AHA Comments on CMS CY 2026 Outpatient, ASC Proposed Payment Rule

September 15, 2025

The Honorable Mehmet Oz, M.D.
Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850

Re: CMS-1834-P, Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency; Proposed Rule (Vol. 90, No. 133), July 17, 2025.

Dear Administrator Oz:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations; our clinician partners - including more than 270,000 affiliated physicians, 2 million nurses and other caregivers; and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services' (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2026.

The AHA supports several proposed policies set forth in the rule. For example, we support permanently extending the ability of virtual presence to satisfy direct supervision requirements for cardiac rehabilitation (CR), intensive cardiac rehabilitation (ICR) and pulmonary rehabilitation (PR) services. In addition, we support CMS' proposals to remove four measures from the Outpatient Quality Reporting program that were recently finalized for removal from the Inpatient Quality Reporting Program and the proposal to offer time extensions for data reporting for facilities experiencing an extraordinary circumstance.

However, we are deeply concerned about other proposals that would negatively impact beneficiary access to hospital-level care and new technologies, while also greatly increasing regulatory burden. Specifically, the AHA opposes CMS' proposals to:

• Reduce payment for all drug administration services furnished in excepted off-campus hospital provider-based departments (PBDs) to the "physician fee schedule (PFS)-equivalent" rate of 40% of the OPPS payment amount.
• Eliminate the inpatient-only (IPO) list over three years.
• Weaken the ASC Covered Procedures List (CPL) standard criteria and general exclusion criteria.
• Accelerate the timeline for clawing back funds resulting from the agency's unlawful policy between CYs 2018 and 2022.
• Conduct a drug acquisition cost survey of all hospitals paid under the OPPS.
• Collect market-based payment rate data for purposes of setting inpatient PPS relative weights beginning in fiscal year (FY) 2029.
• Revise the requirements for hospitals to make public their standard charges.

The AHA urges CMS not to finalize these provisions so that hospitals can continue to provide the highest quality health care to their patients and communities.

We appreciate your consideration of these issues. Our detailed comments are attached. Please contact me if you have questions, or feel free to have a member of your team contact Roslyne Schulman, AHA director for policy, at (202) 626-2273 or [email protected].

Sincerely,

/s/

Ashley B. Thompson
Senior Vice President
Public Policy Analysis & Development

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