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Recent CMS Rules, Payment Updates & Deadlines

Collected 2026-07-21. This is the most time-sensitive file — the weekly refresh updates it. Always confirm against the linked CMS fact sheets and the Federal Register.

Inpatient (IPPS)

FY 2026 IPPS/LTCH Final Rule — CMS-1833-F (in effect)

  • Status: Final; applies to discharges on/after October 1, 2025 (FY 2026 = Oct 1 2025 – Sep 30 2026).
  • Fact sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2026-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0
  • Home page: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2026-ipps-final-rule-home-page

FY 2027 IPPS/LTCH Proposed Rule — CMS-1849-P (proposed)

  • Status: Proposed (not final). Published/displayed April 10, 2026. Watch for the final rule (typically issued around August, effective Oct 1, 2026).
  • Proposed inpatient payment update: +2.4% (3.2% market basket minus 0.8 pp productivity), ~$1.4 billion additional IPPS payments; new-technology add-on payments up ~$464M.
  • LTCH PPS: standard rate update +2.4%.
  • Proposed quality-program changes (do not treat as final):
  • IQR — new measures: Excess Days in Acute Care after Diabetes Hospitalization (FY 2029); Hospital Harm – Postoperative VTE eCQM (FY 2030); Advance Care Planning eCQM (FY 2030).
  • IQR — modified (FY 2028): five 30-day mortality measures (AMI, HF, pneumonia, COPD, CABG) to include Medicare Advantage patients and shorten the performance period from 3 years to 2 years.
  • IQR — removed (FY 2030): VTE-1, VTE-2, and STK-02 eCQMs.
  • HRRP: proposed sepsis readmission measure (FY 2029).
  • HAC Reduction: no updates proposed.
  • VBP: five condition-specific mortality measure modifications beginning FY 2032.
  • Promoting Interoperability: remove ONC attestations and two electronic-referral-loop measures; adopt two new eCQMs (FY 2030); remove three existing eCQMs (FY 2030).
  • Fact sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-ipps-long-term-care-hospital-prospective
  • Home page: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2027-ipps-proposed-rule-home-page

Outpatient (OPPS/ASC)

CY 2026 OPPS/ASC Final Rule — CMS-1834-FC (in effect)

  • Status: Final; effective January 1, 2026 (certain price-transparency enforcement provisions delayed to April 1, 2026).
  • Outpatient payment update: approximately +2.6% for CY 2026.
  • Notable hospital price-transparency changes:
  • Machine-readable files must report actual dollar amounts — the median allowed amount plus the 10th and 90th percentile allowed amounts (replacing estimated allowed amounts).
  • Data must come from EDI 835 electronic remittance advice (or equivalent), using a 12–15 month lookback.
  • Hospitals must encode their Type 2 NPIs in the files.
  • A hospital executive must attest the pricing data is true, accurate, and complete.
  • Civil monetary penalties reduced 35% when a hospital waives its appeal and accepts CMS's violation determination.
  • Fact sheet (price transparency): https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes

The annual rule cycle (so clients know what's coming)

  • Spring (≈April): IPPS proposed rule for the next FY; OPPS proposed rule (≈July).
  • Summer (≈August): IPPS final rule, effective Oct 1.
  • Fall (≈November): OPPS final rule, effective Jan 1.
  • Comment periods are typically ~60 days after a proposed rule displays.

Where to confirm the very latest

  • CMS Newsroom (fact sheets): https://www.cms.gov/newsroom
  • Federal Register, CMS agency feed: https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services
  • Federal Register API (no key): https://www.federalregister.gov/api/v1/documents.json?conditions[agencies][]=centers-for-medicare-medicaid-services&conditions[type][]=RULE&order=newest

Reminder: Items marked proposed can change before finalization. Verify effective dates and figures against the linked primary source before advising a client.