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CMS MLN Connects Weekly Newsletter · April 13, 2026 · Primary source

MLN Connects Newsletter for April 13, 2026

Score 78PRIMARYregulatoryCMS

Summary

The April 13, 2026 CMS MLN Connects special edition announces two major proposed rules. The FY 2027 IPPS and LTCH PPS proposed rule projects a 2.4% rate increase for inpatient hospitals (approximately $1.4B in additional payments) and a 2.4% LTCH standard payment rate update ($55M increase), with comment periods open. Separately, CMS proposes the Interoperability Standards and Prior Authorization for Drugs rule, which would require payers to make prior authorization decisions within 24 hours for urgent requests and 72 hours for standard requests, with full disclosure of claims denials and appeals outcomes.

What this may mean

The prior authorization proposed rule establishes binding decision timelines for impacted payers on drug prior authorizations: 24 hours for urgent requests and 72 hours for standard requests, accompanied by transparency requirements for denial and appeals data. Health plans and MA plans subject to the rule face new operational and reporting obligations if the rule is finalized. The IPPS proposed rule's expiration of Medicare-Dependent Hospital and low-volume hospital payment adjustments on December 31, 2026, absent Congressional action, would reduce payments to qualifying rural hospitals by an estimated $0.4B in FY 2027.

Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.

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