Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2026

<NOTICE> DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <DEPDOC>[CMS-6096-N]</DEPDOC> <RIN>RIN 0938-ZB89</RIN> <SUBJECT>Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2026</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Notice. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This notice announces a $750.00 calendar year (CY) 2026 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2026, and on or before December 31, 2026. </SUM> <DATES> <HD SOURCE="HED">DATES:</HD> The application fee announced in this notice is effective on January 1, 2026. </DATES> <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Frank Whelan, (410) 786-1302. </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <HD SOURCE="HD1">I. Background</HD> In the February 2, 2011, <E T="04">Federal Register</E> (76 FR 5862), we published a final rule with comment period titled “Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers.” This rule finalized, among other things, provisions related to the submission of application fees as part of the Medicare, Medicaid, and CHIP provider enrollment processes. As provided in section 1866(j)(2)(C)(i) of the Social Security Act (the Act) and in 42 CFR 424.514, “institutional providers” that are initially enrolling in the Medicare or Medicaid programs or CHIP, revalidating their enrollment, or adding a new Medicare practice location are required to submit a fee with their enrollment application. An “institutional provider” for purposes of Medicare is defined at § 424.502 as “any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (not including physician and non-physician practitioner organizations), CMS-855S, or associated internet-based PECOS enrollment application.” As we explained in the February 2, 2011 final rule (76 FR 5914), in addition to the providers and suppliers subject to the application fee under Medicare, Medicaid-only and CHIP-only institutional providers would include nursing facilities, intermediate care facilities for persons with intellectual disabilities (ICF/IID), and psychiatric residential treatment facilities; they may also include other institutional provider types designated by a state in accordance with their approved state plan. As indicated in § 424.514 and § 455.460, the application fee is not required for either of the following: • A Medicare physician or non-physician practitioner submitting a CMS-855I. • A prospective or revalidating Medicaid or CHIP provider— ++ Who is an individual physician or non-physician practitioner; or ++ That is enrolled as an institutional provider in Title XVIII of the Act or another state's Title XIX or XXI plan and has paid the application fee to a Medicare contractor or another state. <HD SOURCE="HD1">II. Provisions of the Notice</HD> Section 1866(j)(2)(C)(i)(I) of the Act established a $500 application fee for institutional providers in CY 2010. Consistent with section 1866(j)(2)(C)(i)(II) of the Act, § 424.514(d)(2) states that for CY 2011 and subsequent years, the preceding year's fee will be adjusted by the percentage change in the consumer price index (CPI) for all urban consumers (all items; United States city average, CPI-U) for the 12-month period ending on June 30 of the previous year. Consequently, each year since 2011 we have published in the <E T="04">Federal Register</E> an announcement of the application fee amount for the forthcoming CY based on this formula. Most recently, in the December 2, 2024, <E T="04">Federal Register</E> (89 FR 95215), we published a notice announcing a fee amount for the period of January 1, 2025, through December 31, 2025, of $730.00. The $730.00 fee amount for CY 2025 was used to calculate the fee amount for 2026 as specified in § 424.514(d)(2). According to Bureau of Labor Statistics (BLS) data, the CPI-U increase for the period of July 1, 2024, through June 30, 2025, was 2.7 percent. (See <E T="03">https://www.bls.gov/news.release/archives/cpi_07152025.htm</E> ). As required by § 424.514(d)(2), the preceding year's fee of $730 will be adjusted by 2.7 percent. This results in a CY 2026 application fee amount of $749.71 ($730 × 1.027). As we must round this to the nearest whole dollar amount, the resultant application fee amount for CY 2026 is $750. <HD SOURCE="HD1">III. Collection of Information Requirements</HD> This document does not impose information collection requirements (that is, reporting, recordkeeping, or third-party disclosure requirements). Accordingly, there is no need for review by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995. However, it does reference previously approved information collections. The CMS-855A, CMS-855B, CMS-855I, and CMS-855S applications are approved under, respectively, OMB control numbers 0938-0685, 0938-1377, 0938-1355, and 0938-1056. <HD SOURCE="HD1">IV. Regulatory Impact Statement</HD> <HD SOURCE="HD2">A. Background and Review Requirements</HD> We have examined the impact of this notice as required by Executive Order 12866 on Regulatory Planning and Review (September 30, 1993), Executive Order 13563 on Improving Regulation and Regulatory Review (January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999), and the Congressional Review Act (5 U.S.C. 804(2)). Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits, including potential economic, environmental, public health and safety effects, distributive impacts, and equity. A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). As explained in this section of the notice, we estimate that the total cost of the increase in the application fee will not exceed $100 million. Therefore, this notice does not reach the $100 million economic threshold and is not considered a major notice. <HD SOURCE="HD2">B. Costs</HD> The costs associated with this notice involve the increase in the application fee amount that certain providers and suppliers must pay in CY 2026. The CY 2026 cost estimates are as follows: <HD SOURCE="HD3">1. Medicare</HD> Based on CMS data, we estimate that in CY 2026 approximately— • 12,518 newly enrolling institutional providers will be subject to and pay an application fee; and • 33,863 revalidating institutional providers will be subject to and pay an application fee. Using a figure of 46,381 (12,518 newly enrolling + 33,863 revalidating) institutional providers, we estimate an increase in the cost of the Medicare application fee requirement in CY 2026 of $927,620 (or 46,381 × $20 (or $750 minus $730)) from our CY 2025 projections. <HD SOURCE="HD3">2. Medicaid and CHIP</HD> Based on CMS and state statistics, we estimate that approximately 30,000 (9,000 newly enrolling + 21,000 revalidating) Medicaid and CHIP institutional providers will be subject to an application fee in CY 2026. Using this figure, we project an increase in the cost of the Medicaid and CHIP application fee requirement in CY 2026 of $600,000 (or 30,000 × $20 (or $750 minus $730)) from our CY 2025 projections. <HD SOURCE="HD3">3. Total</HD> Based on the foregoing, we estimate the total increase in the cost of the application fee requirement for Medicare, Medicaid, and CHIP providers and suppliers in CY 2026 to be $1,527,620 ($927,620 + $600,000) from our CY 2025 projections. The RFA requires agencies to analyze options for regulatory relief of small businesses. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $9 million to $47 million in any 1 year. Individuals and states are not included in the definition of a small entity. As we stated in the RIA for the February 2, 2011, final rule (76 FR 5952), we do not believe that the application fee will have a significant impact on small entities. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area for Medicare payment regulations and has fewer than 100 beds. We are not preparing an analysis for section 1102(b) of the Act because we have determined, and the Secretary certifies, that this notice would not have a significant impact on the operations of a substantial number of small rural hospitals. 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