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Jul 08 2010

CMS Releases its CY 2011 Proposed Rules for HOPDs and ASCs

CMS released its CY 2011 proposed rules for hospital outpatient departments and ambulatory surgery centers on July 2, 2010.  The proposed rules update payment policies and rates for hospital outpatient departments and ambulatory surgery centers.  Some of the proposed provisions implement portions of the health reform legislation signed into law in March.  As described by CMS, notable provisions of the proposed rule include:

Hospital Outpatient Departments


  • Waiver of the deductible and copayment for certain preventive services.

  • Additional quality measures to report in CY 2011 (six additional measures, including a health information technology measure), CY 2012 (seven additional measures) and CY 2013 (six additional measures).

  • Validation of quality reporting, including review of randomly selected cases from each hospital.

  • Changes to the supervision requirements for certain non-surgical extended duration services to require direct supervision for the initiation period of such services, followed by general supervision.

  • Payment for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals at an amount equal to the average sales price plus six percent.

  • Removal of CPT codes 21193, 21395 and 25909 from the inpatient-only list.


Ambulatory Surgical Centers

  • Waiver of the deductible and coinsurance for certain preventive services.

  • The addition of five surgical procedures to the list of Medicare-covered ASC procedures.


Other Proposed Rules

  • Reduced availability of the physician self-referral exceptions for ownership or investment interests in a “whole hospital” or “rural provider” for new physician-owned hospitals and those looking to expand capacity.

  • Changes relating to graduate medical education payment.


You can review a summary of most of these provisions on CMS’s website here.  A display copy of the proposed rule is available here.  CMS will accept comment until August 31, 2010.