CMS Updates Medicare Hospital Payment Rates and Health IT Standards
New rules revise prospective payment systems for acute and long-term care hospitals and update electronic prior authorization standards.
The Centers for Medicare & Medicaid Services is revising the inpatient prospective payment systems (IPPS) for the operating and capital-related costs of acute care hospitals. The rule also updates annual payment rates and policies for the prospective payment system (PPS) used by long-term care hospitals.
As part of these changes, the agency is adjusting Medicare severity diagnosis-related group (MS-DRG) classifications and relative weights. These adjustments account for shifts in technology, treatment patterns, and resource consumption to ensure payments reflect the average resources required for specific patient cases.
Teaching hospitals will see changes to Medicare graduate medical education (GME). Additionally, the rule updates requirements for certain quality programs and approves new technology add-on payments, including the Bayesian Health Sepsis Flagging Device.
On behalf of the Department of Health and Human Services, the Office of the National Coordinator for Health Information Technology is adopting updated health IT standards and specifications. These updates specifically target electronic prior authorization and interoperability standards to ensure health IT developers can utilize the latest specifications.
These regulations take effect on October 1, 2026.