Reading the Federal Regulatory and Legislative Calendar
What's Coming in 2026–2027
Every article in this series describes policy that exists within a regulatory environment that is itself moving. Rate notices arrive in April. Proposed rules open in the spring, close comment periods in midsummer, and finalize in the fall. Congressional committees hold hearings, launch investigations, and sometimes pass legislation. The 119th Congress completed its reconciliation cycle with OBBBA in July 2025, and what remains of its legislative bandwidth in health care is contested and finite. This article maps the rulemaking calendar that will govern Medicare payment and program policy through 2027, the legislative environment that frames it, and the strategies available to plans, providers, and advocates for engaging the process while it is still open.
The Annual Rulemaking Cycle#
The Medicare rulemaking calendar is structured around two parallel annual cycles: a fiscal year cycle for inpatient and post-acute settings, and a calendar year cycle for physician payment, hospital outpatient services, and MA and Part D programs. The cycles interlock because coverage, payment, and quality program decisions in one setting frequently affect the others, and because CMS uses each annual rule to advance cross-cutting policy priorities beyond the setting-specific payment updates.
The inpatient cycle follows the federal fiscal year, which begins October 1. CMS issues the IPPS proposed rule in April, opens a 60-day comment period through early June, and issues the final rule in late July or early August for October 1 implementation. The FY 2026 IPPS final rule issued July 31, 2025, finalized a 2.6% payment increase for acute care hospitals and multiple quality program updates, including the launch of TEAM, the mandatory bundled payment model for certain orthopedic and cardiac procedures, effective January 1, 2026. The FY 2027 IPPS proposed rule is expected in April 2026, with final rule in summer 2026. Key items to watch in the FY 2027 cycle include TEAM participation expansion, the 340B drug payment offset trajectory, and the long-term care minimum staffing rule moratorium imposed by OBBBA.
The calendar year cycle covers physician payment, hospital outpatient payment, and MA and Part D program policy. The CY 2026 PFS final rule, issued in November 2025, included the OBBBA-mandated 2.5% conversion factor update for 2026, qualifying APM adjustment differentials, and MSSP methodology changes accelerating ACO movement from one-sided to two-sided risk arrangements beginning in agreement periods starting January 1, 2027. The CY 2026 MA and Part D final rule, CMS-4208-F, finalized D-SNP integrated ID card and HRA requirements effective 2027, IRA drug negotiation program codification, and multiple Part D operational requirements. What CMS did not finalize in that rule is as significant as what it did: the annual health equity analysis requirement for MA utilization management programs, AI guardrails for MA coverage decisions, and Part D coverage of anti-obesity medications were all withdrawn.
For 2027 program years, the CY 2027 MA and Part D Proposed Rule, CMS-4212-P, released November 25, 2025, is the central document. Its comment period closed January 26, 2026. The final rule is expected spring 2026 and will govern MA and Part D contracting, Star Ratings, and program requirements effective January 1, 2027. Key contested items in CMS-4212-P include the HEI reversal, the 12 Star Ratings measure eliminations, the C-SNP and well-being RFIs, and marketing and broker regulation revisions. The final rule will be the clearest signal yet of how far the current administration is willing to move on deregulation in the MA market.
The OPPS and home health cycles follow the same calendar year cadence as the PFS. The CY 2026 OPPS final rule, issued November 2025, finalized skin substitute payment restructuring aligned with FDA regulatory status, site-neutral payment expansion for off-campus provider-based departments, and ASC covered procedure list expansion. The CY 2027 OPPS proposed rule is expected in summer 2026 and will incorporate results from CMS’s required hospital drug acquisition cost survey, planned for early 2026.
Administrator Oz’s Regulatory Agenda#
CMS under Mehmet Oz has articulated three organizing priorities: competition, transparency, and deregulation. These are not equally tractable in regulatory terms, and the gap between a stated priority and a finalized rule is often where the real policy story lives.
Competition, as CMS has operationalized it, encompasses the CMMI innovation model agenda (WISeR, BALANCE, ACCESS, AHEAD, GLOBE, GUARD), the ACO mandatory model signals, and a market entry focus that includes interest in provider-sponsored plans and new entrant MA organizations. Whether competition-focused rhetoric translates into structural market changes depends heavily on whether CMMI’s model portfolio produces savings evidence that supports mandatory extension and whether new plan entrants can survive the rate environment.
Transparency has produced the most concrete regulatory output. The FY 2026 IPPS final rule included new hospital price transparency requirements mandating disclosure of the 10th, median, and 90th percentile allowed amounts in machine-readable files. CMS’s RFI on streamlining regulations, required under Executive Order 14192 issued January 31, 2025, invited public comment on burden reduction across the Medicare program. The encounter data and risk adjustment transparency dimensions are advancing through sub-regulatory guidance rather than formal rulemaking, which means faster movement but less durability.
Deregulation is the priority with the most complex policy content. CMS-4212-P proposes modifications to MA marketing and broker oversight rules that would reduce the requirements imposed in the CY 2023 and CY 2024 rule cycles, partially rolling back the marketing guardrails that were a response to congressional investigation of TPMO practices and beneficiary harm from aggressive third-party marketing. The direction of the final rule on these provisions will determine how much of the prior consumer protection framework survives. The administration’s deregulatory posture also shapes how CMS responds to pressure on MA prior authorization, where the administrator’s stated skepticism of MA PA practices has not yet translated into strengthened regulatory requirements.
