Welcome to another round of PYA Washington Updates! It’s National Tropical Fruit Day, so grab a mango as you review the latest developments in healthcare policy.
2026 Medicare Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule
On Tuesday afternoon, CMS published the 2026 OPPS proposed rule. The 390-page proposed rule is available here, and CMS’ fact sheet highlighting key provisions can be found here. We discussed those key provisions on Wednesday in the latest episode of PYA’s Healthcare Regulatory Round-Up webinar series, One Big Beautiful Bill, Lots of Proposed Rules.
The OPPS proposed rule includes several significant policy developments including a 2.8% increase in reimbursement rates (which is only a 0.88% increase for hospitals that opened prior to 2018 once certain reductions are taken into account), site neutral payments for drug administration (learn more about site neutral payments here), new price transparency requirements, and the beginning of the end of the inpatient only list.
2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule
On Monday afternoon, CMS published the 2026 MPFS proposed rule. The 910-page proposed rule is available here, and CMS’ fact sheet highlighting key provisions can be found here. PYA will present webinars on the MPFS proposed rule on July 30 and August 13. You can register for these webinars here.
During the July 30 webinar, we’ll cover the 2026 payment rate/conversion factor, the new efficiency adjustment, the revised practice expense methodology, the Ambulatory Specialty Model (new mandatory alternative payment model), and changes to the Merit-Based Incentive Payment System (MIPS) and Medicare Shared Savings Program (MSSP). On August 13, the agenda will include telehealth changes, global payments reforms, new reimbursement methodology for skin substitutes, updates to remote monitoring and care management services, and prevention and wellness programs.
Another Big Beautiful Bill?
Congress will be in recess July 25 – September 1. Upon its return, Congress has until September 30 to finalize FY2026 appropriations. Of particular interest to healthcare providers are the extensions of the Sole Community Hospital and Low Volume Hospital programs, expanded Medicare telehealth coverage, and delays in Medicaid DSH cuts, all of which are now set to expire on September 30. And there’s talk in the Republican ranks of another reconciliation bill. Sen Ron Johnson (R-Wisconsin), Rep. Jodey Arrington (R-Texas), and others are pushing more Medicaid cuts (including elimination of 90% FMAP for the expansion population) and more Medicare site neutral payment reforms.
Please do not hesitate to contact us if you have any questions regarding these latest developments, and please continue to check PYA’s website for updates.
