The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 hospital outpatient prospective payment system (OPPS) proposed rule (fact sheet) addressing payments to hospital outpatient departments and ambulatory surgery centers (ASCs).
- What it is. CMS’ wide-ranging proposed rule affects payments to approximately 3,800 facilities paid under the OPPS, including hospital outpatient departments (OPDs), as well as ASC payments beginning on Jan. 1, 2020.
- Why it is important for you. CMS makes significant proposals that would apply to all hospitals operating in the United States, which are designed to implement directives in President Trump’s Executive Order on “Improving Price and Quality Transparency in American Healthcare to Put Patients First” (details). Specifically, the rule outlines the parameters of the requirement that all hospitals publicly post their standard charge information, including negotiated rates, for “shoppable” items and services.
The rule proposes to complete the two-year phase in of a 60 percent cut in reimbursements for clinic visit services furnished at certain off-campus provider-based departments (PBDs), and puts forward several additional policies designed to advance site neutrality across Medicare payment settings and services. Despite litigation, CMS proposes to continue paying for certain separately payable drugs and biologics acquired through the 340B Program at the reduced rate of Average Sale Price (ASP) minus 22.5 percent. Comments are solicited on an appropriate remedy in and alternative 340B payment rate, in the event that CMS cannot successfully appeal in that litigation.
- Potential next steps. Comments on the proposed rule are due by Sept. 27, 2019.
A comprehensive summary is attached.