Hello partners,

We are excited to share that last Friday CMS released its Medicare Outpatient Prospective Payment System (OPPS) CY 2026 final rule, which enacts a number of key policy priorities that our organizations have been fighting for for many years, including through our Consumers First coalition and its OPPS CY 2026 sign on comment letter.

CMS finalized an expansion of same service same price payment reforms that ensures our nation's seniors will be charged the same price for the same service for physician administered drugs in more outpatient care settings, including "off-campus" hospital owned outpatient clinics that were previously exempted from such reforms. This is a huge win for consumers and families across the country and is estimated to save Medicare patients nearly $3 billion in cost sharing over ten years. By finalizing this proposal, CMS is taking a critical step to rein in a key driver of hospital consolidation, including the harmful practice of hospitals buying up independent physician practices in order to shift care delivery to more expensive care settings and charge patients significantly higher prices for the same routine care.

None of this could have been done without your support. We appreciate and thank you for your partnership.

A couple of the major wins in the CY 2026 rule include:

Extending site neutral payments to drug administration services delivered by most* “grandfathered” off-campus provider-based departments to ensure consumers pay the same price for the same service for physician administered drugs in more outpatient care settings.
- *CMS also finalized an exception, where sole community hospitals located in rural areas will not be subject to site neutral payments for drug administration services.
Requiring hospitals to encode a senior official’s name and a strengthened attestation statement in the hospital price transparency data to help verify the accuracy and completeness of such data.

CMS also finalized policies that are detrimental to the health and health care of consumers in the CY2026 final rule. These include:

Weakening price transparency rules that undermine the ability for people to know the price of health care before they receive medical services. They would do this by allowing hospitals to post algorithms and price estimates, instead of actual prices in dollars and cents.
Repealing critical quality measures that would have held hospitals accountable for health equity and the social drivers of health, undermining our ability to drive high value health care and improve health outcomes. The measures removed include the hospital commitment to health equity measure, the screening for social drivers of health measure, and the screening positive rate for social drivers of health measure.

Thank you, and please reach out if you have any questions.

Mike Persley

Strategic Partnerships Campaign Manager

Families USA