| Read this in your browser December 11, 2025 What's New New Toolkit for Rural Veterans. The Department of Veterans Affairs National Cemetery Administration (NCA) released a new Outreach Toolkit (#5) to help raise awareness about VA burial and memorial benefits for Veterans living in rural communities. It includes ready-to-use talking points, social media posts, flyers, info sheets, and digital posters that highlight available benefits and how to apply for them. Organizations and partners may use these materials to provide clear and helpful information to Veterans and their families. Rural Health Research Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway. Sign up to receive alerts when new publications become available. Availability of Higher-Level Neonatal Care Services in Rural U.S. Counties, 2010-2022. Among the key findings, only about one percent of noncore rural counties had higher-level neonatal care availability in 2022; 20 of the 27 noncore counties that had higher-level neonatal care in 2010 lost this service by 2022. Rural Hospital Financial Distress Index: Relative Risk in 2025. The model assigns every rural hospital to one of four financial risk categories: highest, mid-highest, mid-lowest, or lowest. This infographic shows a U.S. map of the number and percent of rural hospitals within each state at highest relative financial distress risk in 2025. Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries. Medicare Current Beneficiary Survey data was used to examine barriers to care, such as out-of-pocket costs, and utilization measures, such as flu shots and cholesterol tests, comparing rural and urban Medicare Advantage enrollees, rural and urban traditional Medicare enrollees, and rural traditional and Medicare Advantage enrollees. Policy Updates Visit the FORHP Policy page to see all recent updates and send questions to ruralpolicy@hrsa.gov. Medicare Survey on Hospital Outpatient Drug Costs Begins January 1. Per an Executive Order and the 2026 Hospital Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare and Medicaid Services (CMS) will survey hospitals to find out how much they pay for outpatient drugs. This survey runs from January 1 through March 31, 2026. The results will help shape Medicare payment policies starting in 2027. Hospitals that received OPPS payments for outpatient drugs between July 1, 2024 and June 30, 2025 must complete the survey. Hospitals should confirm their Point of Contact by emailing OPPSDrugSurvey@cms.hhs.gov as soon as possible. CMS is offering training webinars on December 11. Requirements for States to Establish Medicaid Community Engagement Requirements. On December 8, the Centers for Medicare & Medicaid Services (CMS) released guidance for states about new community engagement requirements for certain Medicaid beneficiaries. The guidance explains requirements from the "Working Families Tax Cut" legislation signed into law on July 4, 2025, which requires certain adult Medicaid recipients to show they are working, going to school, volunteering, or participating in job training programs to qualify for coverage. States must notify current beneficiaries about these new rules and begin implementing the requirements by January 1, 2027, with required outreach starting between July and September 2026 depending on each state's chosen approach. CMS will issue additional rules by June 1, 2026. For more information, please visit: www.medicaid.gov/medicaidreforms. Medicare Finalizes Changes to Medicare Home Health Program. Effective January 1, 2026. On November 28, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates the Medicare payment policies and rates for home health agencies (HHAs). CMS estimates the Medicare payments to HHAs in CY 2026 would decrease in the aggregate by an estimated1.3.1 percent. Also, CMS finalized the policies to remove the COVID-19 Vaccine measure, exemption process for prior authorization for certain Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics and Supplies (DMEPOS) accreditation and improvement to the DMEPOS competitive bidding program to give beneficiaries access to current and supported technology. The rule is effective January 1, 2026. CMS Repeals Minimum Staffing Standards for Nursing Homes. February 2, 2026. On December 3, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities interim final rule. CMS is removing the requirements for nursing homes to provide a minimum of 3.48 hours of nursing care per resident day, including 0.55 hours of care from a registered nurse (RN) per resident day and at least 2.45 hours of care from a nurse aide per resident day. The agency is also removing the requirement for nursing homes to have 24/7 onsite RN services and is reinstating its prior policy requiring facilities to use the services of an RN for at least eight consecutive hours a day, seven days a week and to designate an RN to serve as the director of nursing on a full-time basis except when waived. The facility assessment requirements adopted in the 2024 final rule will remain in place. The interim final rule is effective on February 2, 2026, and comments are due on the same day. Final Outpatient Hospital Payment Rule Released. Effective January 1, 2026. In November, the Centers for Medicare & Medicaid Services (CMS) issued updates to Medicare payment policies and rates for hospital outpatient services under the Hospital Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2026. In addition to finalizing the payment rates, this year's rule includes an update to the methodology used to calculate the Overall Hospital Quality Star Rating to emphasize the Safety of Care measure group in hospitals' star ratings. It finalizes a new payment for drug administration services provided in off-campus outpatient departments, eliminates the 'inpatient only' list, changes the hospital price