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CMS Releases HTI-4 Final Rule

On August 4, 2025, the Centers for Medicare and Medicaid Services (CMS) released the following Final Rule, which is known as HTI-4:

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 

ASTP/ONC released a short fact sheet to support it. 

While not focused on public health, several things caught my eye:

• No mention of public health systems certification that was asked about in the HTI-2 NPRM.
• Robust discussion of the new optional bonus measure for TEFCA-related exchange which they affirmed.
• A discussion on affirming the need to include race/ethnicity in certain eRx transactions, interesting (to me) only because of the current administration’s stance on anything related to race and data collection.
• The removal of the “COVID–19 Vaccination Coverage among HCP” measure beginning with the CY 2024 reporting period/FY 2026 payment determination as the associated public health emergency is “over.”

I’m sure there are some other nuggets embedded in this 2,000+ page rule, but these are the ones that caught my attention.