CMS Finalizes Medicare Payment Rules, Slashing 340B Payments and Adjusting ASC Rates
- Reports
- 9
- Developments
- 9
- Repetition
- 44%
New informationRepeats or wire copies
What happened
The Centers for Medicare and Medicaid Services finalized new payment rules for Medicare services on November 5, 2026, which include a reduction in 340B payments by billions of dollars. The rule also broadens site-neutral policies, meaning Medicare will pay the same amount for certain medical procedures regardless of whether they are performed in a hospital-owned outpatient department or an Ambulatory Surgery Center. Despite the changes, hospital outpatient departments and ASCs will receive a 2.3% payment increase next year.
From biopharmadive.com
Why it matters
The reforms aim to drive affordability for Medicare beneficiaries by lowering out-of-pocket costs for drugs and imaging services. However, the American Hospital Association argued that the payment increase is insufficient to address financial challenges, particularly due to the reduction in 340B payments. Medicare uses the Resource-Based Relative Value Scale to determine payments for physician services, a process that involves input from medical specialty societies and review by CMS.
CMS manages the federal health insurance program and oversees adjustments for Medicare Part B.
Who's involved
- CMSCenters for Medicare and Medicaid Services, which finalized the new payment rules.
- MedicareMedicare, the federal health insurance program affected by the payment changes.
- Social Security AdministrationThe Social Security Administration, which is structurally integrated with Medicare.
Possible ripples
Who this could reach next, traced step by step from the reporting. Possibilities worth considering, not forecasts.- Clover Health may face pressure from changing Medicare reimbursement ratesClover Health may face financial pressure from changing Medicare reimbursement ratesLikely
- New CMS payment rules may prompt House of Representatives actionNew CMS payment rules may prompt the House of Representatives to advance healthcare legislation.Possible
- New cms payment rules may shift financial risk for AetnaAetna may need to adjust financial models due to proposed CMS ASC payment changesPossible
How it developed
Newest first. Tap a step to see who reported it.CMS finalized new payment rules impacting Medicare services.1 source
CMS finalized Medicare payment rates and a specific PLA code was submitted under CPT.1 source
- CMS is adding new codes and driving expansion in Ambulatory Surgical Centers, leveraging shifts toward outpatient care in states like Texas and Arizona.Sub-event
- CMS proposes new pricing rules for Medicare, which will affect the finances of proton centers.Sub-event
- CMS mandates procedural codes for insurer use, while a cyberattack exposes payment system vulnerabilities and the foundation analyzes the actions.Sub-event
CMS finalized the 2027 IRF rule, leading to increased Medicare revenue.1 source
- CMS uses RVU and AMA standards to manage payment rules for Medicare physician labor.Sub-event
AAOS responds to CMS proposals, citing shrinking Medicare reimbursement.1 source
Show 1 earlier step
CMS proposes specific reimbursement rules for ASC procedures under Medicare.1 source
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The entities involved
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Medicare
US federal health insurance
Related events
- Proposed CMS reimbursement rules impacted care access in Connecticut.
- A federal judge issued a ruling in Boston limiting the scope of a CMS policy.
- CMS administers Medicare programs while the Trump administration prioritizes combating healthcare fraud.
- The American College of Rheumatology responded to proposed CMS reimbursement changes, submitted H-1B comments, and addressed physician shortage concerns.
- UnitedHealthcare offers Medicare Rx plans while CMS provides 2027 plan files for projections.