transparency requirements, and changes to the Hospital Outpatient Quality Reporting (OQR) and Rural Emergency Hospital Quality Reporting (REHQR) programs. CMS is not finalizing their proposal to increase the annual offset amount for non-drug items and services per the 340B Remedy Rule at this time. CMS anticipates finalizing a larger reduction (such as 2 percent or other reduction greater than 0.5 percent) beginning in CY 2027; CMS will instead implement the previously finalized 0.5 percent reduction for CY 2026. Medicare Advantage Contract Year 2027 proposed rule. Comments due January 26, 2026. In November, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part D), and Medicare Cost Plan Program. It proposes updates to MA and Part D Star Ratings quality measurements and streamlining certain enrollment processes. CMS Releases Informational Bulletin About Ensuring Medicaid Eligibility Integrity by Addressing Concurrent Medicaid and CHIP Enrollment Across States. On November 6, the Centers for Medicare & Medicaid Services (CMS) released a notice reminding states that they must act quickly when a person's residency changes. The notice explains what states should do to review and update eligibility for people who might be enrolled in Medicaid or the Children's Health Insurance Program (CHIP) in more than one state. CMS will send each state a one-time list of people who may be enrolled in another state's Medicaid or CHIP program. This list is based on data that states have submitted to CMS. States will need to review this information, check if these people are still eligible based on where they live, and, if not, end their coverage in the state where they no longer reside. For technical assistance or additional questions about this bulletin, states may submit an email to: CMSEligEnrollSupport@cms.hhs.gov. CMS Issues Guidance on New Federal Requirements on Medicaid Health Care-Related (provider) Taxes. On November 14, the Centers for Medicare & Medicaid Services (CMS) issued preliminary guidance for states regarding the implementation of new federal requirements on health care-related (provider) taxes in Medicaid that are laid out in the Working Families Tax Cuts legislation (Public Law 119-21). CMS will develop additional policies, guidance, and implementing regulations. The letter provides details regarding limits on new or increased healthcare-related (provider) taxes. It also includes information about transition periods related to the closure of a financing loophole and the next steps for compliance. States with questions about this guidance or needing technical assistance should email taxwaiver@cms.hhs.gov. Public Law 119-21: Summary of Medicaid and Children's Health Insurance Program (CHIP) Related Provisions. The Centers for Medicare & Medicaid Services (CMS) Informational Bulletin provides general information to states, stakeholders, and others on the Medicaid and CHIP provisions contained in Public Law 119-21, which CMS refers to as the Working Families Tax Cut legislation. CMS expects to provide additional detailed guidance in the coming months addressing specific provisions and implementation requirements. They also plan to undertake rulemaking as required under the law or as otherwise warranted. CMS Issues Calendar Year (CY) 2026 End Renal Disease Payments Final Rule. Effective January 1, 2026. In late November, the Centers for Medicare & Medicaid Services (CMS) issued this final rule that finalizes payment updates for the End-Stage Renal Disease (ESRD) Prospective Payment System starting January 1, 2026. The final rule includes increases to the base payment rate for dialysis services and new payment adjustment for non-labor costs for providers located in Alaska, Hawaii, and the US Territories. Additionally, the final rule includes changes to the ESRD Quality Improvement Program and the early termination of the ESRD Treatment Choices Model. CMS Final Rule: Medicare Physician Fee Schedule Payments for Calendar Year 2026. Effective January 1, 2026. This final rule from the Centers for Medicare & Medicaid Services (CMS), issued on November 5 finalized payment updates and policy changes to Medicare's physician fee schedule. CMS is permanently adopting the definition of direct supervision that allows the physician or supervising practitioner to provide supervision through real-time audio and visual interactive telecommunications (excluding audio-only), creating an optional add-on code for Advanced Primary Care Management (ACPM) services that would provide behavioral health integration or psychiatric Collaborative Care Model (CoCM) services, modifications to the way that CMS will pay for skin substitutes, a negative 2.5% adjustment to certain non-time-based Relative Value Units (RVUs), and a new mandatory alternative payment model, the Ambulatory Specialty Model. Telehealth Policy Updates Recent legislation authorized an extension of many of the Medicare telehealth flexibilities including waiving geographic and originating site restrictions through January 30, 2026. In support of the extensions, the Centers for Medicare & Medicaid Services (CMS) published a related FAQ document for calendar year 2026. To support access to care in rural communities, telehealth policies allow: - Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can serve as Medicare distant site providers for non-behavioral/mental telehealth services through January 30, 2026,
- Non-behavioral/mental telehealth services in Medicare can be delivered using audio-only communication platforms through January 30, 2026, and
- FQHCs and RHCs can permanently serve as a Medicare distant site provider for behavioral/mental telehealth services and the in-person visit requirement for mental health services furnished via communication technology to beneficiaries in their homes is not required through January 1, 2026.
