The Centers for Medicare & Medicaid Services (CMS) has announced a proposed rule aimed at modernizing hospital payments and enhancing transparency. The Calendar Year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule, known as CMS-1834-P, introduces reforms focused on patient benefits.
Dr. Mehmet Oz, CMS Administrator, said, "We are advancing our mission to protect Medicare and its beneficiaries, fight fraud, and empower patients with access to the latest innovations, all while holding providers accountable and ensuring taxpayer dollars are spent wisely." He emphasized that these reforms aim to expand options and enforce transparency in healthcare.
Key objectives of the proposal include reducing out-of-pocket costs for Medicare beneficiaries, expanding care choices, increasing hospital accountability, and safeguarding the Medicare Trust Fund. Chris Klomp, Deputy Administrator and Director of the Center for Medicare at CMS, explained that these changes aim to make hospital care more predictable and affordable by simplifying billing processes and ensuring real prices are available to patients.
The proposal seeks to equalize payments for services delivered in hospitals and off-campus facilities. It also suggests phasing out the inpatient-only list to allow physicians greater flexibility in choosing appropriate care settings. Additionally, improvements in hospital price transparency rules would require hospitals to post real prices instead of estimates.
To further promote patient safety and wellness under its "Make America Healthy Again" initiative, CMS proposes updates to the Hospital Star Rating system. Hospitals performing poorly in safety could face rating downgrades. Updates to quality reporting programs would remove certain health equity and COVID vaccine reporting requirements while introducing measures for evaluating emergency department wait times.
CMS projects that these proposals will enhance access to outpatient care while delivering significant savings estimated at nearly $11 billion over ten years. The public can comment on the proposed rule for 60 days following its publication in the Federal Register.
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