September 4, 2025
CMS Proposes Updates to Medicare and Medicaid Programs, Comment by September 15
This proposed rule would revise the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2026 based on continuing experience with these systems.
Included are descriptions of the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment systems.
This proposed rule would also update and refine the requirements for the:
- Hospital Outpatient Quality Reporting Program,
- Rural Emergency Hospital Quality Reporting Program,
- Ambulatory Surgical Center Quality Reporting Program,
- Overall Hospital Quality Star Rating, and
- Hospitals to make public their standard charge information and enforcement of hospital price transparency.
This rule also contains requests for information on measure concepts regarding:
- Well-Being and Nutrition for consideration in future years for all three programs (OQR, REHQR, and ASCQR);
- expanding the method to control for unnecessary increases in the volume of covered OPD services to on-campus clinic visits;
- software as a service; and
- adjusting payment under the OPPS for services predominately performed in the ambulatory surgical center or physician office settings.
Click Here to Read Proposed Changes and Updates and Comment by September 15