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CMS Issues 2021 Outpatient Prospective Payment System Final Rule

​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.
The provisions of the final rule will take effect Jan. 1, 2021, with the exception of changes to the prior authorization policy (which will take effect July 1, 2021).

A CMS fact sheet of the rule is available on the CMS website.

The full text of the rule is available here.

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