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CHA Issues Summary of OPPS Final Rule

For  CEOs, CFOs, government relations, quality & patient safety, and finance & reimbursement staff 

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CHA has issued a detailed summary, prepared by Health Policy Alternatives, Inc., on the calendar year 2021 outpatient prospective payment system final rule. The policies in the final rule are effective Jan. 1, 2021, unless otherwise specified. 

In addition to detailing annual payment updates in the final rule, the summary explains policies related to the payment methodology for 340B purchased drugs, the inpatient-only list, prior authorization, and the overall hospital star ratings methodology.  

The final rule also delays implementation of the radiation oncology model until July 1, and includes a new reporting requirement for hospitals and critical access hospitals to report information about their inventory of COVID-19 therapeutics.  

The Centers for Medicare & Medicaid Services (CMS) is accepting comments on two areas of the final rule: 

  • Payment classifications assigned to the interim ambulatory payment classification assignments and/or status indicators of new or replacement Level II health care common procedure codes. Comments are due to CMS by 2 p.m. (PT) on Jan. 4, 2021. To submit a comment, visit and search “CMS-1736-FC.” 
  • New reporting requirement of COVID-19 therapeutic inventory, usage, and acute respiratory illness data. Comments are due to CMS by 2 p.m. (PT) on Feb. 2, 2021. To submit a comment, visit and search “CMS-1736-IFC.” 

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