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Health and Human Services Department, Centers for Medicare & Medicaid Services, Office of the Secretary

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2026 Rates; Changes to the FY 2025 IPPS Rates Due to Court Decision; Requirements for Quality Programs; and Other Policy Changes; Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization

Published August 4, 2025. Takes effect October 1, 2025, printed at 90 FR 36536, amending 42 CFR 412, 42 CFR 495, 42 CFR 512, 45 CFR 170. 663,146 words.

In plain English

This sets what Medicare pays hospitals for a stay. The rates run for the year.

Read it at the Federal Register →

What the Rule Says It Does

This final rule revises the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals; makes changes relating to Medicare graduate medical education (GME) for teaching hospitals; updates the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs); updates and makes changes to requirements for certain quality programs; and makes other policy- related changes. We are also finalizing the provisions of the interim final action with comment period regarding the changes to the FY 2025 IPPS rates due to the court decision in Bridgeport Hosp. v. Becerra. Lastly, it finalizes certain updates to the ONC Health Information Technology (IT) Certification Program.

This is the rule's own summary, as the Federal Register prints it.

The Order It Names

The rule names this order itself. What it does about it is a reading, and none is recorded here.

On the Face of the Rule

As filed

[Federal Register Volume 90, Number 147 (Monday, August 4, 2025)] [Rules and Regulations] [Pages 36536-37308] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2025-14681]

Vol. 90

Monday,

No. 147

August 4, 2025

Part II

Department of Health and Human Services

45 CFR Part 170

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 495, and 512

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2026 Rates; Changes to the FY 2025 IPPS Rates Due to Court Decision; Requirements for Quality Programs; and Other Policy Changes; Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization; Direct- Interim-Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 495, and 512

Office of the Secretary

45 CFR Part 170

[CMS-1833-F and CMS-1808-F] RINs 0938-AV45, 0938-AV34, and 0955-AA06

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2026 Rates; Changes to the FY 2025 IPPS Rates Due to Court Decision; Requirements for Quality Programs; and Other Policy Changes; Health Data, Technology, and Interoperability: Electronic Prescribing, Real- Time Prescription Benefit and Electronic Prior Authorization

AGENCY

Centers for Medicare & Medicaid Services (CMS) and Assistant Secretary for Technology Policy (ASTP)/Office of the National Coordinator for Health Information Technology (ONC) (collectively, ASTP/ONC), Department of Health and Human Services (HHS).

ACTION

Final rules.

DATES

These final rules are effective on October 1, 2025. The incorporation by reference of certain material listed in this document is approved by the Director of the Federal Register as of October 1, 2025.

FOR FURTHER INFORMATION CONTACT

Donald Thompson, and Michele Hudson, (410) 786-4487 or [email protected], Operating Prospective Payment, MS- DRG Relative Weights, Wage Index, Hospital Geographic Reclassifications, Graduate Medical Education, Capital Prospective Payment, Excluded Hospitals, Medicare Disproportionate Share Hospital (DSH) Payment Adjustment, Sole Community Hospitals (SCHs), Medicare- Dependent Small Rural Hospital (MDH) Program, Low-Volume Hospital Payment Adjustment, and Inpatient Critical Access Hospital (CAH) Issues.

Emily Lipkin, Jim Mildenberger and Hyeyoung Kim, [email protected], Long-Term Care Hospital Prospective Payment System and MS-LTC-DRG Relative Weights Issues.

Lily Yuan, [email protected], New Technology Add-On Payments Issues.

Mady Hue, [email protected], and Andrea Hazeley, [email protected], MS-DRG Classifications Issues.

Radhika Puri, [email protected], Rural Community Hospital Demonstration Program Issues.

Jeris Smith, [email protected], Frontier Community Health Integration Project (FCHIP) Demonstration Issues.

Lang Le, [email protected], Hospital Readmissions Reduction Program--Administration Issues.

Ngozi Uzokwe, [email protected], Hospital Readmissions Reduction Program--Measures Issues.

Jennifer Tate, [email protected], Hospital-Acquired Condition Reduction Program--Administration Issues.

Ngozi Uzokwe, [email protected], Hospital-Acquired Condition Reduction Program--Measures Issues.

Julia Venanzi, [email protected], Hospital Inpatient Quality Reporting Program and Hospital Value-Based Purchasing Program-- Administration Issues.

Melissa Hager, [email protected], and Ngozi Uzokwe, [email protected]--Hospital Inpatient Quality Reporting Program and Hospital Value-Based Purchasing Program--Measures Issues Except Hospital Consumer Assessment of Healthcare Providers and Systems Issues.

