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CMS Releases CY 2022 Outpatient Prospective Payment System Proposed Rule

July 23, 2021

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CONTACTS
Mary Mullaney, Director, Hospital Payment Policies
Phoebe Ramsey, Sr. Regulatory Analyst, Quality & Payment Policy

On July 19, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. Comments are due Sept. 17, 2021.

Notably, the proposed rule contains several modifications to the price transparency of hospital standard charges requirements. The CMS is proposing to increase the civil monetary penalties (CMPs) for noncompliance with the price transparency requirements and update the list of activities that present barriers to access to machine-readable files.

In addition, the CMS is soliciting comments on several issues including reporting of health disparities and extending temporary COVID-19 policies.

Among the proposals are the following key updates for academic medicine:

Payment Proposals

Payment Update: The CMS is proposing to increase payment rates for hospitals that meet applicable quality reporting requirements by 2.3%.

Ratesetting Data Set: The CMS is proposing to use CY 2019 data to set CY 2022 OPPS and ASC payment system rates. The CMS believes that due to a number of COVID-19 public health emergency-related factors, the CY 2020 data are not the best overall approximation of expected outpatient hospital services in CY 2022. 

Hospital Price Transparency: In response to President Biden’s executive order to support existing hospital price transparency rules, the proposed rule increases penalties for noncompliance with the hospital price transparency rules. For hospitals with 30 or fewer beds, a minimum CMP of $300 per day would be imposed for noncompliance. The penalty would rise by an additional $10 per day for each additional bed that would apply to hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500.

340B-Acquired Drugs: The CMS proposes to maintain the payment rate of average sales prices minus 22.5% for certain separately payable drugs or biologics acquired through the 340B Drug Pricing Program. The Supreme Court recently agreed to hear a case brought by the AAMC and other hospital associations that challenges these cuts [refer to Washington Highlights, July 9].

Inpatient Only (IPO) List: The proposed rule would halt the elimination of the IPO list and reinstate 298 services that were removed from the IPO list in CY 2021. The AAMC advocated not to eliminate the IPO list [refer to Washington Highlights, Oct. 9, 2020].  

ASC Covered Procedures List (CPL): The CMS is proposing to reinstate patient safety criteria for adding a procedure to the ASC CPL that were in place in CY 2020 and prior. Under the proposal, 258 of the 267 procedures that were added to the ASC CPL in CY 2021 would be removed.

Quality Proposals

Outpatient Quality Reporting Program: The CMS proposes to add additional reporting requirements including a measure on COVID-19 vaccination coverage among health care personnel.

Inpatient Quality Reporting (IQR) Program: The proposed rule seeks comment on whether to maintain previously finalized policy requiring hospitals to report the Safe Use of Opioids electronic clinical quality measure (eCQM) beginning with CY 2022 reporting or instead to propose in the future to allow hospitals to self-select the measure to report from the set of available eCQMs to meet eCQM reporting requirements.

Comment Solicitation

Health Equity: The CMS seeks input on ways to make reporting of health disparities based on social risk factors and race and ethnicity more comprehensive and actionable.

Temporary Policies for the COVID-19 Public Health Emergency: The proposed rule seeks feedback on whether certain flexibilities put in place during the COVID-19 public health emergency should be made permanent including the use of telehealth for mental health services, direct supervision for certain rehabilitation services, and payment for COVID-19 specimen collection.

More information on the proposed rule can be found in the CMS fact sheet. The proposed rule is scheduled to be published in the Federal Register on Aug. 4, 2021.  

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