CMS to Release Medicare 2026 Proposed Payment Regulations

March marks a significant time for sports enthusiasts with the NCAA basketball tournaments, but for those involved in regulation, it's the beginning of the Medicare regulatory season. The Centers for Medicare & Medicaid Services (CMS) is expected to release the proposed payment regulations for FY 2026, introducing new policies that will affect inpatient payment rates. A colleague, Leigh Feldman, and I delve into the forthcoming regulations, highlighting the unpredictability akin to the NCAA tournaments.

The focus on the Inpatient Prospective Payment System (IPPS) regulations could lead to major changes from the previous administration’s policies. Potential adjustments may include elimination of existing model policies and new payment structures that aim to maximize taxpayer savings. As the regulatory environment is evaluated, the implications of previously vacated policies, particularly around wage index disparities between urban and rural hospitals, will come under scrutiny.

A notable aspect of this year's regulation is the potential alignment of CMS's policies with the administration's emphasis on quality care for children, especially in areas of gender-affirming treatment. The proposed regulations may also revisit guidelines on emergency services and obstetrical care initiated during the Biden administration, giving insight into the future direction of healthcare policies under the Trump administration's oversight. As we approach the release of these regulations, the anticipation of what will unfold during 'reg season' continues to grow.