On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule which includes proposals to update payment rates and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2022. For CY 2022, CMS proposes to increase payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System by a factor of 2.3%. Hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0% reduction in the CY 2022 fee schedule increase factor, in continuation of existing policy.
More on proposed rule
“CMS is committed to addressing significant and persistent inequities in health outcomes in the United States and today’s proposed rule helps us achieve that by improving data collection to better measure and analyze disparities across programs and policies,” said CMS Administrator Chiquita Brooks-LaSure in a release. “We are committed to finding opportunities to meet the health needs of patients and consumers where they are, whether it’s by expanding access to onsite care in their communities, ensuring they have access to clear information about health care costs, or enhancing patient safety.”
There are several important policy changes in the proposed rule. First, for CY 2022, CMS received eight applications for device pass-through payments and is soliciting comment on the applications. Final determinations will be made in the final rule. CMS estimated that drug and biological pass-through payments for CY 2022 will be $462.4 million because CMS proposes that most of these drugs would be paid under CY 2022 OPPS at ASP plus 6 percent. CMS is also proposing to maintain its rate of ASP minus 22.5 percent for separately payable drugs through the 340B program.
Price transparency is another important area in the proposed rule. CMS clarified the expected outcome of hospital online price estimator tools when they are used in lieu of posting standard charges in a consumer-friendly way. CMS is also seeking comments regarding future rulemaking, including hospital data standardization. To encourage compliance, CMS is making three proposals regarding price transparency. First, it aims to increase the amount of penalties for noncompliance through the use of a proposed scaling factor based on hospital bed count. Second, CMS will consider state forensic hospitals that meet certain requirements to comply with 45 CFR part 180, which outlines public hospital standard charge requirements. Third, CMS will prohibit conduct that acts as barriers to accessing standard charge information. Specifically, CMS is proposing that hospitals must ensure that standard charge information is easily accessible without barriers, including ensuring that information is accessible to automated searches and direct file downloads though a link on the website.
Another important proposal involves updates to the Inpatient Only (IPO) list. CMS is proposing to halt the elimination of the IPO list and is proposing to add the 298 services that were previously eliminated from the list for CY 2021 back to the IPO beginning CY 2022. Historically, the IPO list identifies services where Medicare will only pay if such services are furnished in an inpatient hospital setting because of the nature of the procedure, underlying physical condition of the patient, or the need for postoperative recovery of patient monitoring. CMS has gradually made changes to the IPO list to recognize advances in medical technology, and, in the CY 2021 OPPS final rule, CMS finalized a proposal to eliminate the IPO list over the course of three years beginning with the removal of 298 services from the list for CY 2021. The rule would add these 298 services back onto the IPO list for CY 2022 so that such services could be assessed against longstanding criteria historically utilized by CMS to determine whether a service should be removed. CMS is also proposing to formally codify these longstanding criteria for determining removal of a service from the IPO. In addition, CMS is soliciting stakeholder feedback on the IPO list, including whether the agency should maintain the longer-term objective of eliminating the IPO list.
CMS also addressed the Radiation Oncology (RO) Model. The Model was statutorily delayed to January 1, 2022 due to the COVID pandemic, and CMS is subsequently making proposals to address timing and design. CMS aims to begin the Model at that time with a five-year performance period. CMS will lower discounts to 3.5 percent for the professional component and 4.5 percent for the technical component, revise the cancer inclusion criteria, and adopt an extreme and uncontrollable circumstances policy.
Finally, CMS included a request for information seeking stakeholder input on a broad range of issues under consideration that would apply to rural emergency hospitals in order for them to be certified to participate in the Medicare program. These hospitals are a new rural hospital provider type, beginning January 1, 2023, that will be required to furnish emergency department services and may provide other outpatient medical and health services as specified by the Secretary.