Posted in: Government Outreach
August 28, 2026
The Honorable Mehmet Oz, MD, MBA
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1850-P
P.O. Box 8010
Baltimore, MD 21244-8010
RE: CMS-1850-P – CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule
Submitted electronically via: https://www.regulations.gov
Dear Administrator Oz:
The Accreditation Association for Ambulatory Health Care (AAAHC) appreciates the opportunity to submit comment to the Centers for Medicare & Medicaid Services (CMS) regarding the recently proposed rule entitled Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots.
AAAHC commends CMS for continuing to modernize Medicare policy in ways that recognize the expanding role of ambulatory care in delivering high-quality, patient-centered, and cost-effective care. The proposals reflect Medicare’s continued evolution toward outpatient care while reinforcing CMS’s commitment to quality, accountability, transparency, and responsible stewardship of Medicare resources.
As Medicare beneficiaries increasingly receive care in ambulatory settings, AAAHC believes future Medicare policy should continue advancing five complementary objectives:
- Preserve timely access to high-quality ambulatory
- Strengthen organizational readiness for increasingly complex outpatient
- Promote meaningful quality improvement through greater regulatory
- Encourage responsible innovation through effective
- Leverage nationally recognized accreditation as a strategic partner in advancing quality while reducing unnecessary duplication.
These objectives are mutually reinforcing. Expanding access should be accompanied by organizational capability. Innovation should be supported by appropriate governance. Accountability should improve quality without creating unnecessary administrative burden. Together, these principles strengthen patient safety, improve operational resilience, and allow providers to devote more resources to patient care and continuous improvement.
The comments that follow address specific provisions of CMS-1850-P through this broader policy framework. While responsive to the proposed rule, they also reflect AAAHC’s perspective as the nation’s leading independent accrediting organization dedicated exclusively to ambulatory health care.
Introduction
Founded in 1979, AAAHC is the nation’s leading independent accrediting organization dedicated exclusively to advancing quality in ambulatory health care. AAAHC is a private, independent 501(c)(3) nonprofit organization that accredits more than 6,800 organizations committed to high-quality, patient-centered care, including more than 1,000 Medicare-certified ambulatory surgery centers (ASCs) accredited under CMS deeming authority.
For more than four decades, AAAHC has partnered with providers, health systems, government agencies, and policymakers to advance quality, patient safety, and continuous improvement across the ambulatory care continuum. AAAHC accredits a broad range of ambulatory care settings, including HRSA, Federally Qualified Health Centers (FQHCs), U.S. Coast Guard health care facilities, Indian Health Service/Urban Indian Health (IHS/UIH) centers, student health centers, medical and dental group practices, and office-based surgery centers.
CMS-1850-P represents more than an annual payment update. It reflects Medicare’s continued transition toward care delivered in outpatient settings, supported by meaningful quality measurement, innovation, transparency, and collaboration with nationally recognized accrediting organizations. AAAHC welcomes this direction.
As ambulatory care continues to evolve, the organizations delivering it must evolve in parallel. Expanding the scope and complexity of outpatient services requires more than procedural eligibility or payment policy. It requires effective governance, clinical leadership, workforce competency, quality systems, emergency preparedness, and the operational capability to consistently deliver safe, high-quality care.
AAAHC refers to these integrated capabilities as organizational readiness—an organization’s ability to safely, consistently, and sustainably deliver high-quality ambulatory care. Organizational readiness extends beyond regulatory compliance to encompass the capacity to anticipate risk, adapt to change, and continuously improve performance.
AAAHC believes Medicare policy should increasingly evaluate not only what services may appropriately be performed in ambulatory settings, but also whether organizations possess the readiness to deliver those services safely and consistently. Nationally recognized accreditation plays an important complementary role by independently evaluating the governance, leadership, quality infrastructure, and operational systems that support this capability.
The comments that follow address selected provisions of CMS-1850-P. The absence of comments on other provisions should not be interpreted as support or opposition.
IX. Services That Will Be Paid Only as Inpatient Services
B. Proposed CY 2027 Changes to IPO List
AAAHC supports CMS’s proposal to continue expanding appropriate outpatient care through the phased elimination of the Inpatient Only (IPO) List. The proposal appropriately recognizes decades of advancement in surgical techniques, anesthesia, minimally invasive technologies, enhanced recovery protocols, and perioperative care that have enabled an increasing number of procedures to be performed safely in outpatient settings. Expanding appropriate ambulatory care improves patient access, enhances the patient experience, and often reduces overall Medicare expenditures.
