The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2022 outpatient prospective payment system (OPPS) proposed rule on July 19. CMS estimates that Medicare expenditures under OPPS will increase by $1.35 billion based on changes in the proposed rule. Comments on the rule are due by 2 p.m. (PT) on Sept. 17.
Key provisions of the rule are summarized below.
- Payment Update: CMS proposes to update OPPS and ambulatory surgery center (ASC) payment rates for hospitals, and ASCs that meet the quality reporting requirements, by 2.3%. This is based on a market basket increase of 2.5% reduced by 0.2% for the productivity adjustment. The resulting conversion factors for hospitals and ASCs that satisfy the quality reporting requirements are $84.457 (increased from $82.797 in CY 2021) and $50.043 (increased from $48.952).
- Price Transparency Enforcement: CMS proposes to set a minimum civil monetary penalty of $300 per day that applies to smaller hospitals (bed count of 30 or fewer) and apply a penalty of $10 per bed per day for hospitals with a bed count greater than 30. The penalty is capped at a maximum daily dollar amount of $5,500. For a full calendar year of noncompliance, the minimum penalty amount would be $109,500 per hospital, while the maximum total penalty amount would be $2,007,500 per hospital.
- Reversal of Prior Policies Related to the Inpatient Only List (IPO): In the CY 2021 OPPS/ASC final rule, CMS finalized a policy to eliminate the IPO list over a three-year period, removing 298 services from the IPO list in the first phase of the elimination. For CY 2022, CMS proposes to halt the elimination of the IPO list. As such, CMS proposes to add the 298 services removed from the IPO list in CY 2021 back to the IPO list beginning in CY 2022.
- ASC Covered Procedures List (CPL): In the CY 2021 OPPS/ASC final rule, CMS revised the criteria used to add surgical procedures to the ASC CPL. Using these revised criteria, CMS added 267 surgical procedures to the ASC CPL beginning in CY 2021. For CY 2022, CMS proposes to reinstate the criteria for adding a procedure to the ASC CPL that were in place before CY 2021. CMS also proposes to remove from the ASC CPL 258 of the 267 procedures that were added in CY 2021.
- Drugs Acquired Through the 340B Program: CMS proposes to maintain the payment rate of average sales prices minus 22.5% for certain separately payable drugs or biologicals acquired through the 340B program. Rural sole community hospitals, children’s hospitals, and PPS-exempt cancer hospitals continue to be excepted from this policy.
- Rural Emergency Hospital – Request for Information (RFI): Section 125 of the Consolidated Appropriations Act (CAA) of 2021 established a new provider type called rural emergency hospitals (REHs), effective Jan. 1, 2023. While CMS does not propose specific regulations to implement the REH provider type, the proposed rule includes an RFI to seek public input on a broad range of issues that should be taken into account in establishing this new provider type.
- Hospital Outpatient Quality Reporting (OQR) Program: CMS proposes to adopt three new measures (including the COVID-19 Vaccination of Health Care Personnel – NQF #0431), make the reporting of two measures mandatory, remove two measures, and update the validation policies of the Hospital OQR Program to reduce provider burden and improve processes.
- Ambulatory Surgical Center Quality Reporting Program: CMS proposes to adopt the COVID-19 Vaccination of Health Care Personnel (NQF #0431) and make the reporting of six measures mandatory.
- Radiation Oncology Model: The CAA of 2021 prohibited implementation of the radiation oncology model prior to Jan. 1, 2022, delaying the start date. The OPPS proposed rule includes multiple provisions to address necessary changes as a result of the mandated delay and additional modifications to the model’s design.