CMS Proposed Rule Offers $8B Hospital Pay Bump, but Draws Criticism Over Cuts and Transparency Push

The Centers for Medicare & Medicaid Services (CMS) has proposed a rule that would increase hospital outpatient payments by 2.4% in 2026 — adding $8 billion — but hospital groups argue it falls short. The rule also advances site-neutral payment policies, potentially reducing reimbursements for outpatient services delivered at hospital-owned sites. Hospitals oppose this shift, citing operational differences. The rule also proposes stricter price transparency requirements, including disclosure of payer-specific negotiated rates’ percentiles. CMS aims to recover $7.8 billion in overpayments from the 340B drug program faster, proposing a 2% reduction in hospital payments until 2031, which AHA criticized as unfair. Additional changes include the removal of some COVID-19 and health equity quality metrics, as well as a cap on star ratings for hospitals with poor safety scores. While CMS says the rule enhances accountability and affordability, hospitals warn it could undercut resources and stability, especially for underserved communities.

16-07-2025