Comment on CMS-2026-1916-0001

Summary: The National Rural Health Association (NRHA) opposes the proposed rule, arguing that the Medicare-based payment caps on State Directed Payments (SDPs) and targeted Medicaid practitioner payments will disproportionately harm rural hospitals and jeopardize access to care. They specifically request that CMS limit the caps to the four categories specified in the statute, provide longer transition periods, and preserve state flexibility for value-based payment models.