Complete Story
06/03/2026
CASA Federal Advocacy Update
2026 Midyear Review: What's Happening Now and What It Means for Your ASC
Medicare & ASC Reimbursement — Outpatient Surgery Access Act of 2026
Introduced March 25, 2026
On March 25, 2026, bipartisan legislation titled the Outpatient Surgery Access Act of 2026 was introduced in Congress. The legislation is supported by the Ambulatory Surgery Center Association (ASCA) and seeks to improve long-term Medicare reimbursement stability for ASCs.
Key provisions include:
- Permanent application of the hospital market basket update to ASC reimbursement rates
- Elimination of the budget neutrality adjustment that suppresses ASC payment growth
- Improved long-term payment predictability for Medicare-certified ASCs
The current hospital market basket methodology used for ASC annual updates expires at the end of 2026. Without this bill, ASC updates would revert to CPI-U, which typically yields lower annual increases. The bill was introduced by Representatives Beth Van Duyne (R-TX) and John Larson (D-CT) and has formal endorsement from ASCA.
This bill is a direct CASA advocacy priority. Member engagement with California congressional delegations on this legislation is encouraged before the 2026 market basket policy expires.
ASC News - ASC Payment Fight Returns
CMS Payment System Updates - April 2026 ASC Quarterly Payment Update
Effective April 6, 2026
CMS released the April 2026 quarterly update to the ASC Payment System through Change Request (CR) 14445. ASCs were advised to update chargemasters, billing systems, and coding files to ensure compliance.
The update included:
- HCPCS code and payment rate updates
- Revised ASC payment group assignments
- Drug and biological payment adjustments
- Billing and implementation guidance effective April 6, 2026
ASCs should verify that chargemasters, billing systems, and coding files have been updated to reflect the April 6, 2026 changes from CR 14445.
CMS Transmittal R13704CP - April 2026 ASC Quarterly Update (CR 14445)
Prior Authorization Expansion - ASC Prior Authorization Demonstration Continues
Effective December 15, 2025
CMS continues implementation of its prior authorization demonstration project affecting certain ASC procedures in ten states, including California. This remains an important operational and revenue cycle issue for California ASCs due to increased administrative burden and potential reimbursement delays.
The demonstration:
- Applies to selected procedures identified as vulnerable to improper payment concerns
- Requires prior authorization for certain ASC services
- Became effective for dates of service beginning December 15, 2025
California is one of ten states included in this demonstration. ASCs should ensure prior authorization workflows are in place for affected procedure codes to avoid claim denials and payment delays.
CMS Prior Authorization Demonstration for Certain ASC Services
Effective January 1, 2026
The CY 2026 OPPS/ASC Final Rule took effect January 1, 2026. Its provisions continue to shape ASC operations and revenue through the remainder of the year.
Payment Rate
The 2026 ASC payment update is +2.6% (hospital market basket of 3.3% minus a 0.7% productivity adjustment). The new ASC conversion factor is $56.322, up from $54.895 in 2025, and applies to ASCs meeting quality reporting requirements
Cardiac Ablation - Major Cardiology Win
** California: State Legislative Statute Limitations**
**Cardiac catheter ablation was added to the ASC Covered Procedures List for the first time in Medicare history. CPT codes 93650, 93653, 93654, and 93656 are covered effective January 1, 2026. ASCs can now bill Medicare for cardiac ablation procedures, opening a major new revenue stream in cardiology.
ASC Covered Procedures List Expansion
276 procedures were added based on the removal of five restrictive exclusion criteria - the largest single-year expansion in recent history. In addition, 285 procedures (mostly musculoskeletal) were removed from the Inpatient Only (IPO) list, with the full elimination of the IPO list mandated by January 1, 2029. This represents a significant opportunity for ASCs to add procedures currently performed only in hospital inpatient settings.
