On Friday, November 21, the Centers for Medicare and Medicaid Services (CMS) released CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payments Final Rule, updating Medicare rates and announcing policy changes. The rule includes payment increases for hospitals and ASCs meeting quality reporting requirements and outlines significant reforms related to drug payment and procedural lists. There is a 30-day notice for comments on IRA negotiation factors for 2028 (comment period will begin once forms are published). Some key takeaways from the Final Rule:
Payment updates for hospitals and ASCs: CMS finalized a 2.6% OPPS payment increase for hospitals that meet quality reporting requirements, based on a 3.3% hospital market basket increase minus a 0.7% productivity adjustment. Facilities not meeting quality criteria receive a 2% reduction in their update.
Hospital drug acquisition cost survey: CMS confirmed plans to conduct a hospital drug acquisition cost survey for separately paid drugs, aiming to revise Medicare reimbursement for hospital-acquired drugs by 2027. The agency intends to consider multiple hospital characteristics and is not limiting future payment changes solely to 340B drug status.
Additional policy changes: The rule continues implementation of temporary payments for non-opioid pain treatments and applies site-neutral payment rates to certain off-campus hospital departments.
Implementation Timeline
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