CMS & CMMI Updates

Key Actions:

CMS activity in the last 30 days shows three major tracks: MA/Part D transparency, rural health funding, and Medicare operations/payment integrity.

First, CMS issued a proposed Medicare rule, CMS-4214-P, to implement sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026, paired with a broader announcement that CMS is proposing reforms to strengthen transparency and affordability in Medicare Advantage and Part D (press release; fact sheet). CMS has not provided all operative details in the source list, but the framing signals continued scrutiny of plan design, beneficiary affordability, and transparency obligations for MA and Part D sponsors.

Second, the Trump administration announced a wave of rural health investments through CMS/HHS channels, including $92 million for Ohio rural hospital networks, maternal care, and service expansion (Ohio); $78 million for Texas workforce, chronic disease prevention, and facility upgrades (Texas); more than $177 million for Nebraska workforce, mobile care, and service modernization (Nebraska); $209 million for Iowa advanced care, maternal telehealth, and cancer prevention (Iowa); $37.7 million for Louisiana rural workforce training and recruitment (Louisiana); plus targeted rural EMS/mobile care funding in Montana (Montana), New Hampshire—more than $11 million (New Hampshire), Missouri (Missouri), and Delaware early-career rural physicians (Delaware).

Third, CMS released multiple transmittals affecting claims, finance, survey/certification, and post-acute payment operations: R250SOMA revising State Operations Manual Chapter 5 effective October 16, 2026 (R250SOMA); R249SOMA updating Exhibit 286 for hospital, CAH, and REH database worksheets effective October 9, 2026 (R249SOMA); R14001BP updating IRF benefit policy effective November 17, 2026 (R14001BP); R13983CP for the October 2026 ASC payment system update (R13983CP); and payment-integrity edits for hospice, home health, SNF physician services, claims appeals, financial controls, HIGLAS provider-terminated status, and Medicare overpayment/underpayment interest rates (R13997OTN; R13996OTN; R13995CP; R13992CP; R13991FM; R14007FM; R14006FM).