AHA Comments on the CMS’ Hospital OPPS and Ambulatory Surgical Center Payment System Proposed Rule for CY 2022

September 17, 2021

Download the Comment Letter PDF


The Honorable Chiquita Brooks-LaSure
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W., Room 445-G
Washington, DC 20201

Re: CMS–1753–P: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Price Transparency of Hospital Standard Charges; Radiation Oncology Model; Request for Information on Rural Emergency Hospitals Proposed Rule (Vol. 86, No. 147), August 4, 2021.

Dear Administrator Brooks-LaSure:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2022.

A summary of our overarching concerns and comments follows.

Outpatient Clinic Visits in Excepted Off-campus Provider-based Departments (PBDs)

For CY 2022, CMS proposes to continue to pay for the hospital outpatient clinic visit services in excepted off-campus PBDs at 40% of the OPPS payment amount. The AHA continues to urge CMS to reverse this harmful policy and restore full OPPS payment for hospital outpatient clinic visits in excepted PBDs. By continuing to make this payment reduction, CMS has undermined clear congressional intent and exceeded its legal authority.

Payments to 340B Hospitals

The AHA continues to oppose the agency’s deep OPPS payment cuts to 340B hospitals. 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 the crux of the legal issue the U.S. Supreme Court will review in its upcoming term. For more than 25 years, the 340B program has helped participating hospitals stretch scarce federal resources to reach more patients and provide more comprehensive services. The continuation of this harmful policy, especially as the COVID-19 pandemic continues, will undoubtedly result in the continued loss of resources for 340B hospitals and exacerbate the strain on these hospitals and the patients they serve.

Proposed Changes to the Inpatient-Only (IPO) List

The AHA strongly supports CMS’ CY 2022 proposal to halt the elimination of the IPO list. The IPO list was put into place to protect beneficiaries given that many medical and surgical services are complicated, invasive procedures with the potential for multiple days in the hospital and an arduous rehabilitation and recovery period.

Outpatient Quality Reporting (OQR) and ASC Quality Reporting (ASCQR) Programs

The AHA supports a number of proposals related to the OQR and ASCQR Programs. In addition, we have specific recommendations on how the agency should implement the measure on COVID-19 Vaccination among Health Care Personnel. We also have a number of concerns with CMS’ proposals to adopt several measures that lack clinical and statistical reliability, and we urge the agency to reconsider these proposals in light of its goals for meaningful measurement.

Proposed Changes to the List of ASC-Covered Surgical Procedures

The AHA strongly supports CMS’ proposal to reinstate the criteria for adding surgical procedures to its ASC covered procedures list (CPL). We also support its related proposal to remove 258 procedures it had added to the ASC CPL in CY 2021.

Proposed Updates to Requirements for Hospitals to Make Public a List Of Their Standard Charges

The AHA looks forward to working with CMS to improve the hospital price transparency rule, especially as it relates to better aligning these requirements with those in the transparency in coverage final rule and No Surprises Act. However, we strongly oppose increasing the penalties for non-compliance especially during the ongoing COVID-19 pandemic when the personnel required to implement this policy also are critical to helping hospitals manage this crisis. We urge the agency not to finalize the proposed penalty increases and instead focus on aligning the various federal price transparency policies to better serve patients and reduce duplication of effort.

Request for Information (RFI) on Rural Emergency Hospitals (REHs)

The AHA appreciates the opportunity to comment and provide feedback on the RFI for the newly designated provider type of REHs. We held extensive discussions with our members and have a number of recommendations as CMS moves forward. We look forward to continuing to work with the agency to ensure that REHs are able to become a meaningful part of health care delivery in rural areas.

We appreciate your consideration of these issues. Our detailed comments are attached.

Please contact me if you have questions or feel free to have a member of your team contact Roslyne Schulman, director for policy, at rschulman@aha.org.



Stacey Hughes
Executive Vice President

View detailed comments below.