AAAHC agrees that decisions regarding which procedures may appropriately transition to outpatient settings should continue to be guided by clinical evidence, physician judgment, and patient safety. As CMS continues this important evolution, however, procedural eligibility alone does not ensure safe expansion.
CMS appropriately determines which procedures may safely transition to ambulatory settings. Nationally recognized accreditation complements that determination by evaluating whether organizations possess the governance, clinical leadership, workforce competency, quality systems, emergency preparedness, and operational capability necessary to safely perform those procedures on an ongoing basis. Organizational readiness is therefore an essential complement to procedural eligibility, helping ensure expanded access is accompanied by sustained quality and patient safety.
Organizational Readiness Supports Safe Ambulatory Expansion
As outpatient care continues to grow in complexity, Medicare policy should increasingly recognize the importance of organizational readiness. While payment policy establishes where services may be reimbursed, accreditation independently evaluates whether organizations have developed the governance, leadership, quality infrastructure, and operational systems necessary to safely deliver those services over time.
AAAHC encourages CMS to continue monitoring patient outcomes associated with expanded outpatient surgery while recognizing the complementary role of nationally recognized accreditation in strengthening organizational readiness, supporting continuous quality improvement, and promoting safe expansion of ambulatory care.
Considerations for Future Rulemaking
As CMS continues expanding appropriate outpatient care, AAAHC encourages CMS to evaluate the cumulative impact of future payment and regulatory policies on the long-term sustainability of ambulatory care. Although the proposals in this rule generally advance quality and accountability, ambulatory organizations must also address increasing requirements related to quality reporting, prior authorization, cybersecurity, workforce shortages, technology modernization, and other federal and state regulations. Collectively, these obligations influence organizational capability, workforce resilience, financial sustainability, and ultimately patient access.
Reducing unnecessary administrative complexity does not diminish accountability. Rather, it enables organizations to redirect resources toward patient safety, quality improvement, workforce development, and direct patient care. AAAHC encourages CMS to continue identifying opportunities to streamline regulatory requirements while preserving meaningful oversight and quality outcomes.
Preserving a Strong Ambulatory Care Infrastructure
AAAHC encourages CMS to consider how future payment and regulatory policies affect the long-term viability of independent ambulatory providers, particularly those serving rural, Tribal, frontier, and medically underserved communities.
Independent ASCs remain an essential component of the Medicare delivery system by expanding patient choice, promoting competition, encouraging physician leadership and innovation, preserving local access to specialty surgical services, and strengthening a diverse and resilient ambulatory care delivery system. As CMS continues transitioning appropriate services to ambulatory settings, policies should preserve this diversity while avoiding unintended incentives that encourage unnecessary consolidation or reduce access for Medicare beneficiaries.
X. NonrecurringPolicyChanges
B. OPPS Payment for SaMS Diagnostic Services
1. Payment for Software as a Medical Service (SaMS)
AAAHC supports CMS’s proposal to adopt the term Software as a Medical Service (SaMS) in place of Software as a Service (SaaS) for software-enabled technologies that support clinical decision-making. The revised terminology more accurately reflects their clinical purpose and distinguishes software that performs medical functions from general information technology services. This change provides greater clarity as these technologies become increasingly integrated into patient care.
AAAHC also supports CMS’s recognition of the growing role of software-enabled technologies in health care delivery. As these technologies continue to evolve, Medicare policy should remain sufficiently flexible to support innovation while maintaining appropriate safeguards for patient safety and quality.
Governance Supports Responsible Implementation
As software-enabled technologies become more prevalent in ambulatory care, organizational capability depends on effective governance. Software supports clinical decision-making but does not replace the professional judgment of licensed clinicians.
Successful implementation requires governance that addresses technology selection, risk assessment, vendor oversight, workforce education, cybersecurity, transparency, human oversight, performance monitoring, and ongoing evaluation. These capabilities help ensure software enhances clinical decision-making while supporting safe, ethical, and effective patient care.
AAAHC supports CMS’s emphasis on governance, accountability, and risk-based oversight. Because these technologies evolve more rapidly than prescriptive regulatory requirements, governance-based approaches provide organizations with a durable framework for implementing innovation responsibly while maintaining patient safety, transparency, cybersecurity, and organizational accountability.
