On November 21, 2025, the Centers for Medicare & Medicaid Services (CMS) published the CY 2026 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule (the Rule), which includes several significant changes to hospital price transparency regulations. The changes follow from Executive Order 14221, entitled “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” which directs the Department of Health & Human Services (HHS) to take steps to require more uniform, accurate pricing information from hospitals. Key provisions of the Rule’s new requirements are summarized below. Although these new requirements become effective on January 1, 2026, CMS is delaying enforcement until April 1, 2026.
New MRF Data Reporting Requirements
Allowed Amounts
Currently, where a hospital’s standard charge is based on an algorithm or percentage, CMS requires hospitals to report an “estimated allowed amount” in their machine-readable file (MRF). The Rule removes this requirement and instead requires hospitals to report the following four elements:
- Median allowed amount (which replaces estimated allowed amount);
- The 10th percentile allowed amount;
- The 90th percentile allowed amount; and
- The number of allowed amounts used to calculate the prior three amounts.
The median allowed amount and the 10th– and 90th-percentile allowed amounts must be calculated based on amounts the hospital has historically received from a third-party payer (less certain contractual adjustments) over the 12 to 15 months prior to posting the MRF. If an allowed amount falls between two amounts, hospitals are required to report the higher amount. To calculate these data points, hospitals must use electronic data interchange (EDI) 835 electronic remittance advice (ERA), or an equivalent, alternative source of remittance data.
Hospital NPI
The Rule also adds a requirement that hospitals encode in their MRF their organizational (i.e., Type 2) National Provider Identifier or NPI.
Modification of MRF Attestation Statement
Current regulations require each hospital to attest to the accuracy and completeness of the information encoded in its MRF. Beginning January 1, 2026, the Rule replaces the existing affirmation statement with a new, strengthened requirement at 45 C.F.R. § 180.50(a)(3)(iii) (reproduced below).
To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.
The Rule also adds a requirement that hospitals include with the attestation statement the name of the hospital’s CEO, president, or senior official designated to oversee the data encoding process for the MRF.
Changes to Civil Monetary Penalties
Finally, the Rule makes available a 35% reduction to Civil Monetary Penalties (CMP) imposed for certain violations of hospital price transparency requirements, which hospitals can request in exchange for the hospital waiving its right to an administrative hearing. However, the 35% reduction will not apply if the CMP is imposed due to the hospital failing to make its MRF or any shoppable services public.
Conclusion
Hospitals would be well advised to proactively assess their price transparency practices and update their processes and disclosures to align with the enhanced requirements of the new Rule.
This article was co-authored by Ivy Miller