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CMS CY 2022 OPPS Proposed Rule

CMS CY 2022 OPPS Proposed Rule

July 20, 2021, the Centers for Medicare and Medicaid Services released the CY 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule. Key provisions of the proposal include the following:

  • Proposal to use CY 2019 claims data to set the CY 2022 OPPS and ASC payment rates due to the CY 2020 impact of the Covid-19 Public Health Emergency.
  • Using the hospital market basket methodology, for CY 2022, CMS proposes to increase payment rates under the ASC payment system by 2.3 percent for ASCs that meet the quality reporting requirements under the ASCQR Program. (This proposed increase is based on a hospital market basket percentage increase of 2.5 percent reduced by a proposed productivity adjustment of 0.2 percentage point.)
  • Proposal to re-adopt the ASC Covered Procedures List (CPL) criteria that were in effect in CY 2020 and to remove 258 of the 267 procedures that were added to the ASC CPL in CY 2021.
  • Changes to the Inpatient Only (IPO) List: CMS proposes to halt the elimination of the IPO list and, after clinical review of the services removed from the IPO list in CY 2021 propose to add the 298 services removed from the IPO list in CY 2021 back to the IPO list beginning in CY 2022. CMS is also proposing to codify in regulation the five longstanding criteria used to determine whether a procedure or service should be removed from the IPO list.
  • Device Pass-Through Payment Applications: Of the eight applications received for device passthrough payments, one of the applications (the Shockwave C2 Coronary Intravascular Lithotripsy (IVL) catheter) received preliminary approval for passthrough payment status through CMS quarterly review process. Comment is being sought on all eight applications.
  • ASCQR Program Proposal: CMS proposes changes for the CY 2024, CY 2025, and CY 2026 payment determinations and subsequent years. Proposed Measures include:
    • Adopt the COVID-19 Vaccination Coverage Among HCP measure beginning with the CY 2024 payment determination;
    • Resume data collection for four measures beginning with the CY 2025 payment determination: (a) ASC-1: Patient Burn; (b) ASC-2: Patient Fall; (c) ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; and (d) ASC-4: All-Cause Hospital Transfer/Admission;
    • Require the ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery measure beginning with the CY 2025 payment determination; and
    • Require the ASC-15a-e: OAS CAHPS Survey-based measures with voluntary reporting beginning with the CY 2023 reporting period and mandatory reporting beginning with the CY 2024 reporting period/CY 2026 payment determination. In addition, CMS is proposing data submission requirements for the OAS CAHPS Survey-based measures and the COVID-19 Vaccination Coverage Among HCP measure.
  • Hospital Price Transparency increase penalties for noncompliance.

CMS is actively seeking comment on the CY 2022 Proposed Rule with final ruling expected in the fall of 2021.

Read the full document here: https://public-inspection.federalregister.gov/2021-15496.pdf

This post was published July 20, 2021.

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