On July 15, 2025, the Centers for Medicare and Medicaid Services (CMS) released its proposed calendar year (CY) 2026 payment rule for the Medicare Outpatient Prospective Payment System (OPPS). The proposed rule includes updates to the Medicare fee-for-service OPPS payment rates based on changes set forth by CMS and those previously adopted by Congress. In addition to the regular updates to wage indexes and market basket, the following policies are proposed in this rule:

• Updating Ambulatory Payment Classification (APC) Groups and Weights;
• Updating the 340B Final Remedy reduction to the OPPS conversion factor;
• Eliminating the Inpatient-Only (IPO) list;
• Updating current methodology for Overall Hospital Quality Star Rating;
• Updating requirements for the Hospital Outpatient Quality Reporting (OQR) Program;
• Updating requirements for the Rural Emergency Hospital Quality Reporting (REHQR) Program; and
• Updating payment rates and policies for Ambulatory Surgical Centers (ASCs).

KHA will be submitting comments prior to the Sept. 15 submission deadline. After the PYA presentation, Donna Little, KHA’s AVP for Health Policy and Regulatory Affairs, will share information about KHA’s comment letter and also solicit additional feedback regarding your concerns with the OPPS proposed rule.

Target Audience: C-suite hospital leaders

Speakers: Kathy Reep, Consulting & Business Development, PYA

Donna Little, AVP, Health Policy and Regulatory Affairs, Kentucky Hospital Association