On Thursday, July 2, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS/ASC) Proposed Rule.
This proposed rule would update the payment rates for ASCs and hospitals that meet their outpatient quality reporting requirements by 2.4% for CY 2027. This would result in approximately $520 million more for payments to ASCs over 2026 levels, and $9.5 billion more for payments to hospitals over 2026 levels.
This proposed rule also contains several additional policy proposals that could potentially have an impact on PM&R, including:
- Expanding the hospital outpatient department prior authorization program to include botulinum toxin injection codes.
- Revising the OPPS and the ASC payment systems and proposes updates to requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
- Allowing hospital Accrediting Organizations with deeming authority to assess compliance with EMTALA administrative requirements.
- Continuing to phase out the Inpatient Only (IPO) list.
- Opening a Request for Information (RFI) focused on strengthening hospital transparency data.
CMS has also published a fact sheet that highlights several of the more substantive provisions of this proposed rule.
Comments on this proposed rule are due by the end of August 31, 2026. Your Academy is currently working to review this new proposed rule in detail and will share further information as it becomes available.
If you have any questions or concerns about this proposed rule, please reach out to Academy staff at healthpolicy@aapmr.org.