HRS Identifying Administrative Burdens for Removal as Medicare Requests Input & Proposes 2026 Hospital Inpatient Payment Increase

On April 11^th, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2026 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital (LTCH) Prospective Payment System proposed rule and fact sheet.

CMS proposes a 2.4% increase for hospital inpatient payments for facilities that meet their quality and electronic health record meaningful use reporting requirements.  The 2.4% payment update reflects a hospital market basket increase of 3.2% as well as a productivity cut of 0.8%. CMS also proposes to rebase and revise the market basket to a 2023 base year. In addition, the rule includes a proposed $1.5 billion increase in disproportionate share hospital payments and a proposed $234 million increase in new medical technology payments. Overall, it would increase hospital payments by $4 billion in FY 2026 as compared to FY 2025.

Key Takeaways from the FY 2026 IPPS Proposed Rule 

• Quality Reporting Provisions
  In the rule, CMS proposes several changes to inpatient quality reporting requirements.  Specifically, CMS proposes to remove quality measures focused on health equity and social drivers of health from the Hospital Inpatient Quality Reporting (IQR) Program, and the health equity adjustment from the Hospital Value-Based Purchasing (HVBP) program’s scoring methodology.   CMS also proposes numerous changes to the Hospital Readmissions Reduction Program (HRRP), which evaluates readmissions related to acute myocardial infarction and heart failure, among other things.   Beginning with the FY 2027 program year, CMS proposes to add Medicare Advantage data to HRRP measures and provides notice that it is removing COVID-19 exclusions and risk-adjustment covariates from the HRRP measures, which were added during the public health emergency.

• Medicare Administrative Burden RFI
  To comply with President Trump’s Executive Order 14192 “Unleashing Prosperity Through Deregulation,” published January 31^st, included in the proposed rule is a Request for Information (RFI) on approaches and opportunities to streamline regulations and reduce burdens on those participating in the Medicare program.  In particular, the agency is seeking input on:. . . approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries, Medicare Advantage and Part D plans, and other stakeholders participating in the Medicare program. In line with ongoing efforts to reduce unnecessary administrative burdens and costs, and create a more efficient healthcare system, CMS requests information to better understand any challenges to identify opportunities for deregulation, while also ensuring the continued delivery of high-quality care to beneficiaries.

The RFI is available at www.cms.gov/medicare-regulatory-relief-rfi. Comments in response to the RFI should be submitted through the weblink.

• Proposed FY 2026 Applications for New Technology Add-On Payments
  For FY 2026, CMS considered 43 applications for new technology add-on payment (NTAP). The WiSE Cardiac Resynchronization Therapy (CRT) System was included among the applications submitted. CMS also proposes to continue NTAP status for several products that continue to meet the newness criteria required under the program, which includes the Aveir™ AR Leadless Pacemaker, the Aveir™ Dual-Chamber Leadless Pacemaker, and the PulseSelect™ Pulsed Field Ablation (PFA) Loop Catheter.

CMS will accept comments on the FY 2026 IPPS proposed rule through June 10^th.  HRS will continue to review the rule and consider submitting comments by the deadline.  For HRS members interested in sharing input with the agency on opportunities to decrease administrative burden on electrophysiologists, the questions and submission portal can be reviewed on the agency’s Unleashing Prosperity Through Deregulation of the Medicare Program web page.