On Nov. 1, CMS issued a final rule for the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.

In accordance with Medicare law, CMS is updating OPPS rates for hospitals that meet applicable quality reporting requirements by 2.6 percent. This update is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment for Multi-Factor Productivity (MFP).

Using the hospital market basket, CMS is finalizing an update to the ASC rates for CY 2020 equal to 2.6 percent. The update applies to ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment for MFP. This change will also help to promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower-cost ASC setting.

The final rule with comment period includes:

• increasing choices and encouraging site neutrality
• method to control for unnecessary increases in utilization of outpatient services
• changes to the inpatient-only list
• ASC-covered procedures list
• payment for procedures involving skin substitutes
• rethinking rural health
• changes in the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals
• addressing wage index disparities
• unleashing innovation
• device pass-through applications
• protecting taxpayer dollars
• Meaningful Measures/Patients Over Paperwork
• Hospital Outpatient Quality Reporting Program
• Ambulatory Surgical Center Quality Reporting Program
• OPPS payment methodology for 340B purchased drugs
• Partial Hospitalization Program (PHP) rate setting
• Update to PHP per diem rates
• Revision to the organ procurement organization conditions for certification

Read the Final rule here.

Read the CMS Fact Sheet on the Final Rule here.