CMS Released CY2022 Hospital OPPS Proposed Rule. Here’s What You Need to Know.

On July 19, the Centers for Medicare & Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System (OPPS) proposed rule for CY2022. 
A number of proposals included in the rule focus on –
  • Measures to continue fighting the COVID-19 public health emergency (PHE);
  • Hospital price transparency; and
  • A new model of care for radiation oncology that builds on extensive work focused on episode-based payment.

CMS also proposes to update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.3 percent to $84.46. This update is based on the projected hospital market basket increase of 2.5 percent reduced by 0.2 percentage points for the productivity adjustment.

Price Transparency of Hospital Standard Charges
On Jan. 1, 2021, the Hospital Price Transparency final rule went into effect, requiring hospitals to make a yearly list of the hospital's standard charges for services available to the public. The proposed rule underscores the commitment to the rule's requirements. It is clear that enforcement of the rule will be a priority in 2022. The rule also proposes to increase civil monetary penalties and asks stakeholders for feedback on best practices for online price estimator tools and methods to identify and highlight exemplar hospitals.

Temporary Policies for the COVID-19 PHE
CMS's emergency rulemaking amidst the COVID-19 pandemic provided flexibilities to providers as they responded to the pandemic. In the proposed rule, CMS seeks comments on whether to make many of the PHE policies permanent. The rule solicits feedback on –
  • Policies that allowed mental health services to be provided in patient's home through telehealth technology;
  • To what extent providers relied on flexibility for direct supervision of pulmonary and cardiac rehabilitation, and
  • Whether the Health care Common Procedure Coding System (HCPCS) code specimen testing and collection for the coronavirus should be made permanent beyond the PHE.

OPPS Payment for Drugs Acquired Through the 340B Program
CMS proposes to maintain a payment rate of average sales price minus 22.5 percent for certain separately payable drugs or biologicals acquired through the 340B program. The 340B program allows providers to purchase certain covered outpatient drugs from manufacturers at discounted prices.

Reimbursement Charts Coming Soon  
In the next several days, ASNC will release charts compiling reimbursement rates for CY2022. These charts are a valued benefit for ASNC members. If you are not yet an ASNC member, JOIN NOW to ensure you have access to these charts and many more benefits. 
You also may want to review the CY2022 OPPS Proposed Rule Fact Sheet or the CY2022 Proposed Rule.