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11.21.2025 / Statement

Families USA Statement on CMS OPPS and MPFS Final Rules

WASHINGTON, D.C.  – Anthony Wright, Families USA’s Executive Director, issued the following statement in response to the Centers for Medicare & Medicaid Services’ (CMS) release of the final rules for the Hospital Outpatient Prospective Payment System (OPPS) that just dropped Friday, and the Medicare Physician Fee Schedule (MPFS) that dropped earlier this month.

“For too long, specialty interests and corporate health systems have been allowed to rig the system for their benefit, unfairly jacking up health care prices with no accountability and forcing our nation’s families to receive care at higher cost settings for routine care. Families USA is encouraged to see CMS approving some of the critically needed reforms we have long advocated for that move our health care system toward better, more fair pricing and will help address the real drivers of high health care costs.”

Key wins advocated by Families USA in the OPPS CY 2026 Final Rule include:

  • Extending site neutral payments to drug administration services delivered by most “grandfathered” off-campus provider-based departments to ensure consumers pay the same price for the same service for physician administered drugs in more outpatient care settings.
  • Requiring hospitals to encode a senior official’s name and a strengthened attestation statement to help verify the accuracy and completeness of the hospital price transparency data.

Wright added, “We applaud key changes CMS finalized in the Medicare Hospital Outpatient Prospective Payment System rule that take important steps to rein in the unchecked, predatory business practices of large hospital corporations which cause families to experience high hospital bills and fees and drive millions of Americans into medical debt. While more work is needed to address the health care affordability crisis in this country today, the provisions just finalized provide clear momentum for lawmakers to take further action to stop the abusive pricing practices of big health care corporations and prioritize the health and financial security of our nation’s families.

“Families USA has long supported same service, same price payment reforms, including those finalized in this rule that save Medicare billions of dollars and lower costs for our nation’s seniors. At the same time, we urge Congress to re-engage in the bipartisan work needed to enact a more comprehensive site neutral payment package that builds off the Lower Costs More Transparency Act that the House passed in the last Congress.”

Key wins advocated by Families USA in the MPFS CY 2026 Final Rule include:

  • Updating the physician payment rate setting methodology to reflect changes in the health care system and gains in efficiency in the delivery of many professional services that will result in higher payments for primary care services.
  • Reducing the reliance on American Medical Association survey data when setting physician payment rates.
  • Expanding the scope of the Advanced Primary Care Management (APCM) service codes to include collaborative behavioral health and psychiatric care.
  • Introducing 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.

“We also applaud the changes CMS finalized in the Medicare Physician Fee Schedule to address payment rules that have led to overpayments for hospital and specialty care at the expense of primary care and independent practices. The changes will push more dollars into primary care practices that deliver higher-value, lower-cost care to millions of Americans. This is a major win for strengthening our primary care health care system and increasing access to the doctors on the frontlines of treating patients and improving health outcomes,” said Wright.