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AAMC Submits Comments on the CY 2021 OPPS Proposed Rule

October 9, 2020

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CONTACTS
Andrew Amari, Hospital Policy and Regulatory Specialist

The AAMC submitted comments on Oct. 5 on the Centers for Medicare and Medicaid Services’ (CMS’) calendar year (CY) 2021 Outpatient Prospective Payment System (OPPS) proposed rule [see Washington Highlights, Aug. 7].

The AAMC comments on the rule include:

340B Drug Pricing Program

CMS proposes to reduce reimbursement for separately payable drugs paid under the OPPS and acquired through the 340B Program based on a spring 2020 survey sent to 340B hospitals during the public health emergency (PHE). The AAMC believes that the 340B survey results do not accurately reflect 340B hospitals’ acquisition costs and should not be used as the basis for further reimbursement cuts. The AAMC strongly opposes reimbursement cuts to hospitals for 340B-acquired drugs and continues to believe that CMS does not have the legal authority to impose cuts on only a subset of hospitals participating in the OPPS.

Inpatient Only List (IPO List)

CMS proposes eliminating the IPO list over the next three years, beginning Jan. 1, 2021. The AAMC urges CMS to delay finalizing the elimination of the IPO list and solicit stakeholder feedback to evaluate which procedures are appropriate to be performed in the outpatient setting to ensure beneficiary safety and successful outcomes. If finalized, the AAMC believes that CMS should provide physician deference for site-of-service reviews for certain inpatient procedures, and it asks the agency to consider the impact of the changes on alternative payment models (APMs).

Ambulatory Surgical Center Covered Procedures List (ASC-CPL)

CMS proposes significantly modifying the current ASC-CPL criteria by adopting one of two alternative proposals that would permit more services to be added to the list. In consideration of numerous oversight, quality, and safety concerns at ASCs, the AAMC strongly opposes eliminating current exclusion criteria for the ASC-CPL in either proposal. However, the AAMC supports CMS’ proposal to establish a stakeholder nomination process to add procedures to the ASC-CPL through annual notice and comment rule-making.

Prior Authorization

CMS proposes including both cervical fusion with disc removal and implanted spinal neurostimulators to the list of services subject to prior authorization requirements for certain hospital outpatient department (HOPD) services introduced last year. The AAMC urges CMS not to finalize the proposal because valid reasons exist that account for the increased utilization of these services and because doing so could potentially limit beneficiaries’ access to needed medical care and increase burden on providers.

Site-Neutral Payment Policy

CMS proposes continuing its non-budget neutral payment cuts for clinic visits furnished by excepted off-campus provider-based departments. The AAMC maintains that these cuts are unlawful and cause undue harm to hospitals and the patients and communities they serve.

Wage Index

CMS proposes applying the continuing wage index policies adopted in its finalized fiscal year 2021 Inpatient Prospective Payment System post-reclassified wage index as the wage index for the OPPS. CMS also proposes adopting changes to labor market delineations outlined in the Office of Management and Budget (OMB) Bulletin No. 18-04. The AAMC asks CMS to consider the impact of the PHE on area wage indexes and to develop more comprehensive wage index reform once the PHE is over. The AAMC reiterates past requests to the agency to wait until after the decennial census to make changes to the labor market delineations and to not adopt the proposed delineation changes from OMB Bulletin No. 18-04.

COVID-19 Specimen Collection

CMS proposes continuing payment for COVID-19 specimen collection for CY 2021 using Healthcare Common Procedure Coding System code C9803 and Ambulatory Payment Classification (APC) 5371 with status indicator “Q1.” The AAMC strongly supports the proposal and urges CMS to make payment for COVID-19 specimen collection permanent to ensure hospitals are adequately compensated once the PHE ends.

Levels of Supervision Changes in Hospitals

CMS proposes permanently changing the required level of supervision for nonsurgical extended duration therapeutic services to general supervision. The agency is also proposing to permanently allow hospitals and critical access hospitals to meet direct supervision requirements for select rehabilitation services through interactive real-time audio/video communications technology. The AAMC strongly supports finalizing these proposals and also requests CMS consider expanding this policy to stand-alone, non-HOPD providers in rural settings.

Physician-Owned Hospitals

CMS proposes to remove limitations for certain physician-owned hospitals that seek to expand under the “whole-hospital” exception to the Physician Self-Referral (Stark) law. The AAMC strongly opposes removing these limitations and specifically asks CMS not to remove the community input requirement, which offers transparency and accountability to community stakeholders.

Hospital Quality Star Ratings

CMS proposes refining the methodology used to assign quality star ratings beginning with the next update to the ratings planned for January 2021. Major changes include (1) scoring measure groups with an explicit simple average approach instead of the latent variable modeling method, (2) stratifying the readmission measure group by proportion of dual-eligible patients served in alignment with scoring in the Hospital Readmission Reduction Program, and (3) peer grouping hospitals based on the number of measure groups hospitals report before assigning ratings in an effort to stratify comparisons of hospitals within the ratings. The AAMC at this time supports these changes but urges CMS to explore other methodologies that may more closely provide appropriate comparisons of quality of care, including moving beyond an overall composite rating. Additionally, the AAMC is asking CMS to invest in improving measure-level risk adjustment models to appropriately account for social risk factors to provide hospitals with actionable quality improvement data necessary to eliminate inequities of outcomes.

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