July 21, 2021
CMS issues CY2022 medicare hospital outpatient and ASC payment rule
Increases hospital transparency non-compliance penalties, continues Trump-era 340B cuts, reverses changes to inpatient-only list and retains radiation oncology demo
On July 20, the Centers for Medicare & Medicaid Services (CMS) issued their Calendar Year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. According to a CMS Fact Sheet, this year’s rule “includes proposals that align with several key goals of the Administration, including addressing the health equity gap, fighting the COVID-19 Public Health Emergency (PHE), encouraging transparency in the health system, and promoting safe, effective, and patient-centered care.”
Among the proposals is a provision to increase the fines waged against hospitals that fail to comply with the Trump-era Hospital Price Transparency rule, which requires hospitals to post a comprehensive, machine-readable file of all items and services, along with standard and payer-negotiated prices. In an effort to reduce high rates of noncompliance, CMS proposes to set a minimum fine of $300 a day for hospitals with 30 or fewer beds and $10 per bed per day for larger hospitals, with a cap at $5,500 per day. Previously, the penalty was capped at $300 a day across all hospitals. Following release of the rule, Health and Human Services (HHS) Secretary Xavier Becerra said: “As President Biden made clear in his executive order promoting competition, a key to price fairness is price transparency… with today’s proposed rule, we are simply showing hospitals through stiffer penalties: concealing the costs of services and procedures will not be tolerated by this Administration.”
Biden’s CMS also retained Trump-era cuts to reimbursement for 340B drugs and is moving forward with their Radiation Oncology (RO) model, with various refinements. Other Trump-era proposals, however, were walked back. This includes a reversal of the Trump administration’s plan to phase out the inpatient-only procedures list, as well as the former administration’s move to allow ambulatory surgery centers (ASCs) to perform more procedures.
The rule also included a focus on advancing health equity and digital quality measurement, similar to other recent payment rules. CMS Administrator Chiquita Brooks-LaSure said, “CMS is committed to addressing significant and persistent inequities in health outcomes in the United States and today’s proposed rule helps us achieve that by improving data collection to better measure and analyze disparities across programs and policies.”
Additional information is available in the attached Tax Alert.
CY2022 Medicare Hospital Outpatient and ASC Payment Rule