November 3, 2021
  • The CMS released three final rules pertaining to provider payments:
    • The annual Outpatient Prospective Payment System rule increases payment rates for hospital-owned outpatient and ambulatory surgery centers by 2 percent each and finalizes steeper penalties for certain hospitals that are not in compliance with the hospital price transparency requirements. The agency will set a minimum civil monetary penalty of $300 per day for hospitals with 30 or fewer beds. Hospitals with more than 30 beds will be charged $10 per bed per day, which will cap at $5,500 daily. The final rule also extends cuts to the 340B drug discount program. The American Hospital Association voiced concerns over the increased penalties and slammed the agency’s decision to extend 340B cuts. (Press release here; Fact sheet here; Articles here and here)
    • The Home Health Prospective Payment System Rate Update increases reimbursement rates by 2.6 percent and expands the Home Health Value-Based Purchasing Model. The initial pilot program showed an average 4.6 percent improvement in participating agencies’ quality scores over a three-year period and an average annual savings of $141 million, regulators said. Starting in 2025, the agency will adjust fee-for-service payments to Medicare-certified home health agencies based on the quality of care provided to beneficiaries during the 2023 calendar year. The home health final rule will boost data collection efforts to address health disparities and access issues for the underserved. (Fact sheet here)
    • The Physician Fee Schedule final rule reduces Medicare payments to physicians by nearly 9 percent next year; it also promotes greater use of telehealth and encourages growth in the Medicare Diabetes Prevention Program (MDDP). The rule eliminates geographic restrictions by allowing audio-only sessions for mental and behavioral health services and stipulates that Medicare will pay for therapy visits provided by rural health clinics and federally qualified health centers. To increase MDDP suppliers, the CMS is waiving the Medicare enrollment fee for all organizations that apply to enroll as an MDPP supplier, shortening the MDPP services period to one year instead of two years, and restructuring payments so MDPP suppliers receive larger payments for participants who reach milestones for attendance. The final rule also boosts payment rates for several vaccines and increases access to nutrition therapy. (Press release here; Fact sheets here and here)