Elizabeth Goldstein, [email protected], Hospital Inpatient Quality Reporting and Hospital Value-Based Purchasing-- Hospital Consumer Assessment of Healthcare Providers and Systems Measures Issues.

Jennifer Tate, [email protected], PPS-Exempt Cancer Hospital Quality Reporting--Administration Issues.

Kristina Rabarison, [email protected], PPS-Exempt Cancer Hospital Quality Reporting Program--Measure Issues

Ariel Cress, [email protected], Long-Term Care Hospital Quality Reporting Program--Administration Issues.

Jessica Warren, [email protected], and Lisa Marie Gomez, [email protected], Medicare Promoting Interoperability Program.

Bridget Dickensheets, [email protected] and Mollie Knight, [email protected], IPPS Market Basket Rebasing.

[email protected], Transforming Episode Accountability Model (TEAM)

Michael Lipinski, Office of Policy, Assistant Secretary for Technology Policy (ASTP)/Office of the National Coordinator for Health Information Technology (ASTP/ONC), 202-690-7151.

The fields the Federal Register prints at the head of the rule, quoted as printed. Its summary is quoted above.

Why the Agency Says It Is Doing This

SUPPLEMENTARY INFORMATION

Tables Available on the CMS Website

The IPPS tables for this fiscal year (FY) 2026 final rule are available on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html. Click on the link on the left side of the screen titled “FY 2026 IPPS Final Rule Home Page” or “Acute Inpatient--Files for Download.” The LTCH PPS tables for this FY 2026 final rule are available on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html under the list item for Regulation Number CMS-1833-F. For further details on the contents of the tables referenced in this final rule, we refer readers to section VI. of the Addendum to this FY 2026 IPPS/LTCH PPS final rule.

Readers who experience any problems accessing any of the tables that are posted on the CMS websites, as previously identified, should contact Michael Treitel, [email protected].

The passage that opens the rule's preamble, where the agency sets out what it is doing and on what authority. Every heading that follows it is listed below.

What the Rule Contains

Every heading the Federal Register prints in this rule, in the order it prints them. 288 headings, 663,146 words in all.

