CMS Issues CY 2012 Outpatient Prospective Payment System Proposed Rule

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The Centers for Medicare and Medicaid Services recently issued a proposed rule to update the Outpatient Prospective Payment System for calendar year 2012, according to a CMS news release.

The proposed rule, which would go into effect Jan. 1, 2012, seeks to strengthen the Value-Based Purchasing Program and the Hospital Outpatient Quality Reporting Program, change the Medicare Electronic Health Record Incentive Program and implement certain Affordable Care Act provisions.

CMS estimate total payments to hospitals under CY 2012 OPPS will be approximately $41.9 billion. It also estimates an outpatient department fee schedule increase factor, or market basket update, of 1.5 percent for CY 2012.

Some of the proposed changes to the OPPS for CY 2012 include the following:

- Increase cancer hospitals' payments by approximately 9 percent as part of the required payment adjustments.

- Pay for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals except for those that have pass-through status at the manufacturers' average sales price plus 4 percent.

- Pay for partial hospitalization services in hospital-based programs and freestanding community mental health centers through two payment tiers — Level I for days with three services and Level II for days with four or more services.

-  Refer questions about supervision of specific therapeutic outpatient services to the Ambulatory Payment Classification Panel, which would include representatives of critical access hospitals for this purpose.

- Reduce the number of hospitals randomly selected for validation of hospital reporting of chart-abstracted measures from 800 to 450, but establish criteria for selecting up to 50 additional hospitals for targeted validation of their reporting.

CMS has also proposed to add a clinical process of care measure for FY 2014 Hospital Value-Based Purchasing program: Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2.

CMS will accept comments on the proposed rule until Aug. 30, 2011, and will issue a final rule by Nov. 1, 2011.

Read the CMS release on its proposed rule for the CY 2012 Outpatient Prospective Payment System.

Related Articles on CMS Proposed Rules:

CMS Issues Physician Fee Schedule Proposed Rule

CMS Proposes Rescinding Signature Policy on Lab Requisitions

AHA Wants CMS to Reduce Coding Offset for 2012 IPPS


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