MedCom is highlighting the key points of the proposed rule released this week and as CMS published in a Fact Sheet summarizing the content of the proposed rule: CY 2022 Medicare OPPS and ASC Payment. The full Fact Sheet can be accessed at the following link:
CY 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS-1753-P) | CMS
The rule goes beyond the traditional payment rate updates to align with key goals of the current Administration. Specific initiatives incorporated in the proposed rule include:
- OPPS and ASC Payment Updates and Other Key Components
- Price Transparency: Enforcement and Increased Civil Monetary Penalties (CMP)
- Rural Emergency Hospital (REH): New Provider Type for 1/1/2023
- Health Equity Gap Closure
- Covid-19 Public Health Emergency: Ongoing Management
- Patient-Centered Care: Patient Safety and Effectiveness of Care
Each of these initiatives is summarized below:
- OPPS & ASC Payment Rates and Related Considerations
- 2.3% Payment Increase for OPPS and ASC settings
- Use of CY 2019 claims data to set CY 2022 rates due to Covid impact on CY 2020 claims
- IP Only (IPO) List:
- Halt on plan to eliminate the IPO List
- Adding back 298 procedures removed from the IPO List in 2021
- Evaluation of ASC Covered Procedure List for removal and/or reinstatement of procedures based on revised criteria
- Maintaining 340B Program Drug Payment at Average Sale Price (ASP) minus 22.5%
- Modifying the Radiation Oncology Model timing and design
- Updates to Quality Reporting Programs for OPPS and ASC
- Price Transparency Compliance and Enforcement
- New CMP effective 1/1/2022 as follows:
- $300/day for hospitals with bed count <= 30 beds
- $10/bed/day to daily max of $5,500 for hospital bed count >30 beds
These new penalties could translate to a significant amount over a 1-year period, ranging from an annualized minimum penalty of $109,500 to a maximum penalty of just over $2 million.
- CMS is also looking at scaling options in applying penalties based on factors such as hospital revenue, severity of non-compliance, and reasons for non-compliance. Other considerations include clarifying Pricing Transparency requirements relative to the format and standard content of the Machine-Readable File and outlining specific outputs and best practices for a Price Estimator Tool.
- Creation of new provider type: Rural Emergency Hospital (REH)
- Proposed implementation date of 1/1/2023
- Purpose is to address the lack of emergency services in rural areas that has resulted due to the closure of Rural and Critical Access Hospitals across the country.
- Health Equity Gap Closure
- As stated by CMS: CMS is seeking input on ways to make reporting of health disparities based on social risk factors and race and ethnicity more comprehensive and actionable. This includes soliciting comments on potential collection of data and analysis and reporting of quality measure results by a variety of demographic data points including, but not limited to, race, Medicare/Medicaid dual eligible status, disability status, LGBTQ+, and socioeconomic status.
- Covid-19 PHE Ongoing Management
- Per CMS, they are seeking comment on the extent to which hospitals are using flexibilities offered during the COVID-19 public health emergency to provide mental health services remotely and whether CMS should consider changes to account for shifting practice patterns. In addition, CMS is proposing changes to measure how many of our nation’s front-line healthcare workers in hospital outpatient departments and ASCs are vaccinated against COVID-19 and to make this information available to the public, so consumers know how many workers are vaccinated in different health care settings.
- Patient-Centered Care: Patient Safety and Effectiveness of Care
- CMS is increasing Medicare beneficiary safety by reversing changes made for 2021 regarding the care setting for which Medicare will pay for surgical procedures that may pose risk to patients [relative to IPO list initiatives aforementioned]. Per CMS, there are some services designated as inpatient only that, given their clinical intensity, would not be expected to be performed in the outpatient setting.
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