  1. AGENCYOn its face · 33 words
  2. ACTIONOn its face · 3 words
  3. SUMMARYOn its face · 123 words
  4. DATESOn its face · 35 words
  5. FOR FURTHER INFORMATION CONTACTOn its face · 316 words
  6. SUPPLEMENTARY INFORMATIONPreamble · 2 words
  7. Tables Available on the CMS WebsitePreamble · 132 words
  8. I. Executive Summary and BackgroundPreamble · 5 words
  9. A. Executive SummaryPreamble · 3 words
  10. 1. Purpose and Legal AuthorityPreamble · 5,849 words
  11. B. Background SummaryPreamble · 3 words
  12. 1. Acute Care Hospital Inpatient Prospective Payment System (IPPS)Preamble · 1,887 words
  13. C. Summary of Provisions of Recent Legislation That Are Implemented in This Final RulePreamble · 219 words
  14. D. Issuance of a Notice of Proposed Rulemaking and Summary of the Proposed ProvisionsPreamble · 1,807 words
  15. E. Public Comments Received in Response to the FY 2026 IPPS/LTCH PPS Proposed RulePreamble · 157 words
  16. II. Changes to Medicare Severity Diagnosis-Related Group (MS-DRG) Classifications and Relative WeightsPreamble · 12 words
  17. A. BackgroundPreamble · 177 words
  18. B. Adoption of the MS-DRGs and MS-DRG ReclassificationsPreamble · 701 words
  19. C. Changes to Specific MS-DRG ClassificationsPreamble · 78,781 words
  20. D. Recalibration of the FY 2026 MS-DRG Relative WeightsPreamble · 9 words
  21. 1. Data Sources for Developing the Relative WeightsPreamble · 8,309 words
  22. E. Add-On Payments for New Services and Technologies for FY 2026Preamble · 11 words
  23. 1. BackgroundPreamble · 95,172 words
  24. 12. Minima Stent SystemPreamble · 12,377 words
  25. III. Changes to the Hospital Wage Index for Acute Care HospitalsPreamble · 11 words
  26. A. BackgroundPreamble · 2 words
  27. 1. Legislative AuthorityPreamble · 1,007 words
  28. B. Worksheet S-3 Wage Data for the FY 2026 Wage IndexPreamble · 11 words
  29. 1. Cost Reporting Periods Beginning in FY 2022 for FY 2026 Wage IndexPreamble · 5,151 words
  30. C. Method for Computing the FY 2026 Unadjusted Wage IndexPreamble · 2,935 words
  31. D. Occupational Mix Adjustment to the FY 2026 Wage IndexPreamble · 1,381 words
  32. E. Hospital Redesignations and ReclassificationsPreamble · 82 words
  33. 1. Urban to Rural Reclassification Under Section 1886(d)(8)(E) of the Act, Implemented at Sec. 412.103Preamble · 17,311 words
  34. c. Derivation of the Detailed Cost WeightsPreamble · 1,111 words
  35. a. Wages and SalariesPreamble · 777 words
  36. j. Blood and Blood ProductsPreamble · 271 words
  37. l. Rubber and PlasticsPreamble · 6,213 words
  38. C. Market Basket for Certain Hospitals Presently Excluded From the IPPSPreamble · 437 words
  39. D. Rebasing and Revising the Capital Input Price Index (CIPI)Preamble · 4,260 words
  40. V. Payment Adjustment for Medicare Disproportionate Share Hospitals (DSHs) for FY 2026 (Sec. 412.106)Preamble · 14 words
  41. A. General DiscussionPreamble · 1,541 words
  42. B. Eligibility for Empirically Justified Medicare DSH Payments and Uncompensated Care PaymentsPreamble · 1,519 words
  43. C. Empirically Justified Medicare DSH PaymentsPreamble · 224 words
  44. D. Supplemental Payment for Indian Health Service (IHS) and Tribal Hospitals and Puerto Rico HospitalsPreamble · 699 words
  45. E. Uncompensated Care PaymentsPreamble · 14,964 words
  46. VI. Other Decisions and Changes to the IPPS for Operating CostsPreamble · 11 words
  47. A. Changes to MS-DRGs Subject to Postacute Care Transfer Policy and MS- DRG Special Payments Policies (Sec. 412.4)Preamble · 18 words
  48. 1. BackgroundPreamble · 2,251 words
  49. B. Changes in the Inpatient Hospital Update for FY 2026 (Sec. 412.64(d))Preamble · 12 words
  50. 1. FY 2026 Inpatient Hospital UpdatePreamble · 7,012 words
  51. C. Rural Referral Centers (RRCs) Annual Updates to Case-Mix Index (CMI) and Discharge Criteria (Sec. 412.96)Preamble · 1,833 words
  52. D. Payment Adjustment for Low-Volume Hospitals (Sec. 412.101)Preamble · 8 words
  53. 1. BackgroundPreamble · 362 words
  54. 2. Extension of Temporary Changes to Low-Volume Hospital Payment Definition and Payment Adjustment Methodology and Conforming Changes to RegulationsPreamble · 3,902 words
  55. E. Changes in the Medicare-Dependent, Small Rural Hospital (MDH) Program (Sec. 412.108)Preamble · 12 words
  56. 1. Background for the MDH ProgramPreamble · 2,199 words
  57. 1. BackgroundPreamble · 2,860 words
  58. b. Calculating FTE Caps for Cost Reporting Periods Other Than Twelve MonthsPreamble · 1,330 words
  59. G. Reasonable Cost Payment for Nursing and Allied Health Education Programs (Sec. 413.85 and Sec. 413.87)Preamble · 16 words
  60. 1. GeneralPreamble · 1,870 words
  61. 3. Regulatory Changes Regarding the Calculation of Net Cost of NAH Education Programs (42 CFR 413.85(d)(2)(i) and (ii))Preamble · 3,639 words
  62. K. Hospital Readmissions Reduction Program Updates and ChangesPreamble · 8 words
  63. 1. Regulatory BackgroundPreamble · 12,843 words
