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The Centers for Medicare and Medicaid Services (CMS) issued its proposed rule to update CY 2027 payment rates for hospital outpatient departments and ambulatory surgical centers. Comments on the proposed rule are due by August 31st.  If you wish to provide feedback to inform AHPA's response, please email Christina.Luke@AdventHealth.com. Unless otherwise specified, finalized policies will become effective January 1st, 2027. For AHPA’s summary of the proposed rule, click here.  Highlights of the proposed rule include: 

• 340B Payment Cuts: A reduction in payments from ASP+6% to ASP -33.4% for 340B-acquired drugs beginning in CY 2027. CMS is using survey data collected earlier this year to justify this payment cut.  

• 340B Payment Policy Recoupment: CMS proposes to increase the annual reduction to the non-drug OPPS conversion factor from 0.5% to 3% beginning in CY 2027, recovering the overpayment hospitals received between 2018-2022 as an offset for the now-vacated 340B drug payment policy. Hospitals with a CMS certification date of January 2, 2018, or later are excluded.  

• Site-Neutral Payments: CMS proposes to adopt site-neutral payments for imaging services without contrast in off-campus provider-based departments. 

• Inpatient-Only (IPO) List: CMS proposes to remove 637 of the 1,438 services on the list beginning in CY 2027. This would allow those services to be performed in both the inpatient and outpatient settings.  

• EMTALA Accrediting Organizations (AO): CMS proposes to require Accrediting Organizations to assess compliance with select EMTALA administrative requirements (e.g., signage and transfer record retention). CMS notes that AOs would not assess or enforce EMTALA requirements related to medical screening examinations, stabilizing treatment, appropriate transfers or receiving hospital responsibilities.  

• Prior Authorization Expansion to include botulinum toxin injections. 

• Provider-Based Attestation Requirements: Beginning January 1, 2028, off-campus outpatient departments must bill under a separate National Provider Identifier (NPI), and the main provider must submit an initial provider-based attestation within two years before furnishing services, with subsequent attestations at intervals not exceeding five years.  

• Requests for information: CMS included several requests for information to inform future rulemaking. For example, how to better standardize hospital price transparency data within the machine-readable files and potential payment incentives CMS could adopt for domestically manufactured PPE and essential medicines.