The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for hospital outpatient prospective payment systems (OPPS) and ambulatory surgical center (ASC) payment systems and quality reporting programs.
A SDAHO brief summary of the hospital OPPS sections of the proposed rule is provided with page numbers noted from the Federal Register (FR) version of the rule.
The proposed rule includes annual updates to the Medicare fee-for-service (FFS) outpatient payment rates, as well as regulations that implement new policies. The proposed rule includes policies that will:
- Change the rate for biosimilars purchased by hospitals through the 340B program;
- Change the inpatient only list;
- Make payment changes for excepted and non-excepted services furnished in off-campus provider-based departments;
- Extend the 340B drug payment adjustment (average sales price – 22.5 percent) to non-excepted PBDs;
- Change exceptions to the list of services to be packaged into APCs as opposed to separately paid; and
- Update payment rates and policies for ASCs.
SDAHO has released the financial impacts to prospective payment systems member facilities. Comments related to the proposed rule are due to CMS by Sept. 24 and can be submitted electronically here by using the website’s search feature to search for file code “1695-P”.