CMS releases final OPPS rule for 2017: 11 things to know

CMS released its final 2017 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule on Tuesday, which implements site-neutral payment provisions of the Bipartisan Budget Act of 2015.

 Here are 11 things to know about the 2017 final rule.

Site-neutral payment provisions
1. CMS is implementing Section 603 of the Bipartisan Budget Act of 2015. Under this section, certain off-campus provider-based departments that began billing under the OPPS on or after Nov. 2, 2015, will no longer be paid for most services under the OPPS. Instead, beginning Jan. 1, 2017, these facilities will be paid under the physician fee schedule. However, services provided in a dedicated emergency department will continue to be paid under the OPPS.

2. Under the final rule, CMS put certain restrictions on off-campus PBDs that began billing under the OPPS prior to Nov. 2, 2015. The agency finalized a proposal requiring these departments to provide services and bill from the same physical address as they did Nov. 2, 2015, to be exempt from the site-neutral payment provisions. Exceptions will be made for off-campus PBDs forced to temporarily or permanently relocate due to extraordinary circumstances, such as a natural disaster, according to CMS.

3. In July, CMS proposed requiring off-campus PBDs to offer the same services as they did on Nov. 2, 2015, to be excluded from the site-neutral payment provisions. However, CMS chose not to finalize this proposal. "CMS will monitor expansion of clinical service lines by off-campus PBDs and continue to consider whether a potential limitation on service line expansion should be adopted in the future," the agency said.

4. CMS said it is still finalizing certain proposals. For instance, the agency is still working on a proposal that would allow off-campus PBDs to maintain excepted status if the hospital is sold and the new owner accepts the existing Medicare provider agreement.

5. The American Hospital Association is pleased with some of the changes CMS made."We appreciate the modifications CMS made to its proposal to allow existing hospital clinics to expand their services to meet the changing needs of their patients and communities without being penalized," said Tom Nickels, executive vice president of government relations and public policy at the AHA. "However, we are alarmed that CMS continues to ignore the need for hospitals to modernize existing facilities so that they can provide the most up-to-date, high-quality services to their patients. We continue to be concerned that such 'site-neutral' policies and CMS's implementation of them could impede patients' access to care, especially in the most vulnerable communities. We are evaluating the details of the final rule and will provide further comment to CMS."

Payment update
6. CMS will increase OPPS rates by 1.65 percent in 2017. CMS arrived at the rate increase through the following updates: a positive 2.7 percent market basket update, a negative 0.3 percent update for a productivity adjustment and a negative 0.75 percent update for cuts under the ACA.

7. After considering all other policy changes included in the final rule, CMS estimates OPPS payments will increase by 1.7 percent in 2017.

EHR Incentive Program
8. To offer greater flexibility in the meaningful use of EHRs, CMS has finalized a 90-day EHR reporting period in 2016 and 2017 for all eligible professionals and hospitals. The reporting period will be any continuous 90-day period between Jan. 1 and Dec. 31 in 2016 and 2017. 

9. CMS said it is not feasible for physicians and hospitals that have not demonstrated meaningful use in a prior year to attest to the stage 3 objectives and measures in 2017. CMS is finalizing proposals that would allow these new participants to attest to modified stage 2 objectives and measures. 

Hospital Outpatient Quality Reporting Program
10. For 2017, CMS is adding seven measures to the Hospital Outpatient Quality Reporting Program for the 2020 payment determination and subsequent years.

Comment period
11. CMS will accept comments on the OPPS final rule through Dec. 31.

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