  64. L. Hospital Value-Based Purchasing (VBP) ProgramPreamble · 8,609 words
  65. d. Newly Established and Estimated Performance Standards for the FY 2028 Program YearPreamble · 602 words
  66. e. Newly Established Performance Standards for Certain Measures for the FY 2029 Program YearPreamble · 213 words
  67. f. Newly Established Performance Standards for Certain Measures for the FY 2030 Program YearPreamble · 204 words
  68. g. Newly Established Performance Standards for Certain Measures for the FY 2031 Program YearPreamble · 180 words
  69. 5. Update to the Extraordinary Circumstance Exception (ECE) Policy for the Hospital VBP Program (a) BackgroundPreamble · 3,028 words
  70. M. Hospital-Acquired Condition Reduction Program Updates and Changes (HAC Reduction Program)Preamble · 11 words
  71. 1. Regulatory BackgroundPreamble · 3,390 words
  72. N. Rural Community Hospital Demonstration ProgramPreamble · 6 words
  73. 1. IntroductionPreamble · 2,446 words
  74. VII. Changes to the IPPS for Capital-Related CostsPreamble · 8 words
  75. A. OverviewPreamble · 307 words
  76. B. Additional ProvisionsPreamble · 3 words
  77. 1. Exception PaymentsPreamble · 451 words
  78. C. Annual Update for FY 2026Preamble · 135 words
  79. VIII. Changes for Hospitals Excluded From the IPPSPreamble · 8 words
  80. A. Rate-of-Increase in Payments To Excluded Hospitals for FY 2026Preamble · 1,385 words
  81. B. Report on Adjustment (Exception) PaymentsPreamble · 341 words
  82. C. Critical Access Hospitals (CAHs)Preamble · 5 words
  83. 1. BackgroundPreamble · 3,577 words
  84. IX. Changes to the Long-Term Care Hospital Prospective Payment System (LTCH PPS) for FY 2026Preamble · 15 words
  85. A. Background of the LTCH PPSPreamble · 6 words
  86. 1. Legislative and Regulatory AuthorityPreamble · 1,892 words
  87. B. Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC- DRG) Classifications and Relative Weights for FY 2026Preamble · 16 words
  88. 1. BackgroundPreamble · 9,769 words
  89. C. Changes to the LTCH PPS Payment Rates and Other Changes to the LTCH PPS for FY 2026Preamble · 18 words
  90. 1. Overview of Development of the LTCH PPS Standard Federal Payment RatesPreamble · 5,921 words
  91. X. Quality Data Reporting Requirements for Specific ProvidersPreamble · 8 words
  92. A. OverviewPreamble · 112 words
  93. B. Toward Digital Quality Measurement in CMS Quality Programs--Request for InformationPreamble · 6,423 words
  94. C. Requirements for and Changes to the Hospital Inpatient Quality Reporting (IQR) ProgramPreamble · 13 words
  95. 1. Background and History of the Hospital IQR ProgramPreamble · 1,289 words
  96. 3. Refinements to Current Measures in the Hospital IQR Program Measure SetPreamble · 17,844 words
  97. b. Summary of Hospital IQR Program Measures for the FY 2028 Payment DeterminationPreamble · 37 words
  98. c. Summary of Hospital IQR Program Measures for the FY 2029 Payment Determination and for Subsequent YearsPreamble · 6,735 words
  99. D. Changes to the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) ProgramPreamble · 11 words
  100. 1. BackgroundPreamble · 1,759 words
  101. 3. Public Display RequirementsPreamble · 1,916 words
  102. E. Changes to the Long-Term Care Hospital Quality Reporting Program (LTCH QRP)Preamble · 12 words
  103. 1. Background and Statutory AuthorityPreamble · 8,458 words
  104. b. Well-BeingPreamble · 2,911 words
  105. F. Changes to the Medicare Promoting Interoperability ProgramPreamble · 8 words
  106. 1. Statutory Authority for the Medicare Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals (CAHs)Preamble · 253 words
  107. 2. EHR Reporting Period in CY 2026 and Subsequent YearsPreamble · 10 words
  108. a. Definition of the EHR Reporting PeriodPreamble · 1,181 words
  109. 3. Modifications to the Security Risk Analysis MeasurePreamble · 8 words
  110. a. Background on the Security Risk Analysis MeasurePreamble · 4,263 words
  111. b. Modification of the SAFER Guides Measure Beginning With the EHR Reporting Period in CY 2026Preamble · 8,263 words
  112. 8. Clinical Quality Measurement for Eligible Hospitals and CAHs Participating in the Medicare Promoting Interoperability ProgramPreamble · 264 words
  113. XI. Other Provisions Included in This Final RulePreamble · 8 words
  114. A. Changes to the Transforming Episode Accountability Model (TEAM)Preamble · 55,649 words
  115. 1. General CommentsPreamble · 59,076 words
  116. e. High-Cost Outlier (HCO) Threshold for Site Neutral Payment Rate Cases Under the LTCH PPS for FY 2025Preamble · 208 words
  117. XII. MedPAC Recommendations and Publicly Available FilesPreamble · 7 words
  118. A. MedPAC RecommendationsPreamble · 121 words
  119. B. Publicly Available FilesPreamble · 65 words
  120. XIII. Collection of Information RequirementsPreamble · 5 words
  121. A. Statutory Requirement for Solicitation of CommentsPreamble · 183 words
  122. B. Collection of Information RequirementsPreamble · 5 words
