On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes updates to Medicare payment policies and rates for hospital outpatient and Ambulatory Surgical Center (ASC) services under the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule for calendar year (CY) 2026. CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for hospital outpatient and ASCs annually. This fact sheet discusses the major provisions of the proposed rule. 

These proposed payment policies would affect approximately 3,500 hospitals and approximately 6,100 ASCs. In addition to proposing payment rates, this year’s rule includes a proposal to update the methodology used to calculate the Overall Hospital Quality Star Rating to emphasize the Safety of Care measure group in hospitals’ star ratings.  CMS is also proposing changes to and requesting comment on the Hospital Outpatient Quality Reporting (OQR), Rural Emergency Hospital Quality Reporting (REHQR), and Ambulatory Surgical Center Quality Reporting (ASCQR) Programs to further meaningful measurement and reporting for quality of care in the outpatient setting.

To align with current administrative priorities, CMS is including a Request for Information (RFI) to seek public input on future measure concepts related to well-being and nutrition. 

In accordance with Medicare law, CMS proposes updating OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.4%. This update is based on the projected hospital market basket percentage increase of 3.2%, reduced by a 0.8 percentage point productivity adjustment. 

For CY 2026, using the hospital market basket update, CMS proposes an update factor to the ASC rates of 2.4%. The update applies to ASCs meeting relevant quality reporting requirements. This update is based on the proposed IPPS market basket percentage increase of 3.2%, reduced by 0.8 percentage point for the productivity adjustment

In the CY 2019 OPPS/ASC final rule, CMS adopted a method to control unnecessary increases in the volume of the clinic visit service furnished in excepted off-campus provider-based departments (PBDs).  This method prevents Medicare and beneficiaries from paying significantly more in the excepted off-campus PBD setting than in the physician office setting for some services. For CY 2026, CMS is proposing to expand this policy to include drug administration services furnished in excepted off-campus PBDs. Specifically, CMS is proposing to use the agency’s authority under section 1833(t)(2)(F) of the Act to apply the Physician Fee Schedule equivalent payment rate for any HCPCS codes assigned to the drug administration ambulatory payment classifications (APCs) when provided at an off-campus PBD excepted from section 603 of the Bipartisan Budget Act of 2015. CMS is also including a comment solicitation on expanding the agency’s method to control unnecessary increases in the volume of the clinic visit service provided in on-campus hospital outpatient departments.

For CY 2026, we estimate this provision reduces OPPS spending by $280 million, with $210 million of the savings accruing to Medicare, and $70 million saved by Medicare beneficiaries in the form of reduced beneficiary coinsurance.

In order to give beneficiaries more choices on where to obtain care with the potential for lower out-of-pocket expenses, CMS is proposing to phase out the IPO list over a 3-year period, beginning with removing 285 mostly musculoskeletal procedures for CY 2026. CMS believes that the evolving nature of the practice of medicine allows more procedures to be performed on an outpatient basis with a shorter recovery time. This proposal would allow for these services to be paid by Medicare in the hospital outpatient setting when determined to be clinically appropriate, giving physicians greater flexibility in determining the most appropriate site of service. 

Two-Midnight Rule Medical Review Activities Exemptions

In the CY 2021 OPPS/ASC final rule, in conjunction with the elimination of the IPO list, CMS established a policy in which procedures removed from the IPO list beginning January 1, 2021 would be exempted from certain medical review activities related to the two-midnight policy. CMS is proposing to continue this existing exemption for CY 2026 and subsequent years until the Secretary determines that the service or procedure is more commonly performed in the Medicare population in the outpatient setting. 

For CY 2026, CMS is proposing to revise the ASC CPL criteria to modify the general standard criteria and to eliminate five of the general exclusion criteria, moving them into a new section as nonbinding physician considerations for patient safety. As a result of these criteria changes, CMS is proposing to add 276 procedures to the ASC CPL. Additionally, CMS is proposing to add 271 codes to the ASC CPL that are proposed for removal from the IPO list for CY 2026. These policies will maintain safety for Medicare beneficiaries through the physician considerations for patient safety, while allowing physicians to exercise their medical judgment and increasing flexibility for patients to choose from more settings of care for surgical procedures.

