Several federal updates announced in the last week have significant implications for the ASC industry:
1. President Donald Trump postponed a planned announcement to extend enhanced ACA subsidies Nov. 24. He was previously expected to present a proposal that would extend the subsidies for two years while introducing new eligibility restrictions.
2. The proposal would also establish an income cap limiting subsidies to individuals earning up to 700% of the federal poverty line. All enrollees would be required to make minimum premium payments. The proposal also includes a health savings account component, in which enrollees who switch to lower-premium marketplace plans could direct the difference in premium costs into a tax-advantaged savings account funded with their subsidy dollars.
3. The White House plans to ask Congress to appropriate funding for cost-sharing reductions to lower out-of-pocket expenses for ACA enrollees. Current enhanced ACA subsidies are set to expire Dec. 31. Millions of Americans face significant premium increases when open enrollment concludes in January.
4. HHS has officially reinstated all 954 employees who were laid off during the federal government shutdown. Agency workers who received reduction-in-force notices during the shutdown had been notified via email that the layoffs were being rescinded, according to a Nov. 21 court filing.
5. CMS published its 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule Nov. 21. The update included:
- A 2.6% increase to ASC payments via the hospital market basket update. HOPDs will also receive a 2.6% payment increase, and the hospital market basket update will be used again for ASCs next year.
- Finalized plans to phase out the inpatient-only list over the next three years, removing 285 primarily musculoskeletal procedures from the list in 2026. CMS will add 547 codes to the ASC-covered procedure list, including 271 coming off the inpatient-only list.
- Plans to align payment rates for select outpatient services between HOPDs and off-campus facilities to avoid higher copays based on site of service.
- Changes to the ASC Quality Reporting Program: CMS did not adopt two reporting metrics, nor will it require ASCs to use the Hospital Quality Reporting system for ASC data, as was initially proposed. ASCs will not be required to report on COVID-19 vaccinations for healthcare providers, health equity measures or social determinants of health.
- A note regarding a calculation error that negatively impacted cardiac surgeries, reporting that instead of cutting reimbursement by 4.7%, CMS will increase it by 2.4% over 2025 rates.
