The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule and fact sheet. The rule proposes payment and policy changes to the services provided under the OPPS and ASC payment system, including updating payment rates, updating quality measures, proposing changes to the inpatient only procedure list, and other policies.
CMS is taking steps to address the payment disparity between hospital outpatient departments and physician offices by proposing to reduce payment for certain drug administration services furnished in excepted off-campus outpatient departments. Additionally, the proposed rule includes a provision to specify additional criteria for approved Graduate Medical Education (GME) programs, which are currently approved by a national accrediting organization. CMS is proposing to prohibit accreditors from requiring or encouraging institutions to put in place diversity, equity, and inclusion programs that encourage “unlawful discrimination on the basis of race.”
Notably, CMS did not include the electronic clinical quality measure (eCQM) addressing timely pain treatment for Sickle Cell Disease (SCD). ASH invested in the development, testing, and validation of the treatment of SCD pain measure to address critical gaps in care and improve care delivery and efficiencies within the healthcare system. Additionally, the eCQM was recommended for inclusion in CMS’ Hospital Outpatient Quality Reporting Program and the agency’s Rural Emergency Hospital Quality Reporting Program. While the Agency has been limiting measures for inclusion across payment rules this year, ASH will be preparing comments to respond to the non-inclusion of this eCQM.
ASH will continue to review the rule and prepare comments for submission by the September 15 deadline. A summary of the rule is available here.