The 340B Final Remedy rule finalized changes to the calculation of the OPPS conversion factor applicable to non-drug items and services beginning in CY 2026. Specifically, the rule codified a 0.5 percent reduction in the OPPS conversion factor applicable to non-drug items and services, excluding hospitals that enrolled in Medicare after January 1, 2018.  This 0.5 percent reduction would remain in effect until the estimated aggregate payment reduction reached the $7.8 billion of increased non-drug item and services payments made from CY 2018 through CY 2022, which CMS estimated would occur in CY 2041. This prospective offset aimed to balance the goal of restoring hospitals to their financial position had the original 340B policy never existed, while avoiding burdening them with an immediate single year recovery. After subsequent reconsideration of balancing these two goals, CMS has determined a shorter timeframe to be more appropriate. Consequently, CMS is proposing to revise the annual offset percentage for non-drug items and services from 0.5 percent to 2 percent effective CY 2026, excluding hospitals that enrolled in Medicare after January 1, 2018.  This 2 percent reduction would remain in effect until the estimated payment reduction reaches $7.8 billion, which CMS estimates will occur in CY 2031.

Since CY 2014, CMS has unconditionally packaged skin substitute products furnished in the outpatient hospital setting into their associated application procedures as part of a broader policy to package all drugs and biologicals that function as supplies when used in a surgical procedure. The agency currently divides the skin substitutes into a high-cost group and a low-cost group, to ensure adequate resource homogeneity among APC assignments for the skin substitute application procedures. This payment approach differs from the payment policy for skin substitutes furnished in the non-facility setting, where skin substitute products are paid under the ASP plus 6 percent payment methodology. 

For CY 2026, CMS is proposing to unpackage skin substitute products from the application services and establish several APCs based on relevant product characteristics, rather than based on stated prices for provision of these products when they are used during a covered application procedure paid under the OPPS (described by CPT codes 15271-15278). Secondly, CMS is also proposing to align skin substitute categorization consistent with their FDA regulatory status, such as 361 Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P) and the device types: Pre-Market Approvals (PMAs) and 510(k)s. CMS believes grouping and paying for skin substitute products based on relevant product characteristics, consistent with their FDA regulatory status, recognizes the clinical and resource differences in product types and would incentivize competition to create more innovative products, while also resulting in significant savings to the Medicare Trust Fund. We note that, for CY 2026, CMS is proposing to use a single payment rate for these three categories of skin substitute products to ensure we are not underestimating the resources involved with furnishing these services. In future years, we intend to propose payment rates that differentiate between the three FDA regulatory categories. CMS is proposing to implement these policy changes in both the hospital outpatient department and physician office settings to remain consistent across different settings of care. The proposed payment policy for skin substitutes in the physician office setting is provided in the CY 2026 Physician Fee Schedule (PFS) proposed rule. 

In recent years, there have been rapid developments in the use of software-based technologies to support clinical decision-making in the outpatient and physician office settings. Medicare refers to these software-based technologies as software as a service (SaaS). CMS currently does not have a comprehensive Medicare payment policy specific to SaaS that accounts for the unique challenges of paying for these services. For CY 2026, CMS is soliciting comments from the public on payment policies for these services under the OPPS, including applicable lessons learned from risk-bearing payment arrangements and input that helps incorporate the underlying value of technologies within medical practice into payment policy.  CMS notes the agency is similarly seeking comment on this issue under the CY 2026 PFS proposed rule. 

Section 1833(t)(14)(D)(ii) of the Social Security Act requires the Secretary to periodically conduct surveys of hospital acquisition costs for each specified covered outpatient drug for use in setting the payment rates for such drugs.  Accordingly, CMS will be conducting a survey  by early CY 2026 on the acquisition costs for each separately payable drug acquired by all hospitals paid under the OPPS. CMS intends for the survey to be completed in time for the survey results to be used to inform policymaking beginning with the CY 2027 OPPS/ASC proposed rule.

CMS is proposing to collect from hospitals the median payer-specific charges that they have  negotiated with Medicare Advantage organizations and disclosed under CMS’ hospital price transparency rules, and then use these data to help determine relative Medicare payment rates for inpatient hospital services.  CMS is also seeking comment on how market-based approaches such as this one could be utilized to improve additional Medicare FFS payment systems.