  123. 1. ICRs for the Hospital Readmissions Reduction ProgramPreamble · 7,584 words
  124. List of SubjectsRegulatory text · 11,651 words
  125. I. Summary and BackgroundRegulatory text · 870 words
  126. II. Changes to Prospective Payment Rates for Hospital Inpatient Operating Costs for Acute Care Hospitals for FY 2026Regulatory text · 1,268 words
  127. A. Calculation of the Adjusted Standardized AmountRegulatory text · 7 words
  128. 1. Standardization of Base-Year Costs or Target AmountsRegulatory text · 403 words
  129. 2. Computing the National Average Standardized AmountRegulatory text · 70 words
  130. 3. Updating the National Average Standardized AmountRegulatory text · 406 words
  131. 4. Methodology for Calculation of the Average Standardized AmountRegulatory text · 2,314 words
  132. a. Reclassification and Recalibration of MS-DRG Relative Weights Before CapRegulatory text · 535 words
  133. b. Budget Neutrality Adjustment for Reclassification and Recalibration of MS-DRG Relative Weights With CapRegulatory text · 440 words
  134. c. Updated Wage Index--Budget Neutrality AdjustmentRegulatory text · 752 words
  135. d. Reclassified Hospitals--Budget Neutrality AdjustmentRegulatory text · 598 words
  136. e. Rural Floor Budget Neutrality AdjustmentRegulatory text · 723 words
  137. f. Permanent Cap Policy for Wage Index--Budget Neutrality AdjustmentRegulatory text · 256 words
  138. g. Transition for the Discontinuation of the Low Wage Index Hospital Policy Budget Neutrality FactorRegulatory text · 372 words
  139. h. Rural Community Hospital Demonstration Program AdjustmentRegulatory text · 492 words
  140. i. Outlier PaymentsRegulatory text · 14,452 words
  141. 5. FY 2026 Standardized AmountRegulatory text · 816 words
  142. B. Adjustments for Area Wage Levels and Cost-of-LivingRegulatory text · 87 words
  143. 1. Adjustment for Area Wage LevelsRegulatory text · 183 words
  144. 2. Adjustment for Cost-of-Living in Alaska and HawaiiRegulatory text · 1,101 words
  145. C. Calculation of the Prospective Payment RatesRegulatory text · 7 words
  146. 1. General Formula for Calculation of the Prospective Payment Rates for FY 2026Regulatory text · 273 words
  147. 2. Operating and Capital Federal Payment Rate and Outlier Payment CalculationRegulatory text · 583 words
  148. 3. Hospital-Specific Rate (Applicable Only to SCHs and MDHs)Regulatory text · 9 words
  149. a. Calculation of Hospital-Specific RateRegulatory text · 215 words
  150. b. Updating the FY 1982, FY 1987, FY 1996, FY 2002 and FY 2006 Hospital-Specific Rate for FY 2026Regulatory text · 633 words
  151. III. Changes to Payment Rates for Acute Care Hospital Inpatient Capital-Related Costs for FY 2026Regulatory text · 349 words
  152. A. Determination of the Federal Hospital Inpatient Capital-Related Prospective Payment Rate Update for FY 2026Regulatory text · 118 words
  153. 1. Projected Capital Standard Federal Rate UpdateRegulatory text · 1,406 words
  154. 2. Outlier Payment Adjustment FactorRegulatory text · 429 words
  155. 3. Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the GAFRegulatory text · 2,477 words
  156. 4. Capital Federal Rate for FY 2026Regulatory text · 635 words
  157. B. Calculation of the Inpatient Capital-Related Prospective Payments for FY 2026Regulatory text · 263 words
  158. C. Capital Input Price IndexRegulatory text · 5 words
  159. 1. BackgroundRegulatory text · 183 words
  160. 2. Forecast of the CIPI for FY 2026Regulatory text · 983 words
  161. V. Changes to the Payment Rates for the LTCH PPS for FY 2026Regulatory text · 13 words
  162. A. LTCH PPS Standard Federal Payment Rate for FY 2026Regulatory text · 10 words
  163. 1. OverviewRegulatory text · 341 words
  164. 2. Development of the FY 2026 LTCH PPS Standard Federal Payment RateRegulatory text · 500 words
  165. B. Adjustment for Area Wage Levels Under the LTCH PPS for FY 2026Regulatory text · 13 words
  166. 1. BackgroundRegulatory text · 169 words
  167. 2. Geographic Classifications (Labor Market Areas) under the LTCH PPSRegulatory text · 711 words
  168. 3. Labor-Related Share for the LTCH PPS Standard Federal Payment RateRegulatory text · 1,101 words
  169. 4. Wage Index for FY 2026 for the LTCH PPS Standard Federal Payment RateRegulatory text · 1,118 words
  170. 5. Cap on Wage Index DecreasesRegulatory text · 6 words
  171. a. Cap on LTCH PPS Wage Index DecreasesRegulatory text · 595 words
  172. b. Cap on IPPS Comparable Wage Index DecreasesRegulatory text · 579 words
  173. 6. Budget Neutrality Adjustments for Changes to the LTCH PPS Standard Federal Payment Rate Area Wage Level AdjustmentRegulatory text · 772 words
  174. C. Cost-of-Living Adjustment (COLA) for LTCHs Located in Alaska and HawaiiRegulatory text · 900 words
  175. D. Adjustment for LTCH PPS High-Cost Outlier (HCO) CasesRegulatory text · 9 words
  176. 1. HCO BackgroundRegulatory text · 528 words
