2026 Regulatory Agenda from OMB
On July 3, 2026, the Office of Management and Budget, Office of Information and Regulatory Affairs published the 2026 Regulatory Plan and the Unified Agenda of Federal Regulatory and Deregulatory Actions. The regulatory plan and unified agenda include regulatory and deregulatory activities under development or review from approximately 60 federal agencies. Individual agency rule lists can be found for HHS, HUD, DHS, DOL, ED, and Treasury. Some highlights include: a Notice of Proposed Rulemaking (NPRM) from CMS on Comprehensive Regulations to Uncover Suspicious Healthcare; a supplemental NPRM from OSHA on the heat illness prevention standard; an advance notice of proposed rulemaking soliciting comments on HUD’s regulations related to requests for assistance animals as a reasonable accommodation; and an NPRM from IRS on Form 990 Fiscal Sponsorship Reporting. While the dates listed for the regulatory actions are often aspirational, the regulatory plan and unified agenda do provide the public with notice of agency regulatory priorities and planned regulatory actions for the coming year.
CMS Proposes CY2027 Home Health Proposed Rule with 2.4% Update, Only Temporary Adjustment
On Wednesday, July 1, the Centers for Medicare and Medicaid Services (CMS) published the CY2027 Home Health Proposed Rule with a 2.4% aggregate update. An accompanying fact sheet can be found here. This year, CMS decided not to apply a permanent adjustment but will apply a -3% temporary adjustment to recoup 10% of the outstanding temporary adjustments remaining from previous calendar year rules. This is in response to comments from LeadingAge and other sector advocates in CY2026 that CMS could not accurately determine if the behavioral changes were a reaction to the original transition from the previous payment system to the patient driven groupings model. In addition to the payment update, CMS is making changes to the reporting deadlines of the home health quality reporting program, expanding reasons for revocation of all provider enrollments and retroactive revocations, and requesting information on a home health specific wage index and an advance care planning measure for home health providers. Finally, CMS discusses how home health can be used appropriately to support community-based palliative care programs and will be releasing updated subregulatory guidance along with the publication of the CY2027 Home Health Final Rule. LeadingAge will host a call on Tuesday, July 7 at 1 PM CT to discuss the proposals in this rule. All LeadingAge members are welcome to join and can sign up here.
CMS Proposes Medicare Provider Enrollment Changes
In their continued effort to control waste, fraud, and abuse within the Medicare program, the Centers for Medicare and Medicaid Services (CMS) included a number of proposals in the CY2027 Home Health Proposed Rule which will impact all Medicare providers including home health, hospice, and skilled nursing providers. CMS proposes to change the regulatory language around retroactive revocations, making them effective to the date of noncompliance for all revocation grounds. Previously, revocations were effective prospectively 30 days after the date that CMS or the CMS contractor mailed a notice to the effected provider. Additionally, CMS is expanding the reasons for revocation or denial of a provider’s Medicare enrollment. These revocations include suspensions/revocations and issues with managing employees or other similarly owned organizations. For example, CMS proposes to expand the ability to revoke/suspend enrollment for an owner or managing employee’s misdemeanor convictions related to sexual assault or financial misconduct within the past 10 years. CMS also proposes to suspended or revoked enrollment when the provider’s license has been suspended or revoked in another state or the provider has been suspended or revoked from Medicaid or another federal health care program. LeadingAge will have a detailed article for members in the coming days on all the program integrity proposals in the CY2027 Home Health Proposed Rule.
GAO Releases Report on Assisted Living Spending and Coverage
The Government Accountability Office (GAO) released a report on July 2 that profiles federal spending and Medicaid coverage of Assisted Living. The report was driven by a 2025 request from a group of Democratic Senators to update a 2018 GAO report on state and federal oversight of assisted living facilities that participate in Medicaid. For the 2026 report, GAO analyzed Medicaid and traditional, fee-for-service Medicare claims, as well as documentation for other programs that may cover assisted living services through agencies such as the Department of Housing and Urban Development (HUD), Social Security, and the Veterans Administration (VA). GAO found that 44 states covered assisted living services through various Medicaid programs such as the Home- and Community-Based Services (HCBS) waiver, a Medicaid demonstration, or state plan. HCBS waivers were most commonly used.
GAO found that federal spending on assisted living services through Medicaid was at least $3.5 billion in 2024; total federal spending on assisted living services from all programs was unable to be calculated due to data limitations and differences in assisted living categorization by state. Federal-state Medicaid spending on services provided in assisted living averaged about $23,000 per beneficiary, but costs for services varied widely, both across states and within states, based on factors such as facility size, services, and location. Most Medicaid beneficiaries receiving services provided in an assisted living setting were dually-eligible for Medicare and Medicaid, with 24% of beneficiaries being between the ages of 65 – 74 years. Rates of beneficiaries aged 75 – 84 years, and 85 years and older were comparable. Stakeholders interviewed by GAO cited five key barriers affecting access to federally funded assisted living services: lack of coverage outside of Medicaid, coverage limitations within Medicaid, provider participation challenges, and the changing landscape including an increased demand for assisted living services at the same time that Medicaid funding is being cut at the federal level. LeadingAge closely monitors federal involvement in assisted living oversight and understands this report may provide fodder for future proposals to expand federal assisted living requirements, which LeadingAge opposes.
U.S. Department of Education’s Public Service Loan Forgiveness Rule Struck Down by Courts
On June 30, 2026, two federal district courts issued orders vacating the Department of Education’s (ED) Public Service Loan Forgiveness (PSLF) final rule. Under the PSLF program, the Secretary of Education is required to forgive the remaining balance of federal student loans for borrowers who have made ten years of payments on their loans while working for a qualifying public service employer. On October 31, 2025, ED issued a final rule revising what organizations qualify as public service employers by excluding certain nonprofits from PSLF eligibility for engaging in what the Department defines to be “substantial illegal activity”—which it defines, for example, as aiding or abetting violations of federal immigration law, engaging in gender-affirming care, supporting terrorism, or engaging in a pattern of illegal discrimination. Following its issuance, the PSLF rule was subject to legal challenges in several federal district courts. The U.S. District Court for the District of Columbia and the U.S. District Court for the District of Massachusetts issued orders on June 30, 2026 vacating the PSLF final rule. Both opinions cited the rule as being contrary to law and exceeding the Secretary’s statutory authority under the Higher Education Act. The rule was originally set to take effect on July 1, 2026.
