CMS Managed Care Rule on Medicare, Medicaid Reimbursement

CMS Rules & Proposed Rules

Published February 25th, 2026

Detected February 26th, 2026

Summary

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule concerning managed care reimbursement for Medicare and Medicaid programs. This rule, published in the Federal Register, outlines updated policies and requirements for managed care plans.

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What changed

The Centers for Medicare & Medicaid Services (CMS) has published a final rule (Document Number 2026-03779) detailing changes to managed care reimbursement for Medicare and Medicaid programs. The rule, which appears in the Federal Register on February 25, 2026, amends 42 CFR 438 and establishes new requirements or clarifies existing ones for managed care organizations participating in these federal health programs.

This rule will likely impact healthcare providers and managed care entities by altering reimbursement methodologies, payment rates, or operational requirements. Compliance officers should review the specific provisions of 42 CFR 438 as detailed in the Federal Register notice to understand the precise changes and their implications for their organization. While a specific compliance deadline is not explicitly stated in the provided text, entities should prepare for implementation upon the rule's effective date or as otherwise specified within the full document.

What to do next

Review the full text of the final rule (91 FR 9140) concerning managed care reimbursement.
Assess the impact of the updated regulations on current managed care contracts and reimbursement processes.
Update internal policies and procedures to align with the new CMS requirements.

Source document (simplified)

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Rule

Managed Care

A Rule by the Centers for Medicare & Medicaid Services on 02/25/2026

Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Medicare & Medicaid Services CFR 42 CFR 438 Document Citation 91 FR 9140 Document Number 2026-03779 Document Type Rule Page 9140
(1 page) Publication Date 02/25/2026 Published Content - Document Details
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Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Medicare & Medicaid Services CFR 42 CFR 438 Document Citation 91 FR 9140 Document Number 2026-03779 Document Type Rule Page 9140
(1 page) Publication Date 02/25/2026 Published Content - Document Details
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Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Part 438

CFR Correction

This rule is being published by the Office of the Federal Register to correct an editorial or technical error that appeared in the most recent annual revision of the Code of Federal Regulations.

In Title 42 of the Code of Federal Regulations, Parts 430 to 481, revised as of October 1, 2025, in section 438.72, reinstate paragraph (a) to read as follows:

§ 438.72 Additional requirements for long-term services and supports. (a) Nursing facility services and services delivered in intermediate care facilities for individuals with intellectual disabilities (ICFs/IID). The State must comply with the requirements in § 442.43 for nursing facility and ICF/IID services.