Health Care Week in Review: CMS CY 2027 MA Rate Announcement and FY 2027 IPPS/LTCH PPS Proposed Rule

April 13, 2026

Health Care Week in Review | CMS Releases CY 2027 MA Rate Announcement and FY 2027 IPPS and LTCH PPS Proposed Rule

Robert Stone, Timothy Trysla Alston & Bird + Follow Contact LinkedIn Facebook X Send Embed Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and analyses; and other health policy news.

Highlight of the Week

This week, CMS finalized the CY 2027 Medicare Advantage and Part D Rate Announcement and issued a proposed rule that would update Medicare payment policies and rates for inpatient and long-term care hospitals under the Medicare hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) for FY 2027.

Regulations, Notices & Guidance

• On April 6, 2026, the Centers for Disease Control and Prevention (CDC) released a notice entitled, World Trade Center Health Program: Petitions 029, 034, 035, and 062 - Hepatic Steatosis; Finding of Insufficient Evidence. The Administrator of the World Trade Center (WTC) Health Program has received several petitions to add “hepatic steatosis” or “fatty liver disease” to the List of WTC-Related Health Conditions. Upon reviewing the scientific and medical literature, including information provided by the petitioners, the WTC Administrator determined that there is insufficient evidence available to support taking further action at this time regarding hepatic steatosis. The WTC Administrator also found that insufficient evidence exists to request a recommendation of the WTC Health Program Scientific/Technical Advisory Committee, publish a proposed rule, or publish a determination not to publish a proposed rule.
• On April 7, 2026, the Department of Health and Human Services (HHS) released a proposed rule entitled, Reducing Bureaucracy and Burden for Community Services Programs. The HHS Administration for Children and Families (ACF) proposes to amend the Block Grants regulations, the Individual Development Account Reserve Funds Established Pursuant to Grants for Assets for Independence regulations, and the Emergency Community Services Homeless Grant Program regulations to eliminate unnecessary or obsolete regulations.
• On April 8, 2026, the Health Resources and Services Administration (HRSA) released a notice entitled, Funded Extension for the Small Health Care Provider Quality Improvement and Delta States Network Development Programs. HRSA provides grants through two programs seeking a 1-year funded extension: The Small Health Care Provider Quality Improvement Program (Quality) and the Delta States Network Development Program (Delta States). Quality provides support to rural primary care providers for the planning and implementation of quality improvement activities that improve the quality and delivery of rural health care services. This funded extension extends Quality’s 21 award recipients from cohort fiscal year 2022, HRSA-22-093, for a one-time 1-year period (August 1, 2026, to July 31, 2027). The current cohort was funded for a 4-year project period (August 1, 2022, to July 31, 2026). The statutory authority for this program allows for funding up to five years. Delta States funds organizations located in the eight Delta states through planning, implementation, and development of integrated health care networks. This funded extension extends Delta State’s 12 award recipients from cohort fiscal year 2023, HRSA-23-031, for a one-time 1-year period (August 1, 2026, to July 31, 2027). The current cohort was funded for a 3- year project period (August 1, 2023, to July 31, 2026). The statutory authority for this program allows for funding up to five years.
• On April 10, 2026, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule entitled, Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, etc. These proposals would advance reforms to modernize prior authorization for drugs by establishing clear decision deadlines for impacted payers—no later than 24 hours for urgent requests and 72 hours for standard requests—and increasing transparency through full disclosure of claims denials and appeals outcomes. Building on the 2020 CMS Interoperability and Patient Access Final Rule and the 2024 CMS Interoperability and Prior Authorization Final Rule, CMS proposes to require Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) fee‑for‑service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally‑facilitated Exchanges (FFEs)—including small group plans offered through the Federally‑facilitated Small Business Health Options Program (FF‑SHOP)—to support electronic prior authorization for drugs. CMS proposes adopting updated Health Level Seven Fast Healthcare Interoperability Resources (HL7 FHIR) standards under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), shortening and aligning prior authorization decision timeframes for drugs and non‑drug services, expanding transparency through required reporting of prior authorization and application programming interface (API) usage metrics, and requiring payers to make detailed prior authorization information available through Patient Access, Provider Access, and Payer‑to‑Payer APIs. CMS also seeks public input on related issues—including care coordination event notifications, cybersecurity resiliency, step therapy, and prior authorization for laboratory and durable medical equipment items—with most provisions proposed to take effect beginning October 1, 2027.
• On April 10, 2026, CMS released a proposed rule entitled, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2027 Rates; Requirements for Quality Programs; and Other Policy Changes. This proposed rule would revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals; make changes relating to Medicare graduate medical education (GME) for teaching hospitals; update the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs); update and make changes to requirements for certain quality programs; and make other policy-related changes.

