On November 5, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a rule (the “Proposed Rule”) that would cut certain administrative requirements from the Conditions of Participation (CoPs), Conditions for Coverage (CfCs), and Requirements for Participation for Medicare- and Medicaid-participating providers and suppliers (collectively referred to as CoPs).
CMS said in a fact sheet that the regulatory (or deregulatory) revisions would reduce costs, increase transparency, enhance flexibility for providers to deliver innovative patient care, and streamline existing regulations—with an estimated savings of $320 million and 3.26 million hours in staff time. The proposals followed CMS’ “comprehensive review” of CoPs for all 21 provider and supplier types as well as some payment policies.
Below is an overview of the Proposed Rule’s impact on various provider types and patient areas.
Hospitals
The Proposed Rule would:
- remove staff training requirements for transfer protocols and emergency services readiness (both currently effective), and for obstetric (OB) care (effective Jan. 1, 2027).
- remove the OB care-specific Quality Assessment and Performance Improvement (QAPI) requirements (effective Jan. 1, 2027).
- establish new requirements regarding patients’ rights related to birth tissue collection by hospitals that provide OB care services, including standards for informed consent and policies and procedures to support families requesting birth tissues for cultural, religious, or personal reasons.
Critical Access Hospitals (CAHs)
The Proposed Rule would:
- remove staff training requirements related to emergency services readiness (currently effective) and OB care (effective Jan. 1, 2027).
- remove OB care-specific QAPI requirements (effective Jan. 1, 2027).
- establish new requirements regarding patients’ rights related to birth tissue collection by CAHs that provide OB care services, as described above.
- revise regulations to clarify current CMS policy that CAH distance eligibility determinations are based on proximity to hospitals that provide acute care inpatient services or another CAH.
- implement new statutory requirements to allow CAHs that meet certain qualifying criteria, as defined by the statute, to be exempt from the distance eligibility requirements.
Long-Term Care (LTC) Facilities
The Proposed Rule would:
- remove requirements related to educating staff about the benefits and risks of the COVID-19 vaccine, offering the vaccine, and documentation; and streamline the remaining COVID-19 vaccine requirements for residents/clients (this requirement is also removed for Intermediate Care Facilities for Individuals with Intellectual Disabilities).
- remove the continuing respiratory illness data reporting requirement while retaining the requirement for specific reporting during a future public health emergency (PHE) declared by the Secretary of the Department of Health and Human Services.
- modify the requirement for LTC facilities to provide a state ombudsman with notice of resident transfers related to emergent care.
- revise requirements for the involvement of representatives of direct care staff in conducting the LTC facility assessment.
- revise physical environment requirements to exempt existing facilities from the room occupancy and bathroom facility standards.
Rural Emergency Hospitals (REHs)
The Proposed Rule would:
- remove expired COVID-19 and seasonal influenza reporting requirements related to ongoing data reporting and staff vaccination.
- remove REH data reporting requirements during a PHE.
Physical Environment
The Proposed Rule would:
- adopt the 2024 editions of National Fire Protection Association (NFPA) Life Safety Code (LSC) and Health Care Facilities Code (HCFC) and the 2022 edition of the Emergency and Standby Power Systems (ESPS) Codes.
- remove the requirement that patient care areas have access to natural light and ventilation through exterior windows and doors.
Medicaid Payment Transparency for Nursing Facilities and ICFs/IID
CMS further proposes rescinding certain Medicaid institutional payment transparency reporting requirements to reduce burden for states and institutional providers.
Seeking Comments
CMS also seeks comments on:
- allowing LTC facility residents to opt out of discharge notices sent to the state ombudsman.
- minimizing burden for hospitals reporting ongoing illness data.
- flexibility for providers regarding physician supervision of certified registered nurse anesthetists (CRNAs).
- expanding the scope of practice of physician assistants and nurse practitioners providing care in LTC facilities.
- revising criteria for transplant program initial certification.
- policies to address Medicaid institutional workforce shortages.
CMS is accepting comments from interested parties by January 9, 2027. Electronic comments may be submitted here (reference file code CMS-3484-P).
Epstein Becker Green Staff Attorney Ann W. Parks contributed to the preparation of this post.
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The Health Law Advisor blog is currently edited by Emily Chi Fogler.