The Congressional Layer#
OBBBA’s passage in July 2025 consumed the 119th Congress’s primary legislative vehicle for health policy. The reconciliation process is complete for this Congress. What remains of the legislative calendar is ordinary-order legislation, which requires 60 votes in the Senate and faces a more demanding path than reconciliation.
The committee structure governing Medicare divides jurisdiction between House Energy and Commerce, House Ways and Means, Senate Finance, and Senate HELP. Energy and Commerce’s oversight jurisdiction extends to CMS operations, MA plan conduct, and CMMI model testing, and the committee has active investigative interests in MA overpayments, broker compensation practices, and prior authorization reform. Ways and Means holds primary jurisdiction over Trust Fund financing and Social Security, making it the relevant committee for any legislative response to the HI Trust Fund trajectory accelerated by OBBBA. Senate Finance has been the primary vehicle for dual eligible integration oversight, broker and TPMO investigations, and MA overpayment documentation.
Telehealth permanence is the most active legislative vehicle in health policy in the 119th Congress. The current extensions of COVID-era telehealth flexibilities expire, and the cost of permanent authorization has been a barrier to legislation every time it has come up. Bipartisan support for telehealth extension exists but has not translated into permanent law in any prior Congress. Whether the 119th Congress will use a government funding vehicle, a year-end package, or standalone legislation to address telehealth remains open. The CBO score for permanent telehealth is material to whether reconciliation could have been a vehicle, but reconciliation is closed.
Ground ambulance reform has similar political dynamics. The surprise billing provisions of the No Surprises Act left ground ambulance outside its coverage, and the billing practices of private equity-owned ground ambulance operators have generated bipartisan congressional attention. Legislation to address balance billing for ground ambulance services has passed committee but not the floor in multiple Congresses. The 119th Congress has the same dynamic. Whether it moves depends on whether an appropriate legislative vehicle becomes available.
Trust fund solvency legislation is the long-duration item on the congressional calendar. The HI Trust Fund’s projected depletion timeline is now closer than a decade in most CBO projections, and OBBBA’s Social Security benefit tax provisions accelerated it. The options available include payroll tax increases, premium support restructuring, means-testing adjustments to Part B and D premiums, and spending reform through mandatory model expansion or PAC payment restructuring. None of these are politically easy, and none are advancing at speed in the current Congress. The oversight hearings are signaling function. Legislative movement would require either a bipartisan negotiation or a crisis moment, neither of which is imminent.
Rulemaking as Strategy#
For plans, providers, and advocates, the comment period is the primary point of engagement with the rulemaking process. Understanding how CMS responds to comments, and what kinds of submissions are most likely to influence final rules, is the practical skill that determines whether an organization’s policy interests are reflected in the rules it operates under.
CMS responds to comments that are analytically grounded. A comment documenting actuarial impact, citing clinical evidence, or identifying specific regulatory ambiguity that could be interpreted to produce a harmful result carries significantly more weight than a comment expressing general concern. The most effective advocacy submissions pair a specific regulatory provision with quantified impact data and a concrete alternative that CMS can adopt without reopening the entire provision. Plans and health systems that invest in actuarial modeling before comment periods tend to produce comments that appear in final rule preambles. Those that submit without that support tend to produce comments that receive generic acknowledgments.
The comment response obligation also creates a public record. CMS must explain in the final rule preamble how it is responding to significant comments received. When CMS disagrees with a comment, it must document its reasoning. Reviewing the preamble of a final rule against the comment record is one of the most effective methods for understanding where CMS’s legal and policy reasoning is fragile, because the reasoning that is least compelling in response to comments is often the reasoning most vulnerable to litigation.
The regulatory record is not the only channel. Notice and comment is followed by enforcement, and enforcement moratoria are a distinct category of policy signal. When CMS announces it will not enforce a provision, typically through a FAQ or a sub-regulatory memorandum, it is acknowledging an implementation problem without acknowledging a legal one. The Medicare Savings Program rule moratorium in OBBBA is one example. The prior history of CMMI model reconciliation delays is another. When CMS cannot enforce what it has promulgated, the resulting gap between formal policy and operational reality is information about what will and will not change in practice, regardless of what the Federal Register says.
The 2026 and 2027 rulemaking cycles will resolve a series of questions that are currently open across multiple policy dimensions. The CY 2027 MA and Part D final rule will determine whether the HEI reversal stands and what the deregulatory posture in MA looks like in practice. The FY 2027 IPPS cycle will signal whether CMS continues TEAM expansion and where the 340B offset trajectory lands. The encounter-based risk adjustment question will surface somewhere in this cycle, whether in formal rulemaking or sub-regulatory action. The physician fee schedule conversion factor problem will return, as it does every year, unless Congress finds a permanent fix. For every major policy question in this series, there is a rulemaking proceeding or a legislative moment in 2026 or 2027 that will produce the next data point.
Related Reading#
MCR-01_10 The 2025 CMMI Scorecard: Ten Models in One Year MCR-04_03 The Broker Compensation Wars: Court Ruling, DOJ Enforcement, and the Deregulation Pivot