CMS Issues Two Final Rules concerning Medicare Payments

The Centers for Medicare & Medicaid Services (CMS) finalized two Medicare payment rules that increase access to care, putting patients first and ensuring that payments support access to high-quality, affordable care. The Hospital Outpatient rule, in particular, takes steps to preserve access in rural communities.

In the Hospital Outpatient Prospective Payment System (OPPS) final rule, CMS is helping to lower the cost of prescription drugs for seniors and other Medicare beneficiaries by reducing the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B Program. The savings from this change will be reallocated equally to all hospitals paid under the OPPS. CMS will continue to work with Congress to provide the HHS with additional 340B programmatic flexibility, which could include tools to provide additional considerations for safety net hospitals. These hospitals play a critical role in serving the most vulnerable populations.

The OPPS final rule also provides relief to rural hospitals and rural clinicians. A provision would alleviate some of the burdens rural hospitals face by placing a two-year moratorium on the direct-physician supervision requirements for rural hospitals and critical access hospitals.

And, this final rule has policies that would make OPPS payment available when Medicare beneficiaries receive certain procedures in a lower-cost setting of care (ie, the outpatient department), where those procedures can be safely performed in that setting. The new availability of OPPS payment applies to six procedures, included total knee replacements—the most common, and costly, Medicare surgical procedure. Beginning January 2018, Medicare beneficiaries who undergo any of these procedures can opt to have them performed in a lower-cost setting of care, where a clinician believes such a setting is appropriate.

In the Home Health Prospective Payment System final rule, CMS is not finalizing the Home Health Groupings Model and will take additional time to further engage with stakeholders to move toward a system that shifts the focus from volume of services to a more patient-centered model. CMS will take into further consideration the comments that were submitted on the proposed rules regarding patients’ needs that strikes the right balance in putting patients first.

For a fact sheet on the OPPS final rule with comment period, click here.  The OPPS final rule with comment period (CMS-1678-FC) can be downloaded from the Federal Register by clicking here.

For a fact sheet on the Home Health final rule, click here. The Home Health Prospective Payment System final rule (CMS-1672-F) can be downloaded from the Federal Register by clicking here.

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