Accreditation Operationalizes Governance
CMS recently approved AAAHC’s v45 Accreditation Standards which operationalize this governance-based approach by establishing organizational expectations for governance, risk assessment, vendor oversight, workforce education, transparency, cybersecurity, human oversight, and ongoing performance evaluation for artificial intelligence and other software-enabled technologies.
Rather than focusing on individual technologies, the Standards establish enduring governance principles that support responsible implementation while advancing patient safety, quality improvement, and organizational readiness.
XIV. Proposed Measure Removal for the Hospital Outpatient Quality Reporting and Ambulatory Surgical Center Quality Reporting Programs
B. Proposed removal of the Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patient Measure in the Hospital Outpatient Quality Reporting and the ASC Quality Reporting Programs
AAAHC supports CMS’s proposal to remove the Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure from the Hospital Outpatient Quality Reporting (Hospital OQR) and Ambulatory Surgical Center Quality Reporting (ASCQR) Programs. The proposed removal appropriately recognizes that quality reporting should emphasize measures that meaningfully improve patient care and inform clinical decision-making while reducing reporting requirements that no longer provide sufficient value.
Well-designed measures support benchmarking, evidence-based decision-making, organizational learning, and continuous quality improvement. Conversely, measures that become primarily documentation exercises or provide limited opportunity for improving care can divert resources from activities that more directly benefit patients.
The proposed removal reflects an appropriate evolution of the ASCQR and Hospital OQR Programs by shifting emphasis from documenting compliance to measuring outcomes and performance that more directly support quality improvement. This approach is consistent with AAAHC’s accreditation philosophy, which promotes performance measurement as a tool for organizational learning, continuous improvement, and better patient outcomes, rather than merely demonstration of compliance.
AAAHC encourages CMS to continue periodically evaluating quality measures to ensure they remain clinically meaningful, evidence-based, operationally feasible, and capable of producing actionable information that supports improved patient care. As clinical practice and evidence evolve, the quality reporting programs should likewise evolve to maintain their relevance and value for providers, patients, and policymakers.
XVII. Ambulatory Surgical Center Quality Reporting Program
C. Request for Information on Stratification of the All-Cause Transfer/Admission Measure
AAAHC appreciates CMS’s Request for Information regarding potential stratification of the ASC All-Cause Hospital Transfer and Admission Measure. Outcome measures are most meaningful when they account for patient complexity, procedural risk, and clinical context. AAAHC encourages CMS to continue refining stratification and risk-adjustment methodologies that more accurately reflect quality of care while remaining operationally feasible for ambulatory organizations. Any refinements should avoid unintended disincentives for organizations caring for more medically complex Medicare beneficiaries
AAAHC supports CMS’s efforts to strengthen the ASCQR Program by prioritizing clinically meaningful, outcomes-focused measures that improve patient safety, support evidence-based care, enable benchmarking, identify opportunities for performance improvement, and provide meaningful information to Medicare beneficiaries.
Regulatory Efficiency Strengthens Quality
AAAHC commends CMS’s efforts to improve the efficiency of the ASCQR Program. While the proposals in this rule represent meaningful progress, ambulatory organizations continue to contend with the cumulative impact of quality reporting, prior authorization, cybersecurity requirements, workforce shortages, technology modernization, and other federal, state, payer, and accreditation obligations.
AAAHC encourages CMS to continue evaluating these requirements collectively and identify opportunities to eliminate duplication and simplify reporting while maintaining meaningful accountability. Administrative simplification is itself a quality improvement strategy, allowing organizations to redirect resources toward patient safety, workforce development, infection prevention, and continuous performance improvement.
As CMS continues refining the ASCQR Program, AAAHC encourages CMS to maintain a balanced approach that preserves accountability while ensuring reporting requirements remain relevant, operationally feasible, and focused on improving care for Medicare beneficiaries.
XVII. Accrediting Organization (AO) Deeming Authority for the Emergency Medical Treatment and Labor Act (EMTALA)
AAAHC strongly supports CMS’s proposal to permit CMS-approved accrediting organizations to assess compliance with specified administrative components of the Emergency Medical Treatment and Labor Act (EMTALA) during hospital accreditation surveys. Although appropriately limited in scope, the proposal represents a meaningful evolution in the partnership between CMS and nationally recognized accrediting organizations by recognizing accreditation as an effective component of Medicare’s quality oversight framework.