Event Notices

Please note that two asterisks (**) preceding the item indicate a new event.

• April 12, 2026: NIH announced a meeting of the Office of AIDS Research Advisory Council. This is a hybrid meeting open to the public.
• April 16, 2026: CDC announced a meeting of the National Committee on Vital and Health Statistics. This is a virtual meeting open to the public.
• April 17, 2026: NIH announced a meeting of the National Center for Complementary & Integrative Health. This is a hybrid meeting with some sessions open to the public.
• April 23, 2026: NIH announced a meeting of the National Library of Medicine Board of Scientific Counselors. This is a hybrid meeting with some sessions open to the public.
• ***April 28, 2026:* NIH announced a meeting of the Office of the Secretary. This is a hybrid meeting open to the public.
• April 29, 2026: CDC announced a meeting of the Advisory Board on Radiation and Worker Health. This is a virtual meeting open to the public.
• April 30, 2026: FDA announced a meeting of the Oncologic Drugs Advisory Committee. This is a hybrid meeting open to the public.
• May 4-5, 2026: NIH announced **** a meeting of the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This is a hybrid meeting open to the public.
• May 5, 2026: NIH announced a meeting of the National Advisory Council on Alcohol Abuse and Alcoholism. This is a hybrid meeting with some sessions open to the public.
• May 7, 2026: ASTP announced a meeting of the Health Information Technology Advisory Committee. This is a hybrid meeting open to the public.
• May 12, 2026: NIH announced a meeting of the Board of Regents of the National Library of Medicine. This is a virtual meeting with some sessions open to the public.
• May 13, 2026: NIH announced a meeting of the National Institute on Aging. This is an in-person meeting with some sessions open to the public.
• May 13, 2026: NIH announced a meeting of the National Diabetes and Digestive and Kidney Diseases Advisory Council. This is a hybrid meeting with some sessions open to the public.
• ***May 14-15, 2026:* NIH announced a meeting of the Office of the Director. This is a hybrid meeting with some sessions open to the public.
• ***May 18, 2026:* NIH announced a meeting of the National Advisory Council for Human Genome Research. This is a hybrid meeting with some sessions open to the public.
• May 19, 2026: NIH announced a meeting of the National Advisory Council for Nursing Research. This is a hybrid meeting open to the public.
• May 19, 2026: NIH announced a meeting of the Interagency Autism Coordinating Committee. This is a hybrid meeting open to the public.
• May 19, 2026: NIH announced a meeting of the National Advisory Council on Minority Health and Health Disparities. This is a virtual meeting open to the public.
• May 21, 2026: NIH announced a meeting of the National Advisory General Medical Sciences Council. This is a virtual meeting open to the public.
• June 1-2, 2026: NIH announced a meeting of the Fogarty International Center Advisory Board. This is a hybrid meeting with some sessions open to the public.
• June 2, 2026: NIH announced a meeting of the National Arthritis and Musculoskeletal and Skin Diseases Advisory Council. This is a hybrid meeting with some sessions open to the public.
• June 5, 2026: NIH announced a meeting of the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This is a hybrid meeting with some sessions open to the public.
• June 5, 2026: CDC announced a meeting of the Subcommittee on Procedures Reviews of the Advisory Board on Radiation and Worker Health. This is a virtual meeting open to the public.
• June 8-9, 2026: FDA announced a public workshop entitled, Fiscal Year 2026 Generic Drug Science and Research Initiatives Workshop. This is a hybrid meeting open to the public.
• June 10-11, 2026: NIH announced a meeting of the National Institute of Diabetes and Digestive and Kidney Diseases. This is a hybrid meeting with some sessions open to the public.
• June 12, 2026: FDA announced a public hearing related to the Commissioner’s National Priority Voucher (CNPV) Pilot Program. This is a hybrid meeting open to the public.
• June 15, 2026: NIH announced a meeting of the National Institute of Environmental Health Sciences Board of Scientific Counselors. This is a hybrid meeting with some sessions open to the public.
• June 15-16, 2026: HHS announced a meeting of the Physician-Focused Payment Model Technical Advisory Committee (PTAC). This is a hybrid meeting open to the public.
• June 29, 2026: NIH announced a meeting of the National Cancer Advisory Board. This is a hybrid meeting with some sessions open to the public.
• July 8, 2026: NIH announced a meeting of the National Advisory Child Health and Human Development Council. This is a hybrid meeting with some sessions open to the public.
• September 10-11, 2026: NIH announced a meeting of the Fogarty International Center Advisory Board. This is a hybrid meeting with some sessions open to the public.
• September 14-15, 2026: HHS announced a meeting of PTAC. This is a hybrid meeting open to the public.
• September 15-16, 2026: NIH announced a meeting of the National Advisory Council on Aging. This is a hybrid meeting with some sessions open to the public.
• September 24, 2026: ASTP announced a meeting of the Health Information Technology Advisory Committee. This is a virtual meeting open to the public.
• November 5, 2026: ASTP announced a meeting of the Health Information Technology Advisory Committee. This is a virtual meeting open to the public.
• December 7-8, 2026: NIH announced a meeting of the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This is a hybrid meeting open to the public.
• December 8-9, 2026: HHS announced a meeting of PTAC. This is a hybrid meeting open to the public.

