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CMS Releases 2010 Medicare OPPS Final Rule

November 13, 2009—The Centers for Medicare and Medicaid Services (CMS) Oct. 30 released the calendar year (CY) 2010 Medicare outpatient prospective payment system (OPPS) final rule on the CMS website. The final rule includes a 2.1 percent inflation update in base payments for hospital outpatient services. The changes will take effect Jan. 1, 2010.

In response to comments and meetings with the AAMC and others, in the final rule CMS makes changes in the requirements for physician supervision of hospital therapeutic services that are less restrictive than what was proposed. CMS now defines "direct supervision" to mean that the supervising physician or non-physician practitioner providing hospital outpatient therapeutic services can be present anywhere on the same campus of the hospital, as long as he or she is immediately available to furnish assistance and direction throughout the performance of the procedure. While CMS does not define "immediately available," the preamble states that this would not include, "for example, performing another procedure or service that" could not be interrupted.

CMS finalizes its proposal not to include any additional measures in the current Hospital Outpatient Quality Data Reporting Program (HOP QDRP). Hospitals will continue to submit data (where applicable) on the current eleven required measures. CMS will proceed with its plans to report publicly the Outpatient Measures on Hospital Compare in 2010. The agency also will implement a new validation process designed for the chart-abstracted measures for CY 2011. The results of the new process will not affect the CY 2011 payment determination.

CMS will not expand the current Hospital Acquired Conditions (HAC) program to the OPPS at this time. The agency will utilize the results from the impact study on the inpatient program before making any determinations about its expansion to the outpatient setting.

CMS finalizes its proposal to continue to pay for separately payable drugs and biologicals at the current rate. Specifically, payment for the acquisition and overhead cost of these products will be equal to the average sales price (ASP) plus 4.0 percent, a rate that is 2.0 percentage points lower than the payment received when these drugs are furnished in physicians' offices, currently ASP plus 6.0 percent. According to CMS, the ASP plus 4.0 percent rate is based on a new methodology; if it had not applied the new methodology, separately payable drugs and biologicals would be reimbursed at ASP minus 3.0 percent.

The final rule will be published in the Federal Register Nov. 20.


Jennifer Faerberg, MHSA
Director, Clinical Transformation Unit
Telephone: 202-862-6221

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