CY 2022 Hospital OPPS/ASC Proposed Rule, Including Modifications to Price Transparency

AHA Regulatory Advisory
July 30, 2021
 

Download the Regulatory Advisory Here
 

At a Glance

The Centers for Medicare & Medicaid Services (CMS) July 19 released its calendar year (CY) 2022 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) proposed rule. In addition to standard updates, the rule would: reverse two policies related to the inpatient only (IPO) list and the ASC covered procedures list (CPL); significantly increase the civil monetary penalty for noncompliance with the hospital price transparency rule; solicit comments on establishing a new provider type called the Rural Emergency Hospital (REH); and modify the Radiation Oncology Model. Comments on the proposed rule are due by Sept. 17.

Our Take

In a statement shared with the media, AHA said that the proposed rule includes a number of proposals that will help hospitals and health systems better provide care in their communities. We were pleased that CMS recognized the unique role that hospital outpatient departments (HOPDs) serve in caring for patients by proposing to roll back two problematic policies it advanced last year. The first policy would have eliminated the list of medically complex services that Medicare will only pay for when performed in the inpatient setting, and the second would have allowed very complicated procedures to be provided in ASCs, both of which could have negatively impacted Medicare patients’ safety and quality of care.

We also welcome the request for information on the REH model, which will help rural hospitals continue to serve as an access point to care in their communities. The pandemic has been especially challenging to rural facilities and this model will help to ensure that patients continue to have the access they need.

Further, although AHA is committed to helping patients access financial and other information patients need to make decisions about their care, we are deeply concerned about the proposed increase in penalties for non-compliance, particularly in light of substantial uncertainty in the interpretation of the rules.

Finally, we are disappointed that CMS proposes to continue to deeply cut OPPS payments to 340B hospitals, and we urge CMS to reverse this punitive policy in the final rule. These cuts directly harm 340B hospitals and their ability to care for their patients, contravening Congress’ intent in establishing the 340B program. These cuts are enabled by a lower court’s deference to the government’s inaccurate interpretation of the law, which is the crux of the legal issue the Supreme Court will review in its upcoming term. For more than 25 years, the 340B program has helped hospitals stretch scarce federal resources to reach more patients and provide more comprehensive services. This proposal would undoubtedly result in the continued loss of resources for 340B hospitals and exacerbate the strain on these hospitals, especially as the COVID-19 pandemic continues. View the entire report below.

What You Can Do

  • Participate in the AHA’s members-only webinar on Aug. 24 at 3 p.m. ET. Click here to register.
  • Share this advisory with your senior management team, and ask your chief financial officer to examine the impact of the proposed payment changes on your Medicare revenue for CY 2022.
  • Share this advisory with your billing, medical records, quality improvement and compliance departments, as well as your clinical leadership team – including the quality improvement committee and infection control officer – to apprise them of the proposals around the ambulatory payment classifications (APCs) and quality measurement requirements.
  • Submit comments to CMS with your specific concerns by Sept. 17 at www.regulations.gov. The final rule will be published on or around Nov.1 and take effect Jan. 1, 2022.

Further Questions

If you have further questions regarding the proposed rule’s provisions, contact Roslyne Schulman, director of outpatient payment policy, at rschulman@aha.org.

View the entire Regulatory Advisory below.

Key Takeaways

CMS proposes to:

  • Update OPPS payments rates by 2.3% in 2022;
  • Use CY 2019 claims data for CY 2022 OPPS and ASC ratesetting;
  • Reverse the phased elimination of the IPO list;
  • Reinstate several patient safety criteria for adding a procedure to the ASC CPL;
  • Continue to pay for 340B drugs at Average Sales Price (ASP) minus 22.5%;
  • Modify the hospital price transparency rule, including by significantly increasing the civil monetary penalty for noncompliance;
  • Adopt three new measures for the Outpatient Quality Reporting Program, including one on COVID-19 Vaccination among Health Care Personnel;
  • Require the Outpatient/ASC CAHPS Survey beginning CY 2023, and allowing survey administration via web
  • Request feedback on several issues, including health equity and digital quality measurement;
  • Solicit public comments on the establishment of the REH model; and,
  • Make several modifications to the Radiation Oncology Model and officially launch the model on Jan. 1, 2022.

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