ASC Quality Reporting Program (ASCQR) - Measures Removed
Four measures were removed from the ASCQR program:
- COVID-19 HCP Vaccination - removed effective CY 2024 reporting / CY 2026 payment determination
- Facility Commitment to Health Equity - removed effective CY 2025 reporting / CY 2027 payment determination
- Screening for Social Determinants of Health (SDOH) - removed effective CY 2025 reporting period
- Screen Positive Rate for SDOH - removed effective CY 2025 reporting period
CMS CY 2026 OPPS/ASC Final Rule Fact Sheet
Federal Register - CY 2026 OPPS/ASC Final Rule
MedTech Dive - CMS Covers Cardiac Ablation in ASCs
American College of Cardiology - 2026 OPPS Final Rule Highlights
VMG Health - CY 2026 OPPS/ASC Payment System Final Rule
Medicaid - Major Federal Cuts with Patient Volume Implications
The One Big Beautiful Bill Act (signed July 4, 2025) enacted nearly $1 trillion in Medicaid cuts over 10 years. Key provisions are rolling into effect in 2026 and beyond with direct implications for ASC patient volume.
Key provisions:
- Work requirements - Beginning January 2027, most Medicaid recipients must complete 80 hours per month of work, training, or volunteer activities to maintain coverage. CBO estimates 11.8 million will lose coverage.
- Enhanced federal match (FMAP) sunset - Effective January 1, 2026, the 90% federal match that incentivized states to maintain Medicaid expansion has ended, creating significant state budget pressure.
- Eligibility redeterminations - States are required to conduct eligibility redeterminations every 6 months by December 31, 2026, which is expected to accelerate coverage losses.
- California impact - California has not yet announced a Medi-Cal rollback, but the FMAP reduction is pressuring the state budget. ASCs with Medi-Cal patient populations should monitor state budget developments closely.
Medicaid coverage losses will reduce patient access to elective and non-emergency procedures. ASCs should assess their Medi-Cal patient mix and monitor California's state budget response through summer 2026.
AMA - Changes to Medicaid in the One Big Beautiful Bill Act
Fierce Healthcare - 2026 Outlook: Domino Effect of Medicaid Cuts
Healthcare Dive - House Passes Reconciliation Bill with Massive Medicaid Cuts
Federal Regulatory Update: HHS Section 504 Accessibility Rule
Effective May 9, 2024 - Equipment Deadline July 8, 2026
In May 2024, the U.S. Department of Health and Human Services (HHS) updated Section 504 of the Rehabilitation Act, establishing enforceable federal standards requiring healthcare providers receiving federal financial assistance — including ambulatory surgery centers that bill Medicare or Medicaid — to ensure equitable access for patients with disabilities.
Key compliance deadlines:
- Accessible equipment - By July 8, 2026, each facility must have at least one wheelchair-accessible weight scale with a platform large enough to accommodate seated patients. Integrated alternatives — such as scales built into patient lifts or beds - are acceptable. Staff must be trained to operate accessible equipment and assist with patient positioning.
- Digital accessibility - All patient-facing digital systems - including patient portals, scheduling tools, kiosks, and telehealth platforms - must meet the WCAG 2.1 Level AA standard by May 11, 2027 (15 or more employees) or May 10, 2028 (fewer than 15 employees). This obligation cannot be delegated to vendors - the organization remains legally responsible for third-party system compliance.
CASA has reached out to a healthcare attorney (Fisher Phillips) to provide an educational resource for our members as part of the Administrator Mastery Series or as a standalone session. We have also approached ASCA for additional guidance on the direction they are providing to members.
Non-compliance carries meaningful risk. Patients may file complaints with the HHS Office for Civil Rights or pursue direct litigation in federal court under Section 504’s private right of action. ASCs should assess compliance readiness now, given that the July 8, 2026, equipment deadline is weeks away.
Live: California and Federal Legislative Update!
At the CASA Conference, hear directly from CASA Advocates Alison Ramey and Ryan Pierini, alongside ASCA Representatives Bill Prentice and Kara Newbury. This Thursday morning session will provide a comprehensive overview of current and emerging legislation affecting Ambulatory Surgery Centers (ASCs) at both the state and national levels. Attendees will gain insights into regulatory challenges, advocacy efforts, and policy developments that shape the ASC environment in California and across the country.
From regulatory challenges to emerging policy shifts, this session gives you the insight you need to protect your ASC and plan ahead.
The CASA Conference is where it happens. Be in the room!
