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Mandates a CMS study regarding the degree to which inpatient prospective payment system (IPPS) exempt cancer hospitals have outpatient costs that exceed those of other hospitals. Authorizes HHS to make any appropriate adjustments to reflect those higher costs effective for services furnished on or after January 1, 2011.
2012
On April 26, 2012, CMS issued guidance regarding implementation of adjustments authorized by this provision for CY12.
2013
On July 8, 2013, CMS released its CY14 hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule in which it contemplates these provisions of the ACA in its proposal. Comments on the underlying proposed rule are due by September 6, 2013. A CMS press release is available here.
On July 3, CMS issued its CY15 HOPPS/ASC proposed rule in which the agency estimates that CY15 payments would increase hospital OPPS payments by 2.2% compared with CY14 payments, with ASCs to see an estimated 1.2% increase. These key ACA provisions are addressed in the underlying rule. An agency fact sheet is available here. Comments are due by September 2, 2014.
On Oct. 31, CMS released the CY 15 OPPS/ASC final rule (fact sheet), estimating that net OPPS payments will increase by 2.3% (vs. 2.2% in the proposed rule) compared with CY 14 payments. This represents a $5.1B increase or $900M when changes stemming from enrollment, utilization, and case-mix are excluded. The final rule addresses these provisions of the ACA.
On Mar. 23, GAO released a report reviewing payment for PPS-exempt cancer hospitals. GAO recommended Congress consider “requiring Medicare to pay PCHs as it pays PPS teaching hospitals, or provide the Secretary of (HHS) with the authority to otherwise modify how Medicare pays PCHs.”
On July 1, CMS released its CY 16 Medicare hospital OPPS and ambulatory surgical center proposed rule (fact sheet) in which it estimated that net CY 16 OPPS payments will decrease by -0.2%, or $43 million, compared with CY 15 payments. The rule addressed this provision of the ACA. Comments are due by Aug. 31.
2016
On July 6, CMS released the calendar year (CY) 2017 hospital outpatient prospective system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule. CMS estimates that overall, hospital outpatient departments (OPDs) will experience a 1.6 percent – or $5.1 billion – increase relative to CY 2016.
On Nov. 1, CMS released the CY 2017 hospital outpatient prospective system (OPPS) and ambulatory surgical center (ASC) payment system final rule. CMS estimates that overall, hospital outpatient departments (OPDs) will experience a 1.7 percent (up from 1.6 percent under the proposed rule) increase relative to CY 2016.
2017
On July 14 CMS proposed updated payment policies applying to hospital outpatient departments and ASCs beginning on or after Jan. 1, 2018. CMS estimates that overall, hospital outpatient departments (OPDs) will experience a 2.0 percent increase ($5.7 billion) relative to CY 2017.
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