CMS’s 2026 Final Rule brings big changes to Medicare Advantage and Part D—including stronger inpatient review rules, codified cost-sharing caps, expanded appeals rights, and tighter audit protocols. Compliance is no longer optional—these updates are now mandatory. Read on for key takeaways and practical steps your team can take to prepare.

CMS’s proposed Medicaid tax rule may reshape the environment for Managed Care Organizations. While MCOs aren’t directly regulated by the rule, its impact on state tax structures could bring financial pressure, contract uncertainty, and participation risks. Compliance leaders at MCOs should prepare for shifting rates, increased scrutiny, and evolving state financing strategies as Medicaid’s landscape continues to change.

CMS’s proposed Medicaid tax rule may hit states in different ways. Expansion states risk losing key funding streams that support their broader coverage models, while non-expansion states face fewer immediate threats—but may see limits on future flexibility. For compliance leaders, the challenge is navigating divergent impacts, assessing funding models, and preparing for policy shifts that could reshape Medicaid’s landscape nationwide.

CMS’s proposed Medicaid tax rule highlights growing tension between federal oversight and state flexibility. While aimed at curbing provider tax loopholes, the rule signals a shift in power—limiting state innovation and increasing CMS discretion. Compliance leaders should assess risk, engage with state Medicaid agencies, and monitor enforcement trends as this debate reshapes Medicaid financing.

CMS’s proposed Medicaid tax rule could make it harder for states to fund health coverage for undocumented immigrants and others excluded from federal Medicaid. By penalizing certain tax structures, CMS risks limiting state innovation and reducing access to care for vulnerable populations. Compliance leaders should watch for policy shifts, fiscal changes, and impacts on health equity as this debate unfolds.

CMS’s proposed rule on Medicaid provider taxes could close a costly loophole—but not without big implications for states, providers, and vulnerable populations. The rule aims to curb tax schemes that maximize federal funds, yet critics warn it may reduce state flexibility, impact nonprofit providers, and add compliance complexity. Compliance leaders should monitor developments and engage with state agencies now.

CMS just announced a sweeping expansion of its RADV audit strategy, shifting from ~60 annual reviews to audits of every eligible Medicare Advantage plan, every year. With increased sample sizes, a 50x workforce expansion, and AI-powered diagnostics review, the message is clear: audits are no longer an exception—they’re the norm. Learn what this means and how Simply Compliance helps organizations prepare.

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