CMS Proposes 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Rule

Key provisions of the proposed rule include:

• Equalize payments for certain services across hospitals and off-campus facilities to prevent higher copays based solely on site of care.

• Phase out the inpatient-only list to give physicians greater flexibility to determine the most clinically appropriate setting for care and allow more patients to choose outpatient surgical options.

• Require hospitals to post standardized, consumer-friendly pricing data, with civil monetary penalties for noncompliance.

• Update the Hospital Star Rating system so that hospitals performing in the lowest quartile for safety cannot earn a 5-star rating, with automatic 1-star downgrades in future years.

• Streamline reporting by removing certain health equity and COVID-19 vaccine reporting requirements.

• Add new measures to evaluate prolonged emergency room wait times.

• Solicit input on nutrition, wellness, and prevention.

CMS estimates the reforms will expand access, reduce unnecessary costs, and generate nearly $11 billion in savings for Medicare and its beneficiaries over the next decade, while advancing Medicare’s long-term goal of delivering high-quality, patient-centered care.