In OPPS rule, CMS boosts payment rates by 2%, makes modifications to price transparency rule
The Centers for Medicare & Medicaid Services late today issued a final rule that increases Medicare hospital outpatient prospective payment system rates by a net 2.0% in calendar year 2022 compared to 2021.
In addition, as urged by AHA, CMS finalized its proposals to reverse two policies finalized in CY 2021. The first policy halts the elimination of the inpatient only list and adds back to the IPO list almost all of the services removed in 2021. The second reinstates 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. The rule also removes 255 of the 258 surgical procedures that had been added to the ASC CPL in 2021
“We are pleased that CMS recognized the unique role that hospital outpatient departments play in caring for patients by rolling back two problematic policies it put forth last year,” said AHA Executive Vice President Stacey Hughes in a statement shared with the media. “Reinstating the list of services that Medicare will pay for only when performed in an inpatient setting due to their medical complexity, and reinstating long-standing safety criteria for allowing procedures to take place in ambulatory surgical centers, is a win for patients' safety, health and quality of care.”
Further, for certain hospitals that participate in the 340B Drug Pricing Program, CMS maintains the payment rate of average sales price minus 22.5% for separately payable drugs or biologicals.
Hughes expressed disappointment that CMS will continue deep payment cuts to 340B hospitals, which “threatens their ability to care for their patients and communities and goes against Congress’ intent in establishing the 340B program nearly 30 years ago.”
CMS also finalizes as proposed a number of modifications to the hospital price transparency rule, including significant increases to the civil monetary penalty for noncompliance.
“Hospitals and health systems are deeply committed to helping patients access the information they need to make informed decisions about their care, including financial information,” Hughes said. “That said, we are very concerned about the significant increase in penalties for non-compliance with the hospital price transparency rule, particularly in light of the many demands placed on hospitals over the past 18 months, including both responding to COVID-19, as well as preparing to implement additional, overlapping price transparency policies.”
Currently, the CMP is set at a maximum amount of $300/day. CMS will 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 hospitals with a daily cap of $5,500. CMS also will prohibit specific barriers to accessing the machine-readable files, including through automated searches and direct downloads. CMS provides updated clarifications on the price estimator tools for those hospitals that choose to use them to fulfill the shoppable service requirement, including allowing patients to manually input their insurance information and permitting broad disclaimers, as appropriate.
In addition, CMS finalized its proposals 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 will require hospitals to collect and report data from the Outpatient and ASC Consumer Assessment of Healthcare Providers and Systems patient experience survey starting in 2024. For the ASC Quality Reporting Program, CMS will 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 2027, and resume reporting of four measures that were temporarily paused in previous rulemaking.
While CMS did modify certain elements of the forthcoming Radiation Oncology Model, AHA is disappointed the agency declined to postpone the Jan. 1, 2022 start date and reduce the model discount factors, as the AHA advocated.