Federal Register #CMS-1850-FC

CMS final rule on Medicare hospital outpatient and ambulatory surgical center payment and quality policies

CMS finalized regulatory updates to Medicare hospital outpatient and ambulatory surgical center payment and quality reporting policies. - Government agency: Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS). - Scope: Updates payment rates and methodologies for the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems. - Quality and coverage policies: Refines the Hospital Outpatient and ASC Quality Reporting Programs and expands prior authorization to additional Botulinum Toxin Injection services. No changes are made to the Rural Emergency Hospital Quality Reporting Program. - Other policy areas: Implements statutory provisions for certain off-campus hospital outpatient departments; addresses teaching hospital closures and applications for available residency slots; and covers accrediting organizations’ assessment of certain EMTALA administrative requirements. - Information request: Seeks input on improving the standardization and comparability of Hospital Price Transparency data. - Procurement status: This is a final rule, not a procurement or contract award. No products, services, quantities, part numbers, OEMs, or vendors are identified.

Description

This final rule with comment period revises Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems for calendar year 2027, including payment rates and related factors. It updates and refines the Hospital Outpatient and Ambulatory Surgical Center Quality Reporting Programs, expands prior authorization to additional Botulinum Toxin Injection services, and implements certain Consolidated Appropriations Act, 2026 provisions for off-campus outpatient departments. It also announces teaching hospital closures and opportunities to apply for available slots, and addresses accrediting organizations’ assessment of certain EMTALA administrative requirements. The document title also identifies a request for information on strengthening standardization and comparability of Hospital Price Transparency data.

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