Proposed OPPS Rule Includes Expansion of Site Neutral Payments

This week, the Centers for Medicare and Medicaid Services (CMS) published its 2026 Outpatient Prospective Payment System (OPPS) proposed rule which would raise reimbursement for hospitals and ambulatory surgical centers (ASCs) by 2.4%. The proposal also puts forward a site-neutral policy, which would allow CMS to reimburse at the same rate for off-campus care.

Specifically, CMS is proposing to include drug administration services in this policy, which it estimates will reduce OPPS spending by $280 million on the year, with $210 million in savings accruing to Medicare, Inside Health Policy reports. With the rule, the agency is also asking for feedback on potentially expanding the policy.

The 2.4% proposed payment increase for hospitals reflects a 3.2% market basket increase projection with a required productivity adjustment of 0.8%. In total, the proposed rule is expected to increase OPPS expenditures by $8.1 billion over 2025, Fierce Healthcare reports. ASC reimbursement rates also reflect the same market basket projection and productivity adjustment but is projected to increase payments by $480 million.

Hospitals were less than thrilled with the pay increase, as the American Hospital Association released a statement noting that the inadequate pay bump will have collateral outcomes for maternal health services at hospitals.

We believe a less punitive and more collaborative approach would be more effective given that the key drivers of maternal health outcomes are highly complex and involve multiple stakeholders. The AHA remains committed to working with the Administration and other stakeholders to advance a full range of solutions to improve maternal outcomes.

The fact sheet for the proposed rule can be reviewed at the CMS website.