CMS Releases Proposed 2022 OPPS Rule

The proposed 2022 Hospital Outpatient Prospective Payment System (OPPS) rule released by the Centers for Medicare and Medicaid Services (CMS) on July 19 indicates a 2.3% payment update for hospitals and other proposals.

Highlights from the OPPS rule include: 

  • Comment solicitation on temporary policies for the COVID-19 public health emergency (PHE) to include: mental health services, practice patterns that rely on communication technology, direct supervision requirement for cardiac rehabilitation/intensive cardiac rehabilitation to include virtual presence through audio/video real-time communications technology, and HCPCS code C9803 (Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2, any specimen source)
  • Proposed use of calendar year (CY) 2019 claims data for CY 2022 OPPS and Ambulatory Surgery Center (ASC) Payment System rate setting due to the PHE.
  • A proposal to halt the elimination of the Inpatient Only (IPO) List for CY 2022, based on overwhelming stakeholder feedback during the 2021 rulemaking cycle. CMS plans to add the 298 services removed from the IPO list last year. Additionally, CMS proposes to codify the long-standing criteria for removal of procedures from the IPO list.
  • A proposal to reinstate the ASC Covered Procedures List (ASC CPL) criteria and plans to remove the ASC CPL 258 of the 267 procedures, which were added in CY 2021. Part of this plan also includes a proposal to adopt a nomination process, during which an external party could nominate a surgical procedure to be added to the ASC CPL in the next applicable rulemaking cycle.
  • Comment solicitation on future plans to modernize the digital quality measurement (DQM) enterprise. 
  • Several proposed modifications to the Hospital Price Transparency final rule, which took effect Jan. 1. Changes include an increase in civil monetary penalties, standardization of machine-readable files and clarifications on the online price estimator tool.
  • A proposal that would allow nonopioid pain management drugs or biologicals that function as a surgical supply in the ASC setting to be eligible for separate payment when approved by the Food and Drug Administration (FDA) and indicated for pain management or as an analgesic.
  • Proposed multiple device pass-through payments, including preliminary approval of the Shockwave C2 Coronary Intravascular Lithotripsy (IVL) catheter application.
  • Proposed changes to the Hospital Outpatient Quality Reporting (OQR) and ASC QR Programs to further meaningful measurement and reporting of health disparities based on social risk factors, race, ethnicity and more.
  • Finally, comment solicitation via the Rural Emergency Hospital (REH) Provider Type Request for Information (RFI). This RFI addresses health and safety standards, payment policies and quality measures for REHs. 

ACC staff are reviewing the proposed rule to identify additional topics of interest to members and will submit written comments at the end of the summer. More information will be forthcoming in the Advocate newsletter and on in the coming weeks. For a detailed CMS fact sheet, click here. The proposed 2022 Medicare Physician Fee Schedule was also released earlier this month. A detailed overview of that proposed rule can be found here.

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub

Keywords: Centers for Medicare and Medicaid Services, U.S., Healthcare Common Procedure Coding System, SARS-CoV-2, Medicare, Outpatients, Pain Management, Inpatients, United States Food and Drug Administration, Public Health, Cardiac Rehabilitation, Ethnic Groups, Biological Products, Quality Indicators, Health Care, Ambulatory Surgical Procedures, COVID-19, Outpatient Clinics, Hospital, Prospective Payment System, Fee Schedules, Hospitals, Mental Health Services, Physicians, Policy, Lithotripsy, Specimen Handling, Communication, Risk Factors, Technology, Catheters, Pharmaceutical Preparations, ACC Advocacy

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