The Regulator

UPDATE: CMS awarded $10 billion in year-two Rural Health Transformation money to all 50 states, from $142.3 million for New Jersey to $282.0 million for Texas. The Centers for Medicare & Medicaid Services (CMS) published the award table Monday, after missing its October 31 target and delaying the competitive portion, as we reported November 8. Who it hits: state Medicaid agencies and the rural hospitals, clinics and vendors those states will fund. Texas gets $281,976,026, Alaska $272,653,149 and Montana $239,740,669; Connecticut, Rhode Island and Massachusetts all land between $153 million and $159 million, and Missouri gets $218,547,090. So what: CMS says the split is 50% baseline, which works out to $100 million per state, and 50% workload-based funding tied to rural population, facility characteristics, state plans and policy actions. States must obligate funds within their budget period and spend them by September 30, 2032 or return them to the Treasury, and more detailed quarterly reporting starts this month. The program is $50 billion over five years, and CMS counts $20 billion awarded so far. Confidence: High on every figure, which comes from the CMS table and fact sheet; the ranking is our reading of that table. The release does not say how much of the workload half is competitive. Sources: CMS press release, second-year Rural Health Transformation awards, CMS fact sheet, Rural Health Transformation Program year 2 awards.

UPDATE: CMS’s proposal to cut hospital and nursing home paperwork reaches the Federal Register today, with savings estimated at $320 million a year and a 60-day comment clock. The proposed rule, Cutting Administrative Requirements for Excellence in Patient Care (CMS-3484-P), follows CMS’s review of the rules of participation for 21 provider and supplier types. Who it hits: hospitals, critical access hospitals, nursing homes, rural emergency hospitals, intermediate care facilities and others. So what: CMS estimates average annual savings of $142.6 million for long term care facilities ($1.426 billion over 10 years) and $123.2 million for hospitals ($1.23 billion over 10 years). For nursing homes it would end the weekly acute respiratory illness reporting outside a declared public health emergency, drop the COVID-19 vaccine education and offering requirements, and rescind state reporting on what share of Medicaid nursing home payments goes to direct care and support staff pay. For hospitals it would remove the recently finalized obstetric staff training and obstetric quality requirements. Comments are due 60 days after publication, which we count as January 9, 2027; confirm the date in the published notice. Confidence: High on the figures, which come from the notice’s own text; the copy we read is the public inspection version scheduled for publication today. Sources: Federal Register public inspection copy, document 2026-22812, Regulations.gov docket CMS-2026-3631. Supplemental: American Health Care Association summary.

The same CMS rule asks whether Medicare should keep requiring physician supervision of nurse anesthetists and how to lower barriers for new organ transplant programs. These are requests for information, not proposals. Who it hits: certified registered nurse anesthetists (CRNAs), anesthesiologists, hospitals, ambulatory surgery centers, and transplant centers seeking Medicare approval. So what: under current policy a physician must be immediately available when a CRNA administers anesthesia, though since 2001 a state’s governor can request an exemption; CMS asks whether to retain, revise or change the policy. On transplants, CMS notes more than 250 Medicare-approved programs and says programs seeking initial approval report trouble meeting certification requirements. A third request covers easing respiratory illness and infectious disease data reporting for hospitals through the National Healthcare Safety Network. Confidence: High; the language is from the notice. Source: Federal Register public inspection copy, document 2026-22812.

Quiet note: we could not confirm any new Justice Department or HHS inspector general enforcement announcement dated November 9 or 10 at press time, so none is included.