CMS Releases Proposed OPPS Rule

The Centers for Medicare and Medicaid Services (CMS) has released the FY 2023 proposed Outpatient Prospective Payment (OPPS) Rule. The outpatient rule indicates a 2.7% payment update for hospitals based on a projected increase in the hospital market basket of 3.1%, reduced by 0.4% for the productivity adjustment.

Additional highlights include:

  • A request for information about enhancing transparency and competition in the health care system.

  • Proposal to use cost report data from the June 2020 Healthcare Cost Report Information System (HCRIS), which consists of cost report data through CY 2019, predating the COVID-19 pandemic and Public Health Emergency. This is the same cost report extract used to set OPPS rates for CY 2022.

  • Removal of 10 services from the inpatient only (IPO) list, addition of eight services to the IPO, and addition of one service to the ambulatory surgical center (ASC) covered procedures list (CPL). None of these services are cardiology related.

  • Regulations to create and pay for Rural Emergency Hospitals (REHs), a new provider type established by the 2021 Consolidated Appropriations Act.

  • A request for information on software as a service (SaaS), seeking comments on the specific payment approach that may be deployed for these services under the OPPS as SaaS-type technology becomes more widespread.

  • Payment adjustments to incentivize purchase of fully domestically produced N95 masks.

  • Consideration of eight new devices pass-through payments applications, including the MicroTransponder® ViviStim® Paired Vagus Nerve Stimulation System (ViviStim System®).

  • Proposing separate payment in the ASC setting for four non-opioid pain management drugs as surgical supplies to ensure there are no financial disincentives to using non-opioid options.

  • Proposal to address financial barriers to organ donation after cardiac death.

  • Request for comments on changes to the Hospital Outpatient/ASC/REH Quality Reporting Programs.

For more information you can find the press release here; the general fact sheet here; and the Rural Emergency Hospital-specific fact sheet here. ACC staff are reviewing the rule to identify any additional topics of interest and will submit comments to CMS with input from relevant committees/councils and other societies by the Sept. 13 public comment period deadline.

Keywords: Software, Technology, Cardiology, Death, Tissue and Organ Procurement, Health Care Costs, Information Systems, Delivery of Health Care, Vagus Nerve Stimulation, Public Health, Pandemics, Pain Management, Outpatients, N95 Respirators, Motivation, Inpatients, COVID-19, Medicare, Centers for Medicare and Medicaid Services, U.S., ACC Advocacy


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