Federal Register #CMS-1849-P

CMS Proposed Rule: FY 2027 Medicare Hospital Payment System Updates and New Technology Add-On Payment Considerations

CMS is proposing updates to the Medicare Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) for FY 2027: - Government Buyer: - Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) - Products and Technologies Referenced (for new technology add-on payment consideration): - COBENFYTM (Xanomeline and Trospium Chloride): oral drug for schizophrenia - Command Center Electronic Glycemic Management System: EMR-integrated insulin dosing software - GAMIFANT (emapalumab-lzsg): antibody therapy for HLH/MAS - Orca-T: allogeneic stem cell and T-cell immunotherapy - RAPIBLYKTM (landiolol): beta-1 blocker for supraventricular tachycardia - WASKYRATM (etuvetidigene autotemcel): gene therapy for Wiskott-Aldrich Syndrome - YARTEMLEA (narsoplimab-wuug): monoclonal antibody for transplant-associated thrombotic microangiopathy - ZEVASKYNTM (prademagene zamikeracel): gene therapy for epidermolysis bullosa - CERAMENT V: vancomycin-eluting ceramic bone graft - Ceribell Delirium Monitor System: EEG-based delirium detection device - CMORE CT System: spinal fixation system - GORE VIABAHN FORTEGRA Venous Stent: venous stent device - InfuseTM Bone Graft: bone graft for spinal fusion - InVision Precision Cardiac Amyloid: AI software for cardiac amyloidosis detection - MediBeacon Transdermal GFR Measurement System: noninvasive kidney function assessment - Micro Medical Solutions MicroStent: peripheral vascular stent system - NelliTM Seizure Monitoring System: automated seizure detection device - NEXUS Aortic Arch Stent Graft System: endovascular stent graft for aortic arch - OmniaSecureTM MRI SureScanTM Lead: implantable defibrillation lead - PearlMatrixTM P15 Peptide Enhanced Bone Graft: peptide-enhanced bone graft - PMcardio STEMI AI ECG Model: AI ECG analysis software - SAPIEN M3 Transcatheter Mitral Valve Replacement System: mitral valve replacement device - SetPoint System: vagus nerve stimulation for rheumatoid arthritis - Spur Peripheral Retrievable Stent System: peripheral stent for angioplasty - TrilogyTM Transcatheter Aortic Valve Regurgitation System: aortic valve repair device - ViaOneTM Epicardial Access System: pericardial access device - VUNO Med-DeepCARS: AI for cardiac arrest risk assessment - Notable Requirements: - Focus on new technology add-on payment applications for innovative drugs, devices, and software - Updates to payment methodologies, quality programs, and hospital wage indices - Policy changes affecting all Medicare-participating acute care and long-term care hospitals - Public comment period for stakeholders - No direct procurement of products or services; referenced products are for payment policy consideration, not acquisition. - Place of Performance/Contracting Office: - Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244

Description

This proposed rule from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) aims to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals for FY 2027. It includes updates to payment policies and rates for long-term care hospitals (LTCHs), changes to Medicare graduate medical education (GME) policies, and modifications to quality program requirements. The rule also proposes new quality measures, removal and modification of existing measures, and changes to the Medicare Promoting Interoperability Program. Public comments are invited until April 10, 2026.

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