The Centers for Medicare & Medicaid Services today issued a final rule updating hospital outpatient prospective payment system rates by 1.65% in 2017 compared to 2016. The rule also implements Section 603 of the Bipartisan Budget Act of 2015, which requires that, with the exception of dedicated emergency department services, services furnished in off-campus provider-based hospital outpatient departments that began billing under the OPPS on or after Nov. 2, 2015 no longer be paid under the OPPS. Under today’s rule, hospitals will be paid under the physician fee schedule at newly established rates for these services. For 2017, the payment rate for these services will generally be 50% of the OPPS rate. In addition, CMS finalizes its proposal that the relocation of an existing hospital outpatient department will result in the HOPD losing its grandfathered status and being paid at the new rate, except in extraordinary circumstances. CMS also finalizes its policy regarding an HOPD that has a change of ownership. However, CMS will not apply reduced payment to grandfathered HOPDs that expand services. “CMS’s final rule appropriately recognizes that providing no payment to new off-campus hospital clinics for the services they provide to patients was an untenable policy,” said AHA Executive Vice President Tom Nickels, noting that AHA will evaluate the new payment level to “ensure that it is fair and reasonable,” and that CMS can implement it for 2017. “We appreciate the modifications CMS made to its proposal to allow existing hospital clinics to expand their services to meet the changing needs of their patients and communities without being penalized. However, we are alarmed that CMS continues to ignore the need for hospitals to modernize existing facilities so that they can provide the most up-to-date, high-quality services to their patients. We continue to be concerned that such ‘site-neutral’ policies and CMS’s implementation of them could impede patients’ access to care, especially in the most vulnerable communities. We are evaluating the details of the final rule and will provide further comment to CMS.” For the 2020 outpatient quality reporting program, CMS adopts seven new measures, including five measures derived from a new Outpatient and Ambulatory Surgical Center Consumer Assessment of Healthcare Providers and Systems survey. CMS will accept comment for 60 days on the site-neutral payment policies.
Webinar held Thursday, November 29 Video Recording:
The Centers for Medicare & Medicaid Services today released the calendar year 2019 outpatient prospective payment system/ambulatory surgical center final rule.