# 2026-22739: Medicare's Mega-Rule Bundles Prices, Transparency, Emergency Care, and Closures 2026-22739, Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots, is a Federal Register rule from Health and Human Services Department, Centers for Medicare & Medicaid Services published 2026-11-06, effective 2027-01-01; deemed significant under Executive Order 12866; PRIA reads it as touching household money (as of 2026-11-06). - Canonical: https://policyrisk.com/federal-register/2026-22739 - As of: 2026-11-06 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Document number: 2026-22739 - Title: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots - Type: Rule - Agencies: Health and Human Services Department; Centers for Medicare & Medicaid Services - Citation: 91 FR 70284 - Published: 2026-11-06 - Effective: 2027-01-01 - Comments close: not stated - Significant: yes (OIRA_API) - Touches household money: yes - Regulation identifier numbers: 0938-AV83 - Last updated: 2026-11-06 ## In one line Medicare's Mega-Rule Bundles Prices, Transparency, Emergency Care, and Closures ## Summary Starting in 2027, Medicare is updating how hospitals and surgery centers get paid for outpatient care and surgeries. These changes affect hospitals, surgery centers, and patients by adjusting payment rates and improving quality reporting. Plus, CMS is asking for ideas to make hospital price info clearer and easier to compare, while also handling rules about emergency care and teaching hospital closures. ## Abstract This final rule with comment period revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2027 based on our continuing experience with these systems. We also describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment systems. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting Program and the Ambulatory Surgical Center Quality Reporting Program. There are no changes to the Rural Emergency Hospital Quality Reporting Program. We finalized the expansion of the prior authorization requirement to include additional Botulinum Toxin Injection services. We also finalized implementation of certain provisions of the Consolidated Appropriations Act, 2026, for off-campus outpatient departments of a provider. In addition, this final rule with comment period announces notices of closure of teaching hospitals and opportunities to apply for available slots. Additionally, we finalized the policy that hospital accrediting organizations (AOs) with deeming authority may assess compliance with certain Emergency Medical Treatment and Labor Act (EMTALA) administrative requirements under 42 CFR 489.20 during accreditation and reaccreditation surveys. ## Effects PRIA read - Medicare OPPS and ASC Payments Rise 2.3%: benefit, high. Starting January 1, 2027, Medicare increases hospital outpatient (OPPS) and ambulatory surgical center (ASC) payment rates by an OPD fee schedule update factor of 2.3 percent. CMS estimates total OPPS payments for CY 2027 will be about $114.4 billion (roughly $11 billion more than CY 2026) and tota… - Prior Authorization for Botulinum Injections: cost, medium. Hospital outpatient prior authorization is expanded to include Botulinum Toxin Injection services for dates of service on or after July 1, 2027. If you need a covered Botulinum Toxin Injection on or after that date, hospitals must follow the prior authorization process before Medicare pays. - 340B-Acquired Drugs: Payment Set to ASP‑28%: mixed, high. For calendar year 2027, Medicare will pay for drugs acquired under the 340B program at Average Sales Price (ASP) minus 28 percent. CMS states this change will be budget‑neutral by increasing payments for non‑drug OPPS services by an estimated 7.50 percent and estimates that hospitals subject to the… - More Procedures Move to ASCs; IPO List Shrinks: benefit, medium. For CY 2027, CMS is expanding the Ambulatory Surgical Center (ASC) covered procedures list by adding 618 HCPCS/CPT codes and is removing 637 services from the Inpatient Only (IPO) list across many clinical families. These changes allow more procedures to be billed and performed in ASC or outpatient… - Big Payment Increase for CMHC PHP/IOP Services: benefit, medium. CMS estimates a 29.0 percent increase in Medicare payments to Community Mental Health Centers (CMHCs) for calendar year 2027 compared to CY 2026, reflecting the finalized policy for Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) payment rates. The estimate is based on… ## Related documents - [2026-22381](https://policyrisk.com/federal-register/2026-22381): Medicare and Medicaid Programs; Organ Procurement Organizations Conditions for Coverage: Revisions to the Conditions for Coverage, 2026-11-03 - [2026-22194](https://policyrisk.com/federal-register/2026-22194): Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury (AKI) Dialysis Paym…, 2026-10-30 - [2026-21420](https://policyrisk.com/federal-register/2026-21420): Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026, 2026-10-20 - [2026-20281](https://policyrisk.com/federal-register/2026-20281): Global Benchmark for Efficient Drug Pricing (GLOBE) Model, 2026-10-02 - [2026-20131](https://policyrisk.com/federal-register/2026-20131): Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality…, 2026-10-01 - [2026-19959](https://policyrisk.com/federal-register/2026-19959): Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Prog…, 2026-09-30 ## Sources - [2026-22739 on federalregister.gov](https://www.federalregister.gov/documents/2026/11/06/2026-22739/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment) - [2026-22739 as published (PDF)](https://www.govinfo.gov/content/pkg/FR-2026-11-06/pdf/2026-22739.pdf) ## Related - [Previous: 2026-22735, Heightened Requirements for Foreign Importers of Record](https://policyrisk.com/federal-register/2026-22735) - [Next: 2026-22741, Amendments to the “Small Business” and “Small Organization” Definitions for Inv…](https://policyrisk.com/federal-register/2026-22741) - [All Federal Register documents](https://policyrisk.com/federal-register) Source: PRIA, https://policyrisk.com/federal-register/2026-22739 (as of 2026-11-06).