In order to ensure that GME accreditation for approved medical residency programs complies with applicable laws related to race-based admission policies and to improve the accreditation process, CMS is proposing that accreditors may not require as part of accreditation, or otherwise encourage institutions to put in place, diversity, equity, and inclusion programs that encourage unlawful discrimination on the basis of race or other violations of Federal law. CMS also notes that the Secretary may certify other organizations as accreditors to increase the potential for competition in the accreditation space and improve the quality of the accreditation process.

In the CY 2019 OPPS/ASC final rule with comment period, CMS finalized a proposal to apply the hospital market basket update to ASC payment system rates for an interim period of five years (CY 2019 through CY 2023) while CMs determined the impact of the higher update factor on the migration of services from the hospital outpatient setting to the ASC setting. In light of the disruption of health care utilization of elective outpatient surgeries from the COVID-19 PHE, CMS extended the application of the hospital market basket update an additional two years in the CY 2024 OPPS/ASC final rule with comment period, that is, through CY 2024 and CY 2025 so that CMS could analyze claims data further removed from the effects of the COVID-19 PHE. For this CY 2026 OPPS/ASC proposed rule, CMS is proposing to extend our utilization of the hospital market basket update as the update factor for the ASC payment system one additional year, through CY 2026, while CMS continues to study the migration of outpatient surgical procedures.

CMS is proposing to continue policies to provide temporary additional payments for certain non-opioid treatments for pain relief in the hospital outpatient department (HOPD) and ASC settings from January 1, 2025, through December 31, 2027, consistent with statute.

CMS is proposing five drugs and six devices to qualify as non-opioid treatments for pain relief, and CMS proposes these products be paid separately in both the HOPD and ASC settings, starting in CY 2026. CMS is soliciting comment and supporting documentation from interested parties on additional products that may qualify for separate payment under this provision for CY 2026. Ensuring non-opioid treatments for pain relief are available can help reduce use of opioids and incidence of opioid use disorder, helping to prevent this chronic disease from occurring in more Americans. 

In the CY 2025 OPPS/ASC final rule with comment period, CMS finalized a proposal to incentivize domestic production of Mo-99 by establishing a new add-on payment of $10 per dose of Tc-99m derived from domestically produced Mo-99 starting on January 1, 2026. In this CY 2026 OPPS/ASC proposed rule, CMS proposes to codify the definition for domestically produced Mo-99 and to establish new HCPCS C-code C917X (Tc-99m from domestically produced non-HEU Mo-99, [minimum 50 percent], full cost recovery add-on, per study dose). CMS also proposes that at least fifty percent of the Mo-99 used in the Tc-99m generator that produced a dose of Tc-99m must have been domestically produced for the dose to qualify for the add-on payment. CMS believes the $10 add-on payment for domestically produced Tc-99m would ensure equitable payments by paying providers who use domestically produced Tc-99m radiopharmaceuticals when available, an amount that reflects the anticipated higher cost of these products. The $10 add-on payment will help to provide access to domestically produced Tc-99m radiopharmaceuticals by addressing the additional cost of domestically produced Tc-99m radiopharmaceuticals. CMS believes the new HCPCS C-code will help facilitate reimbursement with minimum administrative burden. 

CMS is seeking comment on the technical implementation of this add-on payment for Tc-99m derived from domestically produced Mo-99. 

Consistent with the President’s Executive Order #14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” CMS is proposing several modifications to the HPT regulations to ensure that hospitals provide meaningful, accurate information about the amount they charge for health care items and services. CMS proposes to require, beginning January 1, 2026, hospitals disclose the tenth, median and ninetieth percentile allowed amounts in machine-readable files (MRFs) when payer-specific negotiated charges are based on percentages or algorithms as well as the count of allowed amounts used to determine these percentiles, to more accurately reflect the distribution of actual prices that the hospital has received for an item or service. CMS also proposes to enhance the comparability of hospital standard charges by requiring hospitals to use electronic data interchange (EDI) 835 electronic remittance advice (ERA) transaction data to calculate and encode allowed amounts when a payer-specific negotiated charge is based on a percentage or algorithm and we propose to require that hospitals comply with specific instructions regarding the methodology, including the lookback period, that must be used to calculate the tenth, median and ninetieth percentile allowed amounts. CMS also proposes to require hospitals to attest that they have included all applicable payer-specific negotiated charges in dollars that can be expressed as a dollar amount, and for payer-specific negotiated charges that are not knowable in advance or cannot be expressed as a dollar amount, the hospital has provided in the MRF all necessary information available to the hospital for the public to be able to derive the dollar amount, and included the name of the hospital’s chief executive officer, president or senior official designated to oversee the encoding of true, accurate, and complete data. To advance the comparability of HPT information with other healthcare data, CMS proposes a requirement for hospitals to encode their national provider identifiers (Type 2 NPIs) in their MRF. Lastly, CMS proposes to reduce the amount of civil monetary penalty for a noncompliance with the HPT requirements by 35 percent when a hospital agrees with CMS’ determination of their noncompliance and waives the right to a hearing by an Administrative Law Judge. These changes will ensure that patients have more accurate information about actual prices rather than estimates or algorithms.

