CMS Issues Hospital Outpatient/ASC Final Rule, Including Maintenance of 340B Cuts

AHA Special Bulletin
December 3, 2020

At A Glance

The Centers for Medicare & Medicaid Services (CMS) yesterday released the calendar year (CY) 2021 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) final rule.

In addition to standard updates, the rule maintains previous payment cuts for certain drugs purchased under the 340B drug savings program, expands the list of outpatient services subject to prior authorization, eliminates the inpatient-only list over three years, makes significant changes to the hospital star ratings methodology, changes the physician-owned hospital policy and requires new hospital COVID-19 data reporting.

Sign In and View the Special Bulletin

Key Takeaways

In the final rule, CMS sets policies to:

  • Update OPPS payment rates by 2.4% in CY 2021;
  • Continue to pay for 340B drugs at Average Sales Price (ASP) minus 22.5%;
  • Add two new categories of services to the OPPS prior authorization process;
  • Eliminate the inpatient-only list over three years, including removing 266 musculoskeletal-related services in CY 2021;
  • Create two new comprehensive ambulatory payment classifications for Level 8 Urology and Related Services and Level 5 Neurostimulator and Related Procedures;
  • Change the minimum default level of supervision for non-surgical extended duration therapeutic services to general supervision for the entire service;
  • Make significant changes to the hospital star ratings methodology;
  • Remove certain restrictions on the expansion of physician-owned hospitals that qualify as “high-Medicaid facilities”;
  • Increase payment rates under the ASC payment system by 2.4%;
  • Change the criteria for designating ASC covered procedures, and add 278 procedures; and
  • Expand the hospital COVID-19 data reporting to include therapeutic inventory and acute respiratory illness.