CMS Finalizes 2027 OPPS Rule

The Centers for Medicare & Medicaid Services (CMS) on Nov. 4 issued the final Calendar Year 2027 Outpatient Prospective Payment System (OPPS) rule, which updates payment rates for outpatient health care services in acute-care settings and makes significant reimbursement changes for hospitals participating in the 340B Drug Pricing Program. The rule also reduces payments for certain services provided in off-campus outpatient departments. It takes effect Jan. 1, 2027.

America's Essential Hospitals issued a statement in response to the final rule and is analyzing its provisions. A detailed Washington Briefing for members will follow.

CMS finalized a significant reduction in outpatient drug reimbursement for 340B hospitals from the current rate of average sales price (ASP) plus 6% to ASP minus 28%. The agency estimates that this policy will reduce payments to 340B hospitals by $5.45 billion in 2027. Because statute requires the changes to be implemented in a budget-neutral manner, CMS also finalized a 7.5% increase in payments for non-drug items and services across acute-care hospitals.

The rule also finalized lower reimbursement for imaging services provided without contrast agents in certain off-campus outpatient departments that are otherwise exempt from site-neutral payment policies. The reduction aligns payments with Physician Fee Schedule rates.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.