AAAHC believes accreditation is most effective when it complements governmental oversight. CMS appropriately retains responsibility for statutory interpretation, enforcement, complaint investigations, and protection of Medicare beneficiaries, while accrediting organizations independently evaluate the governance, leadership, quality systems, and operational processes that support sustained compliance and high-quality patient care.
Beyond periodic surveys, accreditation promotes continuous organizational improvement through performance measurement, governance evaluation, education, peer learning, risk identification, benchmarking, and continuous readiness. Together, these activities reinforce CMS’s oversight objectives by helping organizations sustain compliance, strengthen organizational capability and resilience, and continuously improve performance.
AAAHC encourages CMS to continue identifying opportunities where accreditation activities can appropriately complement federal oversight, strengthen accountability, reduce unnecessary duplication, and support continuous quality improvement while preserving CMS’s regulatory authority.
XIX. Expansion of Botulinum Toxin Injection Codes for Hospital Outpatient Department (OPD) Prior Authorization Process
AAAHC appreciates CMS’s efforts to strengthen program integrity through the Hospital Outpatient Department (OPD) Prior Authorization Program and acknowledges the proposal to expand prior authorization requirements to additional botulinum toxin injection services. Prior authorization can promote appropriate utilization of Medicare resources when implemented in a manner that preserves timely access to medically necessary care.
As CMS expands the Prior Authorization Program, AAAHC encourages continued attention to its operational impact. Prior authorization delays may postpone medically necessary procedures, increase administrative burden, require repeated preoperative evaluations, and create additional challenges for patients, caregivers, and providers. These impacts may be particularly significant for older adults, individuals with disabilities, and patients in rural, Tribal, frontier, and medically underserved communities, where rescheduling often requires additional travel, transportation, and caregiver coordination.
AAAHC encourages CMS to continue modernizing prior authorization through standardized electronic processes, greater interoperability, clear documentation requirements, and timely response expectations. These improvements can strengthen program integrity while reducing administrative burden and helping ensure Medicare beneficiaries receive clinically appropriate care without unnecessary delays.
XXIII. Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency Data
C. Consumer-Friendly Display Request for Public Comment
AAAHC appreciates CMS’s Request for Information regarding opportunities to improve the consistency, comparability, and usability of Hospital Price Transparency data. Greater transparency can help Medicare beneficiaries make more informed health care decisions when information is presented in a clear, understandable, and actionable manner.
AAAHC encourages CMS to continue prioritizing standardized data formats and consumer-friendly presentation that facilitate meaningful comparisons across providers while minimizing unnecessary administrative complexity.
Price is only one component of informed decision-making. AAAHC encourages CMS to explore opportunities to present cost information alongside meaningful quality and safety indicators, including accreditation status, quality performance, and patient experience, to provide Medicare beneficiaries with a more complete picture of value.
AAAHC also encourages CMS to balance greater transparency with operational feasibility by ensuring reporting requirements improve comparability and consumer understanding without imposing unnecessary administrative burden that diverts resources from patient care and quality improvement.
AAAHC appreciates the opportunity to comment on CMS-1850-P and commends CMS for continuing to advance policies that expand access to high-quality ambulatory care while strengthening quality, accountability, and patient safety.
As Medicare beneficiaries increasingly receive care in ambulatory settings, public policy should continue to support innovation while promoting the organizational capability, continuous readiness, and quality infrastructure necessary to safely deliver increasingly complex outpatient services. Through these comments, AAAHC has encouraged policies that preserve patient access, advance meaningful quality improvement, promote responsible innovation, and recognize the complementary role of nationally recognized accreditation in strengthening organizational capability and supporting continuous quality improvement.
AAAHC values its longstanding partnership with CMS and appreciates CMS’s continued collaboration with accrediting organizations in advancing high-quality ambulatory care. We look forward to working with CMS to develop policies that strengthen organizational capability, improve patient outcomes, and ensure Medicare beneficiaries continue to receive safe, high-quality care in the most appropriate setting.
Thank you for your consideration of these comments. For any questions, please contact us at 847-853-6060 or CEO@aaahc.org.
Respectfully submitted,
Noel M. Adachi, MBA
President & CEO
