire rule. [Download the TEAM Proposed Changes PDF here].
Outlined in Section XI.A of the preamble, these changes aim to refine the model’s design, enhance equity, and support more accurate financial benchmarks. Below, we highlight the major updates proposed:
1. Limited Deferment Period
CMS proposes a short deferment window for specific hospitals, providing extra time for operational readiness and integration into the TEAM model.
2. Medicare Dependent Hospital (MDH) Program Expiration
Adjustments will be made to accommodate hospitals previously eligible for MDH status, considering its upcoming expiration.
3. New Quality Measure: Information Transfer PRO-PM
A new Patient Reported Outcome-based Performance Measure (Information Transfer PRO-PM) will assess how effectively information is transferred across care settings.
4. Neutral Quality Score for Insufficient Data
TEAM participants lacking sufficient quality data will receive a neutral score, avoiding penalization while promoting data completeness.
5. Target Price Construction with Coding Changes
A new methodology is proposed to adjust target prices when medical coding systems change, ensuring pricing integrity.
6. Normalization and Trend Factor Revisions
CMS plans to reconstruct both the normalization factor and the prospective trend factor used in payment calculations.
7. CDI Replaces ADI
The Community Deprivation Index (CDI) will replace the Area Deprivation Index (ADI) for measuring social risk, reflecting a more updated and inclusive metric.
8. Beneficiary Risk Adjustment Changes
Risk adjustment will now utilize a 180-day lookback and adopt HCC Version 28, aligning with other CMS initiatives.
9. Episode Attribution Alignment
Attribution methodologies will be refined to align the date range used in defining episodes.
10. Removal of Health Equity Plans & HRSN Reporting
CMS proposes removing the requirement for Health Equity Plans and Health-Related Social Needs (HRSN) data reporting to reduce reporting burden.
11. Expansion of SNF 3-Day Rule Waiver
This waiver will be added, offering greater post-acute care flexibility for TEAM participants.
12. Elimination of the Decarbonization and Resilience Initiative (DRI)
The DRI will be removed from TEAM, as CMS reassesses its alignment with the model’s core aims.
It is funny that CMS calls it a "neutral quality measure score". If I'm working through the math correctly, when CMS assigns a score of 50 (out of 100 points), you will lose half of your quality withhold.