Intensive Outpatient Program (IOP) Rate Setting

The CY 2026 OPPS/ASC proposed rule would update Medicare payment rates for intensive outpatient program services furnished in hospital outpatient departments and CMHCs. The IOP is a distinct and organized outpatient program of psychiatric services provided for individuals who have an acute mental illness or substance use disorder, consisting of a specified group of behavioral health services paid on a per diem basis for a minimum of 9 hours of IOP services per week under the OPPS, or other applicable payment system, when furnished in hospital outpatient departments, Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs). IOP services may also be furnished in Opioid Treatment Programs (OTPs) for the treatment of opioid use disorder (OUD).

Update to IOP Payment Rates in Hospital Outpatient Departments and CMHCs

CMS is proposing to maintain the existing rate structure, with two IOP APCs for each provider type; one for days with three services per day and one for days with four or more services per day. CMS is proposing to use the CY 2024 claims data and the latest available cost information, from cost reports beginning three fiscal years prior to the year that is the subject of the rulemaking.

For CY 2026, CMS is proposing to maintain the calculation of hospital-based IOP payment rates for three services per day and four or more services per day based on cost per day using OPPS data that includes IOP or PHP and non-IOP or PHP days. CMS believes continuing to use the OPPS data set will allow CMS to capture data from hospital claims that are not identified as IOP or PHP but that include the service codes and intensity required for an IOP or PHP day. 

CMS proposes to change the methodology for calculating the CMHC IOP costs for three services per day and four or more services per day. Specifically, CMS is proposing to calculate the CMHC costs based on 40 percent of the proposed hospital-based IOP costs. This change would resolve a cost inversion in CMHC cost data that resulted in higher geometric mean costs for three-service days than for four-service days. It would also stabilize rates for CMHCs by basing them on data from a much larger set of providers while preserving the adjustment for the structural differences between CMHC and hospital costs.

Partial Hospitalization Program (PHP) Rate Setting

The CY 2026 OPPS/ASC proposed rule would update Medicare payment rates for partial hospitalization program services furnished in hospital outpatient departments and CMHCs. The PHP is an intensive, structured outpatient program provided as an alternative to psychiatric hospitalization, consisting of a specified group of mental health services paid on a per diem basis for a minimum of 20 hours of PHP services per week under the OPPS, based on PHP per diem costs.

Update to PHP Per Diem Rates

CMS is proposing to maintain the existing rate structure, with two PHP APCs for each provider type; one for days with three services per day and one for days with four or more services per day. Consistent with OPPSfor this CY 2026 ratesetting, CMS is proposing to use the CY 2024 claims data and the latest available cost information, from cost reports beginning three fiscal years prior to the year that is the subject of the rulemaking.

For CY 2026, CMS is proposing to maintain the calculation of hospital-based PHP payment rates for three services per day and four or more services per day based on cost per day using OPPS data that includes IOP or PHP and non-IOP or PHP days. CMS believes continuing to use the OPPS data set will allow CMS to capture data from hospital claims that are not identified as IOP or PHP but that include the service codes and intensity required for an IOP or PHP day. 

CMS is proposing to change the methodology for calculating the CMHC PHP costs for three services per day and four or more services per day. Specifically, CMS is proposing to calculate the CMHC costs based on 40 percent of the proposed hospital-based PHP costs. This change would resolve a cost inversion in CMHC cost data that resulted in higher geometric mean costs for three-service days than for four-service days. It would also stabilize rates for CMHCs by basing them on data from a much larger set of providers while preserving the adjustment for the structural differences between CMHC and hospital costs.

