Medicare Current Beneficiary Survey data were used to examine barriers to care, such as out-of-pocket costs, and utilization measures, such as flu shots and cholesterol tests, comparing rural and urban Medicare Advantage enrollees, rural and urban traditional Medicare enrollees, and rural traditional and Medicare Advantage enrollees.
See Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries.
A new study identifies that only about one percent of noncore rural counties had higher-level neonatal care availability in 2022; 20 of the 27 noncore counties that had higher-level neonatal care in 2010 lost this service by 2022.
See Availability of Higher-Level Neonatal Care Services in Rural U.S. Counties, 2010-2022.
On December 3, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities interim final rule.
CMS is removing the requirements for nursing homes to provide a minimum of 3.48 hours of nursing care per resident day, including 0.55 hours of care from a registered nurse (RN) per resident day and at least 2.45 hours of care from a nurse aide per resident day. The agency is also removing the requirement for nursing homes to have 24/7 onsite RN services and is reinstating its prior policy requiring facilities to use the services of an RN for at least eight consecutive hours a day, seven days a week and to designate an RN to serve as the director of nursing on a full-time basis except when waived.
The facility assessment requirements adopted in the 2024 final rule will remain in place. The interim final rule is effective on February 2, 2026, and comments are due on the same day.
On November 28, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates the Medicare payment policies and rates for home health agencies (HHAs).
CMS estimates the Medicare payments to HHAs in CY 2026 would decrease in the aggregate by an estimated1.3.1 percent. Also, CMS finalized the policies to remove the COVID-19 Vaccine measure, exemption process for prior authorization for certain Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics and Supplies (DMEPOS) accreditation and improvement to the DMEPOS competitive bidding program to give beneficiaries access to current and supported technology.
The rule is effective January 1, 2026.
Per an Executive Order and the 2026 Hospital Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare and Medicaid Services (CMS) will survey hospitals to find out how much they pay for outpatient drugs. This survey runs from January 1 through March 31, 2026.
The results will help shape Medicare payment policies starting in 2027. Hospitals that received OPPS payments for outpatient drugs between July 1, 2024 and June 30, 2025 must complete the survey.
Hospitals should confirm their Point of Contact by emailing OPPSDrugSurvey@cms.hhs.gov as soon as possible. CMS is offering training webinars on December 11.
On December 8, the Centers for Medicare & Medicaid Services (CMS) released guidance for states about new community engagement requirements for certain Medicaid beneficiaries.
The guidance explains requirements from the “Working Families Tax Cut” legislation signed into law on July 4, 2025, which requires certain adult Medicaid recipients to show they are working, going to school, volunteering, or participating in job training programs to qualify for coverage. States must notify current beneficiaries about these new rules and begin implementing the requirements by January 1, 2027, with required outreach starting between July and September 2026 depending on each state’s chosen approach.
CMS will issue additional rules by June 1, 2026. For more information, please visit: www.medicaid.gov/medicaidreforms.
In November, the Centers for Medicare & Medicaid Services (CMS) issued updates to Medicare payment policies and rates for hospital outpatient services under the Hospital Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2026.
In addition to finalizing the payment rates, this year’s rule includes an update to the methodology used to calculate the Overall Hospital Quality Star Rating to emphasize the Safety of Care measure group in hospitals’ star ratings. It finalizes a new payment for drug administration services provided in off-campus outpatient departments, eliminates the ‘inpatient only’ list, changes the hospital price transparency requirements, and changes to the Hospital Outpatient Quality Reporting (OQR) and Rural Emergency Hospital Quality Reporting (REHQR) programs.
CMS is not finalizing their proposal to increase the annual offset amount for non-drug items and services per the 340B Remedy Rule at this time. CMS anticipates finalizing a larger reduction (such as 2 percent or other reduction greater than 0.5 percent) beginning in CY 2027; CMS will instead implement the previously finalized 0.5 percent reduction for CY 2026.
In November, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part D), and Medicare Cost Plan Program. It proposes updates to MA and Part D Star Ratings quality measurements and streamlining certain enrollment processes.
Comments due on January 26, 2026.
On November 6, the Centers for Medicare & Medicaid Services (CMS) released a notice reminding states that they must act quickly when a person’s residency changes. The notice explains what states should do to review and update eligibility for people who might be enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in more than one state.
CMS will send each state a one-time list of people who may be enrolled in another state’s Medicaid or CHIP program. This list is based on data that states have submitted to CMS. States will need to review this information, check if these people are still eligible based on where they live, and, if not, end their coverage in the state where they no longer reside.
For technical assistance or additional questions about this bulletin, states may submit an email to: CMSEligEnrollSupport@cms.hhs.gov.
On November 14, the Centers for Medicare & Medicaid Services (CMS) issued preliminary guidance for states regarding the implementation of new federal requirements on health care-related (provider) taxes in Medicaid that are laid out in the Working Families Tax Cuts legislation (Public Law 119-21).
CMS will develop additional policies, guidance, and implementing regulations. The letter provides details regarding limits on new or increased healthcare-related (provider) taxes. It also includes information about transition periods related to the closure of a financing loophole and the next steps for compliance.
States with questions about this guidance or needing technical assistance should email taxwaiver@cms.hhs.gov.
