CMS Releases Hospital OPPS CY 2021 Proposed Rule

August 5, 2020
Rick Gawenda

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2021 proposed rule titled “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; and Physician-owned Hospitals.

Highlights of the proposed rule include:

  • CMS is proposing to eliminate the Inpatient Only (IPO) list over a three-year transitional period with the list completely phased out by CY 2024
  • CMS is proposing to expand the number of procedures that Medicare would pay for when performed in an Ambulatory Surgical Center (ASC), including a total hip arthroplasty
  • CMS is proposing to establish, update, and simplify the methodology that would be used to calculate the Overall Hospital Quality Star Rating
  • CMS is proposing to include critical access hospitals (CAHs) in the Overall Star Rating as well as Veterans Health Administration (VHA) hospitals
  • CMS proposes to update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.6 percent
  • CMS is proposing to update the ASC rates for CY 2021 by 2.6 percent

To access the proposed rule, click HERE. To access the CMS Fact Sheet on the proposed rule, click HERE.

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