The Hospital OQR Program is a pay-for-reporting program that requires hospital outpatient departments (HOPDs) to report data on certain quality measures specified by CMS. HOPDs that fail to submit the required quality data receive a 2-percentage point reduction to their annual payment update.  CMS also makes data submitted by HOPDs for the Hospital OQR Program available to the public on Care Compare, permitting patients and their caregivers to review hospitals’ performance on quality measures. 

CMS is proposing to adopt the Emergency Care Access & Timeliness electronic clinical quality measure (eCQM) beginning with voluntary reporting for the CY 2027 reporting period followed by mandatory reporting beginning with the CY 2028 reporting period/CY 2030 payment determination.

CMS is also proposing to remove: (1) the COVID–19 Vaccination Coverage Among  Healthcare Personnel (HCP) measure beginning with the CY 2024 reporting period/CY 2026 payment determination; (2)  the Hospital Commitment to Health Equity (HCHE) measure beginning with the CY 2025 reporting period/CY 2027 payment determination; (3) the Screening for Social Drivers of Health (SDOH) measure beginning with the CY 2025 reporting period; and (4) the Screen Positive Rate for SDOH measure beginning with the CY 2025 reporting period.

Furthermore, CMS is proposing to remove: (1) the Median Time from Emergency Department (ED) Arrival to ED Departure for Discharged ED Patients (Median Time for Discharged ED Patients) measure and (2) Left Without Being Seen measure, beginning with the CY 2028 reporting period/CY 2030 payment determination, contingency on the Emergency Care Access & Timeliness eCQM being finalized as proposed.

CMS is also proposing to extend the voluntary reporting for the Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults eCQM, beginning with the CY 2027 reporting period.

Lastly, CMS is proposing to update the Hospital OQR Program’s Extraordinary Circumstances Exception (ECE) Policy. This proposed update would explicitly include extensions as a type of extraordinary circumstances relief option, in addition to exceptions.

The REHQR Program is a pay-for-reporting program that requires REHs to report data on certain quality measures specified by CMS.

CMS is proposing to adopt the Emergency Care Access & Timeliness eCQM beginning with the CY 2027 reporting period/CY 2029 program determination as an optional measure; specifically, as an alternative to reporting the Median Time from ED Arrival to ED Departure for Discharged ED Patients measure. CMS is also establishing related eCQM data submission and reporting requirements beginning with the CY 2027 reporting period/CY 2029 program determination.

CMS is proposing to remove: (1) HCHE measure beginning with the CY 2025 reporting period/CY 2027 program determination; (2) Screening for SDOH measure beginning with the CY 2025 reporting period; and (3) Screen Positive Rate for SDOH measure beginning with the CY 2025 reporting period. 

Lastly, CMS is proposing to update the Hospital REHQR Program’s ECE Policy. This proposed update would explicitly include extensions as a type of extraordinary circumstances relief option, in addition to exceptions.

The ASCQR Program is a pay-for-reporting program that requires ASCs enrolled in the Medicare Program to report data on certain quality measures specified by CMS. These quality measures reflect CMS priorities including safety and readmissions to align with National Quality Strategy and CMS Quality Strategy priorities. Under the ASCQR Program, ASCs that fail to submit required data on quality measures as specified by CMS receive a 2-percentage point reduction to their annual payment rate update. CMS also makes data submitted by ASCs for the ASCQR Program available to the public on Care Compare, permitting patients and their caregivers to review ASCs’ performance on quality measures.

For the ASCQR Program, CMS is proposing to adopt the Patient Understanding of Key Information Related to Recovery After a Facility-Based Outpatient Procedure or Surgery, Patient Reported Outcome-Based Performance Measure (Information Transfer PRO–PM) with voluntary reporting beginning with the CY 2027 reporting period, followed by mandatory reporting beginning with the CY 2029 reporting period/CY 2031 payment determination.  CMS is also proposing that ASCs must use the Hospital Quality Reporting (HQR) system for data submission of PRO–PMs generally, including the proposed Information Transfer PRO–PM. This data submission method was finalized for the Total Hip Arthroplasty and/or Total Knee Arthroplasty PRO–PM in the CY 2024 OPPS/ASC final rule with comment period (88 FR 82041).

