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CMS releases OPPS/ASC proposed rule for CY2022 summary

In its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule for CY 2022 the Centers for Medicare & Medicaid Services (CMS) proposes to:

  • Increase OPPS payments by 2.3% subject to the statutory 2.0 percentage point reduction for hospitals that fail to meet the hospital outpatient quality reporting requirements.
  • Increase ASC payments by 2.3% for ASCs that meet Ambulatory Surgical Center Quality Reporting Program requirements.
  • Add 298 services that were removed from the Inpatient Only (IPO) list in calendar year (CY)2021 back to the IPO list beginning in CY2022. This would restore these medically complex services to the list that must be performed in the inpatient setting to receive Medicare reimbursement. 
  • Rescind the policy that would have allowed 258 very complicated procedures to be provided in ASCs. 
  • Continuing to pay certain 340B hospitals at the rate of Average Sales Price (ASP) minus 22.5% for most separately payable drugs and biologicals acquired under the 340B program, which is the subject of a pending U.S. Supreme Court case brought by the American Hospital Association.
  • Implement the following penalties for noncompliance with price transparency requirements, all of which constitute a significant increase from previous penalties except for the penalties applicable to hospitals with 30 or fewer beds.
    • For a noncompliant hospital with 30 or fewer beds, the maximum daily penalty would be $300, with a maximum annual penalty of $109,500 per hospital.
    • For a noncompliant hospital with 31 to 550 beds, the maximum daily penalty would be the number of beds times $10 with a maximum of $5,500 per day, with annual penalties ranging from $113,150 - $2,007,500 per hospital.
    • For a noncompliant hospital with more than 550 beds, the daily penalty would be $5,500, for a total maximum annual penalty of $2,007,500 per hospital.

Additionally, CMS is seeking public comment via a Request for Information (RFI) on establishing the new rural emergency hospital (REH) provider type pursuant to the Consolidated Appropriations Act of 2021.  The RFI solicits comments on health and safety standards, payment policies, enrollment processes, quality measures and reporting requirements that should apply to REHs.

Comments on the proposed rule are due September 17, 2021. Contact AzHHA’s Director of Policy, Liz Lorenz, with any questions.