CHA has released two summaries of Centers for Medicare & Medicaid Services (CMS) policies finalized under the calendar year (CY) 2020 outpatient prospective payment system (OPPS) final rules. The first summary details payment, policy, and outpatient quality reporting changes finalized for the CY 2020 OPPS under the Nov. 1 final rule, which take effect Jan. 1, 2020. The second summary, prepared by Health Policy Alternatives, Inc. (HPA), details specific price transparency requirements finalized in a separate final rule, issued Nov. 15 and effective Jan. 1, 2021.
CHA’s summary of the first CY 2020 OPPS final rule details a number of payment and policy provisions effective on Jan. 1, including a payment update of 2.6%, compared to CY 2019, as well as a number of CHA-opposed provisions, such as continued implementation of site-neutral payment rates for clinic visits in hospital outpatient departments and cuts to 340B payments. In addition, the final rule applies area wage index (AWI) policies finalized under the federal fiscal year 2019 inpatient prospective payment system (IPPS) to OPPS payments. CHA continues to lead a legal challenge to the AWI policies finalized in the IPPS final rule on behalf of impacted member hospitals. There is no cost to participate in this litigation, but hospitals must sign an engagement agreement before the end of the year. For more information, visit CHA’s AWI litigation resource page.
The HPA summary outlines in detail CMS’ finalized price transparency requirements, which will apply to all hospitals: critical access hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and long-term acute care hospitals. The final rule requires all hospitals to post gross charges, payer-specific negotiated rates, the de-identified minimum and maximum negotiated rates, and the cash discount price for all items and services on a website in a machine-readable format. In addition, it requires posting of information for 300 “shoppable” services in a consumer-friendly manner. The summary details the final rule’s definitions of a hospital for the purposes of the reporting requirements, describes the items and services that must be reported, and defines standard charges, as well as what constitutes a comprehensive machine-readable format and “consumer-friendly” manner.
On Dec. 3, the American Hospital Association (AHA) — joined by the Association of American Medical Colleges, the Children’s Hospital Association, the Federation of American Hospitals, and a representative group of member hospitals including a California-based hospital — filed a legal challenge to this requirement to publicly disclose negotiated rates. The groups sued on grounds that the rule exceeds the Administration’s statutory authority and violates First Amendment commercial speech protections. CHA and its member hospitals agree that consumers should have the information needed to make informed health care decisions, including what their expected out-of-pockets costs will be. However, the CMS recent final rule missed an opportunity — instead of helping patients determine their out-of-pocket costs, the rule will introduce widespread confusion and accelerate anticompetitive behavior from commercial health insurers. AHA has also prepared talking points for member hospitals that can be found here.