  177. 2. Determining LTCH CCRs Under the LTCH PPSRegulatory text · 8 words
  178. a. BackgroundRegulatory text · 350 words
  179. b. LTCH Total CCR CeilingRegulatory text · 159 words
  180. c. LTCH Statewide Average CCRsRegulatory text · 719 words
  181. d. Reconciliation of HCO PaymentsRegulatory text · 132 words
  182. 3. High-Cost Outlier Payments for LTCH PPS Standard Federal Payment Rate CasesRegulatory text · 12 words
  183. a. High-Cost Outlier Payments for LTCH PPS Standard Federal Payment Rate CasesRegulatory text · 125 words
  184. b. Fixed-Loss Amount for LTCH PPS Standard Federal Payment Rate Cases for FY 2026Regulatory text · 5,680 words
  185. 4. High-Cost Outlier Payments for Site Neutral Payment Rate CasesRegulatory text · 1,359 words
  186. E. Update to the IPPS Comparable Amount To Reflect the Statutory Changes to the IPPS DSH Payment Adjustment MethodologyRegulatory text · 992 words
  187. F. Computing the Adjusted LTCH PPS Federal Prospective Payments for FY 2026Regulatory text · 563 words
  188. VI. Tables Referenced in This Final Rule Generally Available Through the Internet on the CMS WebsiteRegulatory text · 1,288 words
  189. Appendix A: Economic AnalysesRegulatory text · 4 words
  190. I. Regulatory Impact AnalysisRegulatory text · 4 words
  191. A. Statement of NeedRegulatory text · 221 words
  192. 1. Acute Care Hospital Inpatient Prospective Payment System (IPPS)Regulatory text · 9 words
  193. a. Update to the IPPS Payment RatesRegulatory text · 406 words
  194. b. Changes for the Add-On Payments for New Services and TechnologiesRegulatory text · 81 words
  195. c. Transition for the Discontinuation of the Low Wage Index Hospital PolicyRegulatory text · 587 words
  196. d. Additional Payment for Uncompensated Care to Medicare Disproportionate Share Hospitals (DSHs) and Supplemental PaymentRegulatory text · 208 words
  197. e. Rural Community Hospital Demonstration ProgramRegulatory text · 151 words
  198. 2. Frontier Community Health Integration Project (FCHIP) DemonstrationRegulatory text · 200 words
  199. 3. Update to the LTCH PPS Payment RatesRegulatory text · 119 words
  200. 4. Hospital Quality ProgramsRegulatory text · 407 words
  201. 5. Other Provisions--Transforming Episode Accountability Model (TEAM)Regulatory text · 339 words
  202. 6. Finalization of the IFC on the Changes to the FY 2025 Hospital IPPS Rates Due to Court Decision (CMS-1808-IFC)Regulatory text · 132 words
  203. 7. ONC Health IT Certification Program UpdatesRegulatory text · 170 words
  204. B. Overall ImpactRegulatory text · 635 words
  205. C. Objectives of the IPPS and the LTCH PPSRegulatory text · 170 words
  206. D. Limitations of Our AnalysisRegulatory text · 107 words
  207. E. Hospitals Included in and Excluded From the IPPSRegulatory text · 305 words
  208. F. Quantitative Effects of the Policy Changes Under the IPPS for Operating Costs and Medicare Uncompensated Care PaymentsRegulatory text · 18 words
  209. 1. Basis and Methodology of EstimatesRegulatory text · 1,228 words
  210. 2. Impact Analysis of Final Changes on Payments for IPPS Operating Costs and Uncompensated Care PaymentsRegulatory text · 2,114 words
  211. a. Effects of the Outlier Adjustment (Column 1)Regulatory text · 235 words
  212. b. Effects of the Hospital Update (Column 2)Regulatory text · 160 words
  213. c. Effects of the Expiration of MDH Special Payment Status (Column 3)Regulatory text · 233 words
  214. d. Effects of the Changes in Uncompensated Care Payments (UCP) (Column 4)Regulatory text · 101 words
  215. e. Effects of the Changes to the MS-DRG Reclassifications and Relative Cost-Based Weights With Recalibration Budget Neutrality (Column 5)Regulatory text · 286 words
  216. f. Effects of the Wage Index Changes (Column 6)Regulatory text · 1,071 words
  217. g. Effects of All FY 2026 Changes (Column 7)Regulatory text · 361 words
  218. 3. Estimated Average Payments per DischargeRegulatory text · 753 words
  219. G. Effects of Other Policy ChangesRegulatory text · 129 words
  220. 1. Effects of the Changes Relating to New Medical Service and Technology Add-On PaymentsRegulatory text · 14 words
  221. a. FY 2026 Status of Technologies Approved for FY 2025 New Technology Add-On PaymentsRegulatory text · 605 words
  222. b. FY 2026 Applications for New Technology Add-On PaymentsRegulatory text · 977 words
  223. c. Total Estimated Costs for NTAP in FY 2026Regulatory text · 2,531 words
  224. 3. Effects of Expiration of the Temporary Changes to the Low-Volume Hospital Payment PolicyRegulatory text · 515 words
  225. 4. Impact for Proposed Revision to Regulation Text Regarding Calculation of Net Cost of NAH Education Programs (42 CFR 413.85(d)(2)(i))Regulatory text · 137 words
  226. 5. Effects Under the Hospital Readmissions Reduction Program for FY 2026Regulatory text · 1,412 words
  227. 6. Effects of Changes Under the FY 2026 Hospital Value-Based Purchasing (VBP) ProgramRegulatory text · 817 words
