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Hello partners,
Last month, the Trump Administration proposed major changes to how Medicare pays for hospital care and physician services in the Outpatient Prospective Payment System and Medicare Physician Fee Schedule. These proposed rules take important steps to paying better for primary care and stopping payment distortions that drive hospital consolidation. At the same time, these rules roll back important requirements that drive health equity improvements.
Medicare payment sets the benchmark for how most other health care is paid for and delivered. Therefore, it is critical that a powerful range of organizations representing consumers, families, workers, and employers come together to be a counterweight to industry interests and ensure that the Administration prioritizes pro-consumer reforms in this year's Medicare payment rules.
Families USA, along with the Consumers First Steering Committee, reviewed these proposed rules and wrote two comment letters responding to select proposals that are particularly important for the health and health care of our nation's families. Join us in asking the Administration to prioritize pro-consumer reforms in this year's Medicare payment rules by signing on to our MPFS and OPPS CY 2026 comment letters.
If you missed our recent webinar outlining which proposals we have chosen to comment on, here is a link to its slides [[link removed]] , as well as the webinar recording [[link removed]] .
Outpatient Prospective Payment System (OPPS)
The OPPS plays a major role in setting Medicare payments for hospital care. Our comment letter includes recommendations across several key areas, including CMS's proposals to:
* Allow hospitals to comply with the hospital price transparency rule by posting price estimates instead of dollars and cents negotiated rates, undermining the ability of people to know the price of health care before they receive services
* Extend site neutral payments to drug administration delivered by "grandfathered" off-campus provider-based departments, except for those hospitals classified as rural sole community hospitals, to ensure consumers pay the same price for the same service for physician administered drugs in more outpatient care settings.
* Repeal key health care quality measures from the hospital outpatient quality reporting program that would have held hospitals accountable for health equity and the social drivers of health, including the Hospital Commitment to Health Equity , The Screening for Social Drivers of Health, and The Screen Positive Rate for Social Drivers of Health measures.
You can read the letter [[link removed]] here, and to sign-on , please complete this form [[link removed]] by EOD Friday, September 12. If you have any questions, please reach out to Aaron Plotke, at [email protected] [[email protected]] .
Medicare Physician Fee Schedule (MPFS)
The MPFS plays a major role in making sure our health system prioritizes patient centered health and primary care, and delivers care in an equitable manner. Our MPFS comment letter includes thoughts and recommendations across several key areas, including CMS's proposals to:
* Update physician payment rate setting methodology to reflect changes in the health care system and gains in efficiency in the delivery of many professional service
* Reduce the reliance on American Medical Association survey data when setting physician payment rates
* Expand the scope of the Advanced Primary Care Management (APCM) service codes to include collaborative behavioral health and psychiatric care.
* Introduce a new alternative payment model, Ambulatory Specialty Model (ASM), focused on improving cost and quality outcomes for patients experiencing heart failure and low back pain
* Reduce the amount of time that an ACO can spend in one-sided risk models under the Medicare Shared Savings Program
You can read the letter [[link removed]] here, and to sign-on, please complete this form [[link removed]] by EOD Thursday, September 11. If you have any questions, please reach out to Alicia Camaliche, at [email protected] [[email protected]] .
Thank you,
Mike Persley
Strategic Partnerships Campaign Manager
Families USA
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