The shutdown of the federal government brought the usual flow of Medicare and Medicaid regulations to an almost complete halt.  Now that the shutdown has ended, the logjam should end fairly quickly – and with a sense of urgency.

Currently, a number of major Medicare and Medicaid regulations remain with the Office of Management and Budget for review.  Even though the shutdown has now ended, it is not yet clear when they will be addressed.

By statute, the following regulations must be implemented by January 1.

  • CY 2026 Hospital Outpatient Prospective Payment System Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates
  • CY 2026 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System and Quality Incentive Program
  • CY 2026 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement
  • CY 2026 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts
  • Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2026

CMS traditionally gives 60 days’ notice before the January 1 implementation date.  That has not happened this year.

The following regulation must be implemented sometime in 2026 but has no specific implementation date.

  • Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities

Rules currently with OMB for final review that do not have a statutory deadline for release and implementation include:

  • Medicaid Managed Care-State Directed Payments
  • Medicaid Program; Prohibition on Federal Medicaid Funding for Sex Trait Modification Procedures Furnished to Children and Youth
  • Medicare and Medicaid Programs; Hospital Condition of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children
  • Center for Medicare & Medicaid Innovation Payment Models
  • Transparency in Coverage
  • Amendments to Rules Governing Organ Procurement Organizations
  • Contract Year 2027 Policy and Technical Changes to Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly Programs
  • Global Benchmark for Efficient Drug Pricing (GLOBE) Model
  • Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model

The progress of proposed and final regulations with OMB for review are listed and can be tracked on this OMB web page.