New CMS regulations promote cost clarity and flexibility in outpatient care
The Centers for Medicare & Medicaid Services (CMS) announced the publication of a final rule regarding hospital price transparency. Key regulations are summarized in a press release.
The final rule, the calendar year (CY) 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, aims to boost hospital price transparency and better patient care. Hospitals will now be required to post accurate pricing information in language patients will understand so there are no surprise costs. Hospitals that don’t do this will have to pay civil monetary penalties.
Regulations will no longer allow “unnecessary increases in the volume of covered outpatient department services to align payments for certain services delivered in hospitals and off-campus facilities.” Medicare beneficiaries will not be punished with extra copays “based on where they receive care.” Additionally, the rule “finalizes phasing out the inpatient-only list and expanding the ambulatory surgical center covered procedures list, which will give physicians greater flexibility to determine the most clinically appropriate setting for care and allow more patients to choose outpatient surgical options while maintaining patient safety.”
CMS reported that the Overall Hospital Star Rating system is being changed to put more emphasis on patient safety. Hospitals that perform low in “Safety of Care” will not be able to receive a 5-star rating.
According to U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr, “This final rule from CMS closes the loopholes hospitals exploit to hide real prices and advances President Trump’s demand for radical hospital price transparency.” The rule also covers addiction services and senior care.
The rule is expected to save the Medicare program and its beneficiaries $11 billion over the next decade.
For more information, read the final rule here
Fact sheets:
CY 2026 OPPS and Ambulatory Surgical Center Final Rule - Hospital Price Transparency Policy Changes