Reports, Studies & Analyses

• On April 8, 2026, the Government Accountability Office (GAO) released a report entitled, STEM: Additional Data Needed on Graduate Researcher and Postdoctoral Scholar Compensation. A robust science, technology, engineering, and mathematics (STEM) workforce drives innovation and economic growth and supports U.S. national security. Federal agencies have invested billions of dollars annually in STEM research, which includes investments in training graduate researchers and postdoctoral scholars (postdocs) to join this workforce. GAO was asked to examine federal financial support for STEM graduate researchers and postdocs. GAO found that federal agencies support a substantial share of the U.S. STEM research workforce by funding graduate researchers and postdoctoral scholars either directly, through agency-run programs, or indirectly, through grants to universities, with compensation set by agencies for direct awards and by universities for indirect awards. In academic year 2023, about 62,500 STEM graduate researchers and 22,000 postdocs—representing roughly 27 percent and 50 percent of the national totals, respectively—received some form of federal funding. Although no centralized data exist on graduate researcher compensation, available information suggests median compensation levels in the mid-$30,000 range for graduate researchers and around $60,000 for postdocs, with variation by funding mechanism and institution. GAO also found that decisions to enter or remain in federally funded research positions depend on factors such as career goals, job prospects, funding stability, perceived adequacy of compensation, and local cost of living. To address data gaps that limit oversight, GAO recommends that the National Science Foundation analyze what additional compensation data are needed and whether they can be feasibly collected, and establish a timeline to complete a congressionally mandated study on graduate student funding that had not yet begun as of March 2026.

Other Health Policy News

• On April 6, 2026, CMS released the Announcement of CY 2027 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate Announcement). For CY 2027, CMS will continue to use the 2024 MA risk adjustment model, which was calibrated using Medicare Fee-for-Service (FFS) diagnoses from 2018 and expenditure data from 2019 and was fully phased in by CY 2026. CMS is not finalizing the newer risk adjustment model, calibrated with 2023 diagnoses and 2024 expenditures, that had been proposed in the CY 2027 Advance Notice. For CY 2027 risk score calculations, CMS is finalizing its policy to exclude diagnoses from audio-only encounters and from unlinked chart review records (CRRs), while allowing diagnoses from unlinked CRRs for beneficiaries who switch from one MA organization to another. CMS expects an average year-over-year increase in revenue of 2.48 percent based on the policies included in the 2027 Rate Announcement and broader trends.

The full Rate Announcement can be found here. The CMS fact sheet can be found here.
- On April 7, 2026, HRSA announced that it plans to award up to 15 new grants of up to $750,000 each over three years through the Rural Residency Planning and Development (RRPD) Program. The RRPD program supports new rural residency programs in high-need specialties, including family medicine, internal medicine, psychiatry, OB-GYN, general surgery, and preventive medicine. The RRPD program provides start-up funding to establish sustainable rural residency programs supported by long-term funding sources like Medicare and Medicaid. The goal of the program is to address rural workforce shortages by increasing the number of physicians trained in rural settings, increasing the likelihood that the physicians will remain to practice in these settings.

More information can be found here. The application portal can be found here.
- On April 8, 2026, CMS issued new guidance to help states prepare for upcoming statutory limits on the use of federal Medicaid and CHIP matching funds for certain noncitizens. The guidance outlines state responsibilities for implementing these changes, which will take effect on October 1, 2026, and are intended to align federal claiming practices with existing statutory eligibility requirements.

The guidance, issued through a State Health Official (SHO) letter, provides operational direction on eligibility systems, application processes, verification procedures, and claims processing related to Section 71109 of the One Big Beautiful Bill Act (OBBBA). CMS indicated that it will offer technical assistance and rely on existing oversight mechanisms to support state compliance and ensure accurate federal fund claiming once the changes are implemented.

Further, the guidance notes that federal Medicaid matching funds will continue to be available for the treatment of emergency medical conditions. In addition, the statutory changes do not affect states’ existing options to provide Medicaid and CHIP coverage to lawfully residing children and pregnant women, nor do they alter federal matching eligibility for Health Services Initiatives funded through CHIP.

The full SHO letter can be found here. A press release can be found here.
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