On 2nd Dec 2020, the Centers for Medicare & Medicaid Services released the calendar year 2021 outpatient prospective payment system/ambulatory surgical center (OPPS/ASC) final rule. Earlier on August 4, 2020, CMS proposed policies which will increase patient choice by making Medicare payment available for more services in different sites of service and adopting policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.
This final rule will reduce provider burden so that hospitals and ambulatory surgical centers can operate with increased flexibility, and patients are better equipped to be active healthcare consumers.
CMS proposed changes to update and refine requirements for the Ambulatory Surgical Center Quality Reporting (ASCQR) Programs to further meaningful measurement and reporting for quality of care in the outpatient surgical setting while limiting burden. CMS proposed to revise and codify previously finalized administrative procedures and to propose and codify an expanded review and corrections process to further align the ASCQR Programs while clarifying program requirements.
CMS proposed to maintain the unified rate structure established in CY 2017, with a single PHP Ambulatory Payment Classification (APC) for each provider type for days with three or more services per day. CMS proposed to use the CMHC and hospital-based PHP (HB PHP) geometric mean per diem costs, consistent with existing policy, using updated data for each provider type and a cost floor equal to the CY 2019 final geometric mean per diem cost for each provider type. Accordingly, CMS proposed to calculate the CY 2021 PHP APC per diem rate for HB PHPs based on updated cost data and to calculate the rate for CMHCs based on the proposed cost floor.
In the CY 2019 OPPS/ASC final rule with comment period, CMS finalized a proposal to apply the hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023). Using the hospital market basket, CMS is proposed to update the ASC rates for CY 2021 by 2.6 percent.
The proposed update applies to ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3 percent minus a 0.4 percentage point adjustment for MFP. This proposed change would 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.
Final Rule: DEPARTMENT OF HEALTH AND HUMAN SERVICES
Proposed Rule: CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS-1736-P)