How a Rural Add-On Dies in the Provider Specific File

CMS issued Transmittal 13930 on Friday. Change Request 14592, the FY 2027 update to the IPPS and LTCH PPS, twenty-four pages, no fanfare.

Section II of the cover sheet is the table of manual revisions. It reads N/A N/A.

So the CR changes no manual language at all. What it does instead is tell every MAC which fields to blank in the Provider Specific File, and on what date, and the date is January 1, 2027.

"Which of the 589 hospitals losing the low-volume add-on can get it back, and who decides?"

Two Fields and a Date

The first instruction is a short paragraph and it ends a program. Verbatim: "The special payment provisions provided to a Medicare Dependent Small Rural Hospital (MDH) are not authorized by statute beyond December 31, 2026."

Then the operational half, which is where provider types 14 and 15 stop existing: "Provider Types 14 and 15 are no longer valid beginning January 1, 2027, and contractors shall update the PSF accordingly."

The second runs three pages and turns a percentage into a blank. For hospitals that stop qualifying as low-volume, the MAC "must ensure the low-volume hospital indicator field on the PSF contains a value of 'blank'" (position 74) and blanks the LV Adjustment Factor field too (positions 252 through 258).

Neither program is dying of policy. Section 6202 of the Consolidated Appropriations Act, 2026 extended MDH through December 31, 2026 by striking "January 31, 2026" from section 1886(d)(5)(G) and inserting "January 1, 2027," and section 6201 did the same arithmetic for the low-volume adjustment.

Congress bought fifteen months and the fifteen months are nearly up.

CMS answered the commenters who asked for more in one line: "CMS does not have the authority under current law to extend the MDH program beyond the statutory expiration date."

The CFR has not caught up, so do not trust the section you look up today. As of this week 42 CFR 412.108(a)(1) still ends MDH classification at "before October 1, 2025," with an eCFR note pointing at the amendment that writes in January 1, 2027. That amendment takes effect October 1.