In OPPS rule, CMS proposes to boost payment rates by 2.3%, make modifications to price transparency rule
Jul 19, 2021
The Centers for Medicare & Medicaid Services late today issued a proposed rule that would increase Medicare hospital outpatient prospective payment system rates by a net 2.3% in calendar year 2022 compared to 2021.
In addition, as urged by AHA, CMS proposes to reverse two policies finalized in CY 2021. The first proposed policy would halt the elimination of the inpatient only list. The second would reinstate several patient safety criteria for adding a procedure to the ambulatory surgical center covered procedures list that were in place in CY 2020 and prior.
“We are pleased that CMS recognizes the unique role that hospital outpatient departments serve in caring for patients, and that it proposes to roll back two problematic policies it advanced last year,” AHA Executive Vice President Stacey Hughes said in a statement.
Further, for hospitals that participate in the 340B Drug Pricing Program, CMS proposes to maintain the payment rate of average sales price minus 22.5% for certain separately payable drugs or biologicals.
CMS also proposes a number of modifications to the hospital price transparency rule, including significant increases to the civil monetary penalty for noncompliance. Currently, the CMP is set at a maximum amount of $300/day. CMS proposes to scale up the CMP based on a hospital’s bed count, with a minimum of $300/day for small hospitals (30 or fewer beds) and an additional $10/bed/day for larger hospital with a daily cap of $5,500. CMS also proposes to prohibit specific barriers to accessing the machine-readable files, including through automated searches and direct downloads. CMS proposes clarifications to the expected output of price estimator tools for those hospitals that chose to use them to fulfill the shoppable service requirement. CMS specifies that the tools need to provide a cost estimate for the amount expected to be paid by the patient that takes into consideration the individual’s insurance information.
In the statement shared with the media, Hughes said, “Hospitals and health systems are committed to helping patients access the information they need to make decisions about their care, including financial information. We will closely review the agency’s regulations related to price transparency and advocate that any final policies meet this objective. However, we are deeply concerned about the proposed increase in penalties for non-compliance, particularly in light of substantial uncertainty in the interpretation of the rules.”
In addition, CMS is soliciting public comments on the establishment of a new provider type, Rural Emergency Hospitals. For example, CMS is requesting stakeholder feedback on health and safety standards, conditions of participation, health equity-focused issues, payment policies and quality measure requirements.
Moreover, CMS proposes to remove two measures and adopt three for the Outpatient Quality Reporting Program, including a measure assessing COVID-19 vaccination rates among health care personnel. CMS also would require mandatory reporting of the Outpatient and ASC Consumer Assessment of Healthcare Providers and Systems patient experience survey starting in 2024. For the ASC Quality Reporting Program, CMS would adopt the same measure for COVID-19 vaccination among health care personnel as proposed for the Outpatient Quality Reporting Program, require reporting of previously voluntary measures in 2025, and resume reporting of four measures that were temporarily paused in previous rulemaking.
While CMS did propose to modify certain elements of the forthcoming Radiation Oncology Model, the agency did not propose to postpone the Jan. 1, 2022 start date, as urged by the AHA.
CMS will accept comments on the proposed rule through Sept. 17.