  228. 7. Effects of Requirements Under the Hospital-Acquired Condition (HAC) Reduction Program for FY 2026Regulatory text · 1,063 words
  229. 8. Effects of the Implementation of the Rural Community Hospital Demonstration (RCHD) Program in FY 2026Regulatory text · 663 words
  230. 9. Effects of Continued Implementation of the Frontier Community Health Integration Project (FCHIP) DemonstrationRegulatory text · 1,171 words
  231. 10. Effects of the Transforming Episode Accountability Model (TEAM)Regulatory text · 583 words
  232. a. Effects on the Medicare ProgramRegulatory text · 1,576 words
  233. b. Effects on Medicare BeneficiariesRegulatory text · 274 words
  234. a. Regulatory Planning and Review AnalysisRegulatory text · 5,240 words
  235. b. Revised Electronic Prescribing Certification CriterionRegulatory text · 2,635 words
  236. c. New Real-Time Prescription Benefit Certification CriterionRegulatory text · 3,981 words
  237. d. New Electronic Prior Authorization Certification CriteriaRegulatory text · 6,760 words
  238. e. New Certification Criteria for Modular API CapabilitiesRegulatory text · 2,723 words
  239. f. Revisions to Real World Testing RequirementsRegulatory text · 1,063 words
  240. g. Corrections for HTI-2 Final RuleRegulatory text · 28 words
  241. 13. Finalization of the Provisions of the FY 2025 IFCRegulatory text · 408 words
  242. 13. Finalization of the Provisions of the FY 2025 IFCRegulatory text · 408 words
  243. H. Effects on Hospitals and Hospital Units Excluded From the IPPSRegulatory text · 608 words
  244. I. Effects of Changes in the Capital IPPSRegulatory text · 8 words
  245. 1. General ConsiderationsRegulatory text · 505 words
  246. 2. ResultsRegulatory text · 1,320 words
  247. J. Effects of Payment Rate Changes and Policy Changes Under the LTCH PPSRegulatory text · 13 words
  248. 1. Introduction and General ConsiderationsRegulatory text · 2,418 words
  249. 2. Impact on Rural HospitalsRegulatory text · 135 words
  250. 3. Anticipated Effects of the LTCH PPS Payment Rate Changes and Policy ChangesRegulatory text · 13 words
  251. a. Budgetary ImpactRegulatory text · 369 words
  252. b. Impact on ProvidersRegulatory text · 435 words
  253. c. Calculation of LTCH PPS Payments for LTCH PPS Standard Federal Payment Rate CasesRegulatory text · 1,449 words
  254. d. ResultsRegulatory text · 859 words
  255. 4. Effect on the Medicare ProgramRegulatory text · 199 words
  256. 5. Effect on Medicare BeneficiariesRegulatory text · 127 words
  257. K. Effects of Requirements for the Hospital Inpatient Quality Reporting (IQR) ProgramRegulatory text · 615 words
  258. L. Effects of New Requirements for the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) ProgramRegulatory text · 264 words
  259. M. Effects of Requirements for the Long-Term Care Hospital Quality Reporting Program (LTCH QRP)Regulatory text · 663 words
  260. N. Effects of Requirements Regarding the Medicare Promoting Interoperability ProgramRegulatory text · 779 words
  261. O. Alternatives ConsideredRegulatory text · 38 words
  262. 1. Alternatives Considered to the LTCH QRP Reporting RequirementsRegulatory text · 209 words
  263. 2. Alternatives Considered for the Transforming Episode Accountability ModelRegulatory text · 578 words
  264. P. Overall ConclusionRegulatory text · 3 words
  265. 1. Acute Care HospitalsRegulatory text · 265 words
  266. 2. LTCHsRegulatory text · 111 words
  267. Q. Regulatory Review Cost EstimationRegulatory text · 377 words
  268. II. Accounting Statements and TablesRegulatory text · 5 words
  269. A. Acute Care HospitalsRegulatory text · 148 words
  270. B. LTCHsRegulatory text · 213 words
  271. Table VI--Accounting Statement: Classification of Estimated ExpendituresRegulatory text · 36 words
  272. C. HTI-2Regulatory text · 247 words
  273. III. Regulatory Flexibility Act (RFA) AnalysisRegulatory text · 586 words
  274. IV. Impact on Small Rural HospitalsRegulatory text · 373 words
  275. V. Unfunded Mandates Reform Act AnalysisRegulatory text · 83 words
  276. VI. Executive Order 13132Regulatory text · 67 words
  277. VII. Executive Order 13175Regulatory text · 148 words
  278. VIII. Executive Order 14192Regulatory text · 51 words
  279. IX. Executive Order 12866Regulatory text · 39 words
  280. I. BackgroundRegulatory text · 197 words
  281. II. Inpatient Hospital Update for FY 2026Regulatory text · 7 words
  282. A. FY 2026 Inpatient Hospital UpdateRegulatory text · 747 words
  283. B. FY 2026 SCH UpdateRegulatory text · 260 words
  284. C. FY 2026 Puerto Rico Hospital UpdateRegulatory text · 814 words
  285. D. Update for Hospitals Excluded From the IPPS for FY 2026Regulatory text · 348 words
  286. E. Update for LTCHs for FY 2026Regulatory text · 281 words
  287. III. Secretary's RecommendationsRegulatory text · 286 words
  288. IV. MedPAC Recommendation for Assessing Payment Adequacy and Updating Payments in Traditional MedicareRegulatory text · 515 words

