Regulatory NewsBREAK: CMS Issues Hospital Outpatient Prospective Payment System Proposed Rule
On July 2, 2026, the Centers for Medicare and Medicaid Services (CMS) released the CY 2027 Medicare Outpatient Prospective Payment System (OPPS) proposed rule (Proposed Rule).
Among the provisions in the Proposed Rule, CMS is proposing to:
- Increase OPPS and ASC payment rates by 2.4 percent, reflecting a 3.2 percent market update and a 0.8-point productivity adjustment.
- Reduce payments to 340B-covered entities for drugs acquired at the 340B discount to ASP minus 33.4 percent, with no add-on.
- Eliminate the alternative pathway for FDA Breakthrough Devices to qualify for pass-through status without separately demonstrating substantial clinical improvement for applications filed on or after October 1, 2026.
- Require prior authorization for certain additional botulinum injection codes beginning July 1, 2027.
CMS is also requesting information from stakeholders on the challenges with comparing the data reported in machine-readable files (MRFs) and consumer-friendly displays across hospitals to improve consistency across hospital price transparency reporting.
For questions, please reach out to Geni Tunstall.
Related
On June 3, 2026, the Centers for Medicare and Medicaid Services (CMS) released educational materials for the Medicare GLP-1 Bridge program.
The Medicare GLP-1 Bridge program will start on July 1, 2026. Through this short-term demonstration, CMS will be expanding access to certain GLP-1 medications to eligible Medicare Part D beneficiaries who do not currently have access to these medications through the Part D benefit.
On June 1, 2026, the Centers for Medicare and Medicaid Services issued an interim final rule (IFR) with comment period to implement provisions in Public Law 119-21 (also known as “H.R. 1” or the "One Big Beautiful Bill Act").
On April 21, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a Status Update on the Medicare GLP-1 BRIDGE Demo and BALANCE Model in Part D for CY 2027.
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