News: CMS releases 2026 IPPS proposed rule with payment updates, significant changes to numerous programs
CMS is seeking feedback on potential modifications to existing quality and reporting programs and possible new reporting measures, according to the fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule, which was released on April 11. CMS is proposing a 2.4% increase in operating payments for acute care hospitals, Revenue Integrity Insider reported.
This update is expected to increase hospital payments by $4 billion, including $1.5 billion in additional Medicare disproportionate share hospital payments and $234 million in new technology add-on payments, Becker’s Hospital Review reported.
The agency is also proposing modifications to numerous quality and reporting programs. For example, CMS aims to remove four social determinant of health assessment items from the Skilled Nursing Facility Quality Reporting Program beginning October 1, 2025, including:
- One item for “living situation”
- Two items for “food”
- One item for “utilities”
Also, CMS plans to remove four quality measures beginning with the 2024 reporting period/FY 2026 payment determination:
- Facility commitment to health equity
- COVID-19 vaccination coverage among healthcare personnel
- Screening for social drivers of health
- Screen positive rate for social drivers of health
Furthermore, the proposal outlines CMS’ plan to address its low wage index hospital policy. The policy, which was adopted in the 2020 IPPS final rule, created a temporary, budget-neutral fix for wage index disparities that affected low-wage index hospitals, particularly rural hospitals. In July 2024, the Court of Appeals for the D.C. Circuit ruled that CMS lacked the authority to adopt the policy and that the policy must be vacated. Therefore, CMS is proposing to discontinue the policy in FY 2026 and to implement a budget-neutral transition exception for hospitals that would be significantly affected by the discontinuation of the law-wage index hospital policy.
Comments on the proposed rule are due June 10. CDI professionals should carefully read the proposed rule, focusing on proposals that may directly affect their job duties, facility, or patient population. Make note of any proposals that could have a meaningful impact, whether positive or negative, on reimbursement, systems, or programs. Discuss the proposals with colleagues in other affected departments and consider responding to CMS’ various requests for information and feedback. If you are looking for tips for how to comment on the 2026 IPPS proposed rule, you can read NAHRI’s white paper Advocacy in Action: Commenting on Proposed Rules.
Editor’s note: To read Revenue Integrity Insider’s coverage of this story, click here. To read Becker’s Hospital Review’s coverage, click here. To access the 2026 IPPS proposed rule, click here.