CMS issued a proposed rule that makes policy and payment changes for services provided to Medicare beneficiaries in hospital outpatient departments (HOPDs). If finalized, the changes in the proposed rule would be effective for the 2012 calendar year.
In a fact sheet and press release, CMS highlighted the following changes to the rules governing hospital outpatient departments and payments under the OPPS:
- A projected 1.5% outpatient department fee schedule increase (2.8%, based on the projected hospital inpatient market basket percentage increase minus an estimated 1.2% multifactor productivity adjustment minus a 0.1% adjustment) for CY 2012.
- Application of a payment adjustment to each cancer hospital’s OPPS payments, with some hospitals receiving a 0% adjustment. As a result, most cancer hospitals would no longer quality for Transitional Outpatient Payments. Although the statute requires that cancer hospital payment adjustments be budget neutral, CMS projects a resulting payment increase of 9% to cancer hospitals.
- Payment of acquisition and pharmacy overhead costs for separately payable drugs and biologicals (excluding new pass-through drugs and biologicals) at the manufacturers’ average sales price plus 4%.
- Payment for partial hospitalization services in hospital-based programs and freestanding community mental health centers with the establishment of two payment tiers.
- Establishment of an independent advisory review process for consideration of stakeholder requests for assignment of supervision levels other than direct supervision for specific outpatient hospital therapeutic services.
- Additional measures for reporting in either CY 2012 or CY 2013 for the CY 2014 payment determination, and a modified process for validating hospital reporting of chart-abstracted measures adopted for CY 2012.
The proposed rule also introduces a quality reporting program for ambulatory surgery centers, with eight quality measures for reporting in CY 2012 for the CY 2014 payment determination.
Comments to the proposed rule must be received by CMS no later than August 30, 2011.