The Centers for Medicare & Medicaid Services (CMS) has announced new measures aimed at improving care quality and increasing transparency for Medicare beneficiaries. The final rule for the calendar year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System introduces reforms to modernize hospital payments, expand access, enhance accountability, and protect the Medicare Trust Funds.
Health and Human Services Secretary Robert F. Kennedy, Jr. stated, “This final rule from CMS closes the loopholes hospitals exploit to hide real prices and advances President Trump’s demand for radical hospital price transparency. We are also confronting addiction head-on by expanding access to non-opioid treatments and implementing common-sense payment policies that make care more affordable and accessible for seniors.”
CMS Administrator Dr. Mehmet Oz added, “We are strengthening Medicare’s foundation by protecting beneficiaries, eliminating fraud, and advancing medical innovation —all while maintaining strict provider accountability and responsible use of taxpayer funds. These comprehensive reforms expand patient choice and establish the price transparency Americans need for confident healthcare decisions.”
Under the new policy, CMS will use its authority to manage increases in outpatient department service volumes by aligning payments across different sites of care. This aims to prevent patients from incurring higher copays based solely on where they receive services. The rule also includes phasing out the inpatient-only list and expanding procedures eligible at ambulatory surgical centers, giving physicians more flexibility in choosing appropriate care settings.
Chris Klomp, CMS Deputy Administrator and Director of the Center for Medicare, said, “We continue to advance Medicare payment reform by advancing policies that help prevent services from unnecessarily being performed in hospitals when they can be safely provided in less intensive settings, streamlining hospital billing systems, and ensuring patients receive transparent, accurate pricing information. These comprehensive changes deliver greater predictability, accountability, and affordability in hospital care.”
To improve price transparency further, hospitals will now be required to post actual prices rather than estimates in standardized formats accessible to consumers. Non-compliance will result in civil monetary penalties.
Other updates include changes to the Overall Hospital Star Rating system: hospitals performing poorly on safety measures cannot receive a 5-star rating and may face automatic downgrades in future years. Reporting requirements related to health equity and COVID vaccines have been reduced; a new measure will assess emergency department wait times; public input is being considered on future quality measures around nutrition and preventive health.
CMS estimates these updates will improve outpatient care access while saving $11 billion over ten years for both Medicare and its beneficiaries by better aligning payments with actual costs.
The full text of the final rule is available at www.federalregister.gov/public-inspection/. Additional details can be found on fact sheets at www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center and www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes.
