August 21, 2025

Comments Requested on Proposed Changes to the Medicare Hospital Cost Report, Comment by September 15

In the CY2026 Medicare Hospital Outpatient Prospective Payment System (OPPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) seeks comments on their proposal to require that hospitals include in their Medicare cost reports, beginning January 1, 2026, the median payer-specific charges that they have negotiated with Medicare Advantage organizations, by Medicare Severity-Diagnosis Related Groups.

The rule also requests comments on a proposed methodology hospitals would use to calculate the median payer-specific charge.

Critical Access Hospitals, Rural Emergency Hospitals, and hospitals operated by an Indian Health Program would not report median payer-specific charges on cost reports because these hospitals are not paid using the inpatient prospective payment system (IPPS).

Click Here to Read Proposed Rule and Make Comment

Click the links below to learn more about:

• Medicare Severity-Diagnosis Related Groups
• Proposed methodology hospitals would use to calculate median payer-specific charge

August 21, 2025

Announcement for Providers that Reassign their Benefits to CAHs

The Centers for Medicare & Medicaid Services (CMS) announced that some Method II Critical Access Hospitals may be experiencing denials with Fiscal Intermediary Shared System (FISS) reason codes 31006 and 31007 indicating that providers do not have a reassignment on file in the Provider Enrollment Chain, and Ownership System (PECOS).

Medicare Administrative Contractors will reprocess these claims within approximately two weeks and Method II CAHs do not need to take any action.

Additional information to ensure eligible health care providers accurately reassign their benefits to Method II CAHs will be issued shortly.

Click Here to Learn More

August 15, 2025

CMS Seeks Comments: Proposed Changes to the Overall Hospital Star Rating System, Comment by September 15

Published in the CY2026 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) requests feedback on their proposal to update how they calculate the Overall Hospital Quality Star Rating, which summarizes a variety of quality measures across five areas into a single star rating for each hospital.

The five areas of quality are Safety of Care, Mortality, Readmission, Patient Experience, and Timely and Effective Care. CMS proposed to emphasize the contribution of the Safety of Care measure group in hospitals; ratings by limiting the total number of stars that hospitals with the lowest Safety of Care scores can earn.

They also propose that this change, if finalized, would only apply to hospitals and Critical Access Hospitals with at least 3 Safety of Care measures. CMS estimates that about 830 rural hospitals with star ratings had at least 3 Safety of Care measures in 2024.

Click Here to Learn More

August 15, 2025

Request for Comments: Newborn Screening, Comment by September 15

The Health Resources and Services Administration (HRSA) is considering recommending the Secretary of Health and Human Services add Metachromatic Leukodystrophy (MLD) and Duchenne Muscular Dystrophy (DMD) to the Recommended Uniform Screening Panel (RUSP).

HRSA is providing notice and requesting comments from the public on these potential recommendations. The notices can be found here:

• MLD Federal Register Notice
• DMD Federal Register Notice

HRSA is particularly interested in comments that address the potential benefit of early screening for these conditions within the newborn period, the ability of state newborn screening programs to screen for them, and the availability of effective treatments.

Submit comments by September 15, 2025

See evidence reviews for MLD and DMD for additional information:

• MLD Evidence Reviews
• DMD Evidence Reviews

August 12, 2025

Policy Update: FY 2026 Medicare Hospital Inpatient Prospective Payment System Final Rule

On July 31, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for inpatient and long-term care hospitals under the Medicare hospital inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) for fiscal year (FY) 2026.

The increase in IPPS operating payment rates for general acute care hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) program and are meaningful electronic health record (HER) users under the Medicare Promoting Interoperability Program is 2.6 percent.

This rule also finalizes changes to

• the Medicare Readmissions Reduction Program,
• the Value Based Purchasing Program,
• the IQR program, and
• the interoperability program.

These regulations are effective October 1, 2025.

Click Here to Learn More