CMS releases 2019 OPPS/ASC payment system rule

The Centers for Medicare & Medicaid Services (CMS) released the 2019 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) final rule. Changes include expanded Medicare “site-neutral” payment policies and changes to the payment policies for 340B-acquired drugs.

Key takeaways noted by the American Hospital Association (AHA) include:

  • CMS finalized a policy to phase-in, over two years, a reduction in payments for clinic visit services in grandfathered (excepted) off-campus provider-based departments. In CY 2019, these services will be paid 70 percent of the OPPS rate, and in CY 2020 and beyond, 40 percent of the OPPS rate.
  • CMS did not finalize a policy to reduce payments for new families of services furnished in grandfathered (excepted) off-campus PBDs.
  • CMS finalized a policy to reduce payments for 340B-acquired drugs in non-grandfathered (non-excepted) off-campus PBDs to average sale price minus 22.5 percent.

The AHA has issued a special bulletin highlighting the critical points of the rule.

The AHA, joined by the Association of American Medical Colleges and member hospitals, intends to promptly bring a court challenge to the new rule’s site-neutral provisions. The AHA, along with other hospital associations and member hospitals, is already challenging the 340B policy included in the current outpatient rule.

Read the CMS fact sheet.