The Centers for Medicare & Medicaid Services (CMS) has announced a new rule aimed at improving care quality for Medicare beneficiaries while reducing unnecessary spending. The calendar year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, identified as CMS-1834-FC, introduces reforms to modernize payments, expand access to care, and enhance hospital accountability.
Health and Human Services Secretary Robert F. Kennedy, Jr. said, "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." He added that the rule also addresses addiction by expanding access to non-opioid treatments and implementing payment policies that make care more affordable.
Dr. Mehmet Oz, CMS Administrator, emphasized the importance of protecting beneficiaries and advancing medical innovation while maintaining provider accountability. "These comprehensive reforms expand patient choice and establish the price transparency Americans need for confident healthcare decisions," he said.
The new policy aims to control unnecessary increases in outpatient services volume by aligning payments for services delivered in hospitals and off-campus facilities. This approach is intended to prevent additional copays based on care location. Additionally, the rule phases out the inpatient-only list and expands the ambulatory surgical center covered procedures list, allowing physicians more flexibility in choosing care settings.
Chris Klomp, CMS Deputy Administrator and Director of the Center for Medicare, highlighted efforts to streamline billing systems and ensure transparent pricing information. "These comprehensive changes deliver greater predictability, accountability, and affordability in hospital care," he noted.
To improve price transparency further, hospitals are now required to post actual consumer-usable prices instead of estimates. Non-compliance will result in civil monetary penalties. The Overall Hospital Star Rating system will also be updated to reflect safety performance more accurately.
The changes are projected to save $11 billion over ten years by aligning payments with actual care costs. These updates aim to improve outpatient care access while supporting program sustainability.
For detailed information on the final rule: www.federalregister.gov/public-inspection/. Fact sheets can be accessed at https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes and https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center
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