CMS is proposing to remove the following measures from the ASCQR Program: (1) COVID–19 Vaccination Coverage Among HCP measure beginning with the CY 2024 reporting period/CY 2026 payment determination; (2) Facility Commitment to Health Equity (FCHE) measure beginning with the CY 2025 reporting period/CY 2027 payment determination; (3) Screening for SDOH measure beginning with the CY 2025 reporting period; and (4) Screen Positive Rate for SDOH measure beginning with the CY 2025 reporting period.

Lastly, CMS is proposing to update the ASCQR Program’s ECE Policy. This proposed update would explicitly include extensions as a type of extraordinary circumstances relief option, in addition to exceptions.

In addition to the proposed changes to the Hospital Outpatient Quality Reporting (OQR), Rural Emergency Hospital Quality Reporting (REHQR), and Ambulatory Surgical Center Quality Reporting (ASCQR) Programs described, CMS is seeking input to further meaningful measurement and reporting for quality of care in the outpatient setting.

To align with current administrative priorities, CMS is including a Request for Information (RFI) to seek public input on future measure concepts related to well-being and nutrition. The RFI requests information on tools and measures that assess overall health, happiness, and life satisfaction that could include aspects of emotional well-being, social connections, purpose, and fulfillment.  The RFI also seeks public input on tools and frameworks that promote healthy eating habits, exercise, nutrition, or physical activity.

Patient safety constitutes a fundamental component of the CMS National Quality Strategy, representing a sustained commitment to fostering optimal health outcomes and ensuring the safest possible care for all patients. CMS is proposing to update the methodology used to calculate the Overall Hospital Quality Star Rating to emphasize the contribution of the Safety of Care measure group in hospitals’ ratings.

Measures that are publicly reported on the provider comparison tool on Medicare.gov (https://www.medicare.gov/care-compare/) are organized into five conceptually coherent measure groups under the Overall Star Rating: Safety of Care, Mortality, Readmission, Patient Experience, and Timely and Effective Care. For additional details regarding the current methodology, CMS refers readers to 42 CFR § 412.190(d) and the Overall Hospital Quality Star Rating Methodology Reports, available at https://qualitynet.cms.gov/inpatient/public-reporting/overall-ratings/resources.

After seeking interested party input on the potential modifications to the current methodology to increase the Safety of Care measure group’s contribution to the Overall Hospital Quality Star Rating in the CY 2025 OPPS/ASC final rule with comment period (89 FR 94514 through 94521), CMS is proposing to make a 2-stage methodologic update.  This methodology update will retain all aspects of the current methodology (e.g., annual refresh, inclusion and exclusion criteria for measures, standardization of measure scores, calculation of measure group & summary scores, use of K-means clustering to assign a rating) and proposes adding a new methodology step (which will become the final step of the methodology):

Stage 1 methodology update will be used to calculate the Overall Hospital Star Rating in 2026, while the Stage 2 methodology update will be used to permanently calculate the Overall Hospital Star Rating beginning in 2027 and later years. The Stage 2 methodology update is intended to replace the Stage 1 methodology update, not to supplement it. That is, no 5-star hospital will be capped to 4 stars and then further reduced to 3 stars; in both stages, 5-star hospitals could only be reduced to 4 stars.

Only rated hospitals with at least 3 Safety of Care measures would be subject to either the 4-star cap or the 1-star reduction. This is to ensure that any reduction is based on reliable measurement across multiple elements of patient safety. Hospitals with 1 or 2 Safety of Care measures will still receive a Safety of Care group score and their star rating will reflect their performance on these measures, but they would not be subject to additional reduction based on limited information. Hospitals with 0 Safety of Care measures do not receive a Safety of Care group score, and their patient safety performance is not reflected positively or negatively in their Overall Star Rating due to insufficient data for reliable measurement of patient safety outcomes.

Proposed changes reflect CMS' commitment to improving healthcare outcomes and advancing patient safety and aims to:

Additionally, CMS is seeking public input on approaches and opportunities to streamline regulations and reduce burdens on those participating in the Medicare program through a standalone RFI available at https://www.cms.gov/medicare-regulatory-relief-rfi. The public should submit all comments in response to this RFI through the provided weblink.

For more information about Hospital Outpatient PPS, please visit: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient.

The proposed rule (CMS-1834-P) can be downloaded at the Federal Register here: https://www.federalregister.gov/d/2025-13360. 

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