Visit Telehealth.HHS.gov for FAQs on telehealth policies for RHCs and FQHCs. CMS Announces New GENEROUS Medicaid Drug Payment Model. The Centers for Medicare & Medicaid Services (CMS) recently announced a new initiative aimed at lowering prescription drug spending in Medicaid and improving health outcomes by increasing access to critical medications. Medicaid programs that choose to participate in the GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model will be able to purchase drugs included in the pilot at prices aligned with those paid in select other countries. The model will launch in January 2026 and run for five years. State Medicaid agencies interested in participating in this model will need to submit letters of intent to CMS and then later will have the opportunity to formally apply. NARHC: Medicare Care Management Opportunities – What's New for RHCs in 2026 – Wednesday, December 17, 2:30 PM Eastern. The National Association of Rural Health Clinics (NARHC) will host a free, FORHP-supported webinar via Zoom with information for Rural Health Clinics (RHCs) on the basic requirements of care management, plus the latest changes from the 2026 Medicare Physician Fee Schedule. This webinar will feature a subject matter expert from the NORC Walsh Center for Rural Health Analysis. Additional time for Q&A will be provided. Advanced registration is required. Approaching Deadlines USDA Rural Development: Intermediary Relending Program – December 30 HRSA State Loan Repayment Program – January 12, 2026 Ongoing Opportunities - Updated December 2025 Bold indicates HRSA- and/or FORHP-funded opportunities Administration for Children & Families: Low Income Home Energy Assistance Program Cybersecurity & Infrastructure Security Agency – Rural Emergency Medical Communications Demonstration Project Delta Regional Authority: Community Infrastructure Fund Delta Region Community Health Systems Development Program General Services Administration: Federal Surplus Property Available for Public Use HRSA Needs Rural Reviewers for Grant Applications HRSA National Health Service Corps Medications for Opioid Use Disorder Training HRSA Look-Alike Initial Designation for the Health Center Program Indian Health Service/Department of Defense: Medical Supplies and Equipment for Tribes (Project TRANSAM) Licensure Portability: The Multi-Discipline Licensure Resource Project National Rural Health Resource Center: Rural Hospital Stabilization Program ProviderBridge: Mobilizing Health Care Workforce via Telehealth Rural Graduate Medical Education Planning and Development Small Business Administration Guaranteed Loans for Small Business Small Business Administration Rural Initiative Pilot Program Substance Abuse and Mental Health Services Administration/Federal Emergency Management Agency/: Post-Disaster Crisis Counseling Assistance and Training Program Targeted Technical Assistance for Rural Hospitals Program USDA: National School Lunch Afterschool Snack Program USDA: Summer Food Service Program USDA/National Rural Health Association: Rural Hospital Technical Assistance USDA Rural Development: America's Healthy Food Financing Initiative USDA Rural Development: Circuit Rider Program – Technical Assistance for Rural Water Systems USDA Rural Development: Community Facilities Programs USDA Rural Development: Emergency Community Water Assistance Grants USDA Rural Development: Grants for Rural and Native Alaskan Villages USDA Rural Development: Intermediary Relending Program – Ongoing with deadlines every quarter USDA Rural Development: Multifamily Housing Loan Guarantees USDA Rural Development: Rural Business Investment Program USDA Rural Development: Rural Energy Savings Program USDA Rural Development: SEARCH – Special Evaluation Assistance for Rural Communities and Households (for Water/Waste Projects) USDA Rural Development: Telecommunications Infrastructure Loans and Loan Guarantees U.S. Department of Transportation: Rural Opportunities to Use Transportation for Economic Success (R.O.U.T.E.S) U.S. Environmental Protection Agency: Drinking Water State Revolving Fund U.S. Department of Veterans Affairs: Physical Therapy Telehealth Research Study for Older Veterans – Ongoing until October 2026 | 
