The Centers for Medicare & Medicaid Services (CMS) issued its proposed rule on the calendar year 2019 outpatient prospective payment system (OPPS). According to the CMS press release and fact sheet, CMS proposes to significantly expand site-neutral payments across the OPPS, physician fee schedule and ambulatory surgery center setting, following previous recommendations from the Medicare Payment Advisory Commission (MEDPAC).
The highlights of the proposed changes include:
- Update OPPS payment rates by 1.25 percent in CY 2019;
- Reduce payments for clinic visit services in excepted off-campus provider-based departments (PBD) to 40 percent of the OPPS rate;
- Reduce payments for new families of services furnished in excepted off-campus PBDs to 40 percent of the OPPS rate;
- Reduce payments for 340B-acquired drugs in non-excepted off-campus PBDs to average sales price (ASP) minus 22.5 percent;
- Reduce payments for new drugs without ASP data to wholesale acquisition cost plus 3 percent;
- Remove 10 measures from the Outpatient Quality Reporting Program;
- Remove the “Communication about Pain” questions from the inpatient
Hospital Consumer Assessment of Healthcare Providers and Systems(HCAHPS) survey; and
- Remove seven measures from the Ambulatory Surgical Centers (ASC) Quality Reporting Program.
The South Dakota Association of Healthcare Organizations (SDAHO) is currently reviewing the proposed rule. A detailed brief and impact analysis will be distributed to SDAHO members in the coming weeks.