CMS CARE rule would save providers $320 million a year

CMS estimates its CARE proposed rule would save hospitals, nursing homes and other providers about $320 million a year, according to the rule filed for public inspection on Nov. 5. The rule, CMS-3484-P, rewrites Conditions of Participation that facilities must meet to bill Medicare and Medicaid. It publishes Nov. 10, and comments are due 60 days after that.

CMS says it reviewed the conditions for all 21 provider and supplier types. Its yearly savings estimates by sector:

• Long term care facilities: $142.6 million a year, $1.426 billion over 10 years.
• Hospitals: $123.2 million a year, $1.23 billion over 10 years.
• Critical access hospitals: $16.6 million a year, $166 million over 10 years.
• Intermediate care facilities for people with intellectual disabilities: $6.6 million a year, $66 million over 10 years.
• Providers freed from Medicaid institutional payment transparency reports: $30.4 million a year, $304.1 million over 10 years.

Rural emergency hospitals see no change in cost. Life Safety Code updates add about $112,000 a year.

Hospitals lose training mandates

The biggest hospital change ends the staff training requirement for emergency services readiness, in force since July 1, 2025 under the 2025 outpatient payment rule. CMS estimated that training at $1.73 billion and 16.4 million staff hours over 10 years, or about $173 million a year. The rule also drops the annual staff training requirement on transfer protocols. Hospitals keep their written transfer policies.

Obstetric rules that were due to start Jan. 1, 2027 go too. CMS would remove the OB staff training requirement, which it had priced at $242 million and 1.8 million staff hours over 10 years. It would also remove the OB specific quality assessment and performance improvement (QAPI) rules, priced at about $18.8 million a year. Hospitals keep facility wide QAPI programs that cover OB care. CMS wrote that the OB burden may fall hardest on small and rural hospitals and could contribute to labor and delivery unit closures. Critical access hospitals get the same emergency readiness and OB changes.

One new requirement is added. Hospitals and critical access hospitals that offer OB care would need informed consent standards and policies for birth tissue collection, including for families who ask to keep birth tissues for cultural, religious or personal reasons.

Nursing homes and rural hospitals

Nursing homes would no longer have to educate staff about COVID-19 vaccines, offer them or document those steps. The remaining resident vaccine rules would be streamlined. Ongoing respiratory illness data reporting would end, though it returns during any future declared public health emergency.

For critical access hospitals, CMS clarifies that distance eligibility is measured to hospitals with acute inpatient services or to another critical access hospital. It also carries out a new statutory exemption from distance rules for qualifying facilities.

Fierce Healthcare reported that CMS expects the changes to return more than 3.26 million hours of staff time. CMS also asks for input on physician supervision of nurse anesthetists, wider scope of practice for nurse practitioners and physician assistants in nursing homes, and easier first certification for new transplant programs. The American Hospital Association said some proposals match ideas on its list of 100 regulatory relief items.

Why it matters: hospital and nursing home operators are setting 2027 compliance budgets now. The OB rules still take effect Jan. 1, 2027. CMS wrote that the proposal is unlikely to be final by then, and that it would ask surveyors after that date to focus on conditions “not potentially subject to imminent revision.” Nursing homes carry the largest share of the savings. Comments run 60 days from the Nov. 10 publication.