On December 2, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2021 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule. In the final rule, CMS set policies to:
- Update OPPS payment rates by 2.4% in CY 2021;
- Continue to pay for 340B drugs at Average Sales Price (ASP) minus 22.5%;
- Add two new categories of services to the OPPS prior authorization process;
- Eliminate the inpatient-only list over three years, including removing 298 services in CY 2021;
- Change the minimum default level of supervision for non-surgical extended duration therapeutic services to general supervision for the entire service;
- Make significant changes to the hospital star ratings methodology;
- Remove certain restrictions on the expansion of physician-owned hospitals that qualify as “high-Medicaid facilities”;
- Change the criteria for designating ASC covered procedures, and add 278 procedures; and
- Expand the hospital COVID-19 data reporting to include therapeutic inventory and acute respiratory illness.
