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2026 OPPS Final Rule

Quality

CMS recently released the CY 2026 Outpatient Prospective Payment System (OPPS) Final Rule, which finalized several changes for the Hospital Outpatient Quality Reporting Program (OQR) Program. For the full text of the rule, see the Federal Register.

2026 Outpatient Prospective Payment System (OPPS)

In this rule, CMS finalized the adoption of the Emergency Care Access & Timeliness eCQM beginning with voluntary reporting for the CY 2027 reporting period followed by mandatory reporting beginning with the CY 2028 reporting period/CY 2030 payment determination. The numerator of this measure overlaps with two chart-abstracted measures currently in the OQR Program: (1) the Median Time from Emergency Department (ED) Arrival to ED Departure for Discharged ED Patients (Median Time for Discharged ED Patients) measure and (2) the Left Without Being Seen measure. Since CMS has finalized the Emergency Care Access & Timeliness eCQM, CMS has finalized removal of both the Median Time for Discharged ED Patients measure and the Left Without Being Seen measure beginning with the CY 2028 reporting period/CY 2030 payment determination. The measures are removed from the program when the Emergency Care Access & Timeliness eCQM is mandatory to report.

CMS also finalized removal of the following measures as the costs associated with each of the measures outweigh the benefit of the measure’s continued use in the program.

  • COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure beginning with the CY 2024 reporting period/CY 2026 payment determination
  • Facility Commitment to Health Equity (FCHE) measure beginning with the CY 2025 reporting period/CY 2027 payment determination
  • Screening for Social Drivers of Health (SDOH-01) beginning with the CY 2025 reporting period
  • Screen Positive Rate for Social Drivers of Health (SDOH-02) beginning with the CY 2025 reporting period

CMS finalized extending the voluntary reporting for the Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults eCQM beginning with the CY 2027 reporting period. This measure was previously finalized for mandatory reporting beginning with the CY 2027 reporting period. CMS intends to propose a date to begin mandatory reporting in the CY 2027 OPPS Proposed Rule.

Lastly, CMS finalized updates to the Extraordinary Circumstances (ECE) policy. CMS finalized that a hospital may request an ECE within 60 calendar days of the date that the extraordinary circumstance occurred. The current policy allows a request within 90 days, and while CMS proposed shortening this timeframe to 30 days in the OPPS Proposed Rule, CMS finalized a change to 60 days following public comment.  CMS finalized that CMS will notify the requestor with a decision in writing and will include if the hospital is exempted from one or more reporting requirements or if the hospital is granted an extension of time to comply with one or more reporting requirements.

Should you have any questions or need help with reporting your OQR measures, contact us.