The Rest of the Text

This rule runs to 663,146 words. The rest of it is set out over 27 pages, split at the rule's own headings so that no heading is parted from the words printed under it.

How to cite this
  1. The rule itself

    Health and Human Services Department, Centers for Medicare & Medicaid Services, Office of the Secretary, “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2026 Rates; Changes to the FY 2025 IPPS Rates Due to Court Decision; Requirements for Quality Programs; and Other Policy Changes; Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization,” 90 FR 36536 (August 4, 2025). Effective October 1, 2025.
    https://www.federalregister.gov/documents/2025/08/04/2025-14681/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-ipps-and

  2. This page

    “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2026 Rates; Changes to the FY 2025 IPPS Rates Due to Court Decision; Requirements for Quality Programs; and Other Policy Changes; Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization,” a final rule naming an order indexed here. Read the Mandate, https://readthemandate.org/rules/rule-2025-14681/ (retrieved October 10, 2026).

Cite the document when the claim is about what the document says. Cite this page when the indexing, the wording or the record of what has happened is what is being relied on.

How This Rule Is Set Out

Federal Register documents are United States government works and are not under copyright, so the rule is here whole rather than cut to an excerpt. It is split at the headings the Register itself prints: the line it is filed under, the captioned fields on its face, the preamble where the agency says what it is doing and why, and the amendments to the Code of Federal Regulations. No passage is shortened. This rule is long enough that its text is set out over 27 pages rather than one.

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A heading with nothing quoted under it is one the rule prints on its own, with the words that follow it set under the headings beneath.