Association Comments on CY 2022 OPPS Proposed Rule

In a letter to the Centers for Medicare & Medicaid Services (CMS), America’s Essential Hospitals commented on the calendar year (CY) 2022 Outpatient Prospective Payment System (OPPS) proposed rule.

The rule would continue cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments (PBDs); pause the elimination of the inpatient-only (IPO) list; and increase penalties for failing to report standard charges. The policies in the rule, if finalized, would start Jan. 1, 2022.

In comments to CMS, the association urged the agency to:

• pay hospitals in the 340B program the statutory default payment of average sales price (ASP) plus 6 percent, as the current policy of paying 340B hospitals at 77.5 percent of ASP has irreparably harmed low-income patients and the hospitals committed to treating them;
• withdraw its proposal to continue reduced payments for clinic visits at excepted off-campus PBDs, as doing so reduces underserved patients’ access to lifesaving services;
• implement Section 603 of the Bipartisan Budget Act consistent with the legislative text by allowing PBDs to relocate and change ownership to minimize the adverse effect on patient access;
• account for unique health and social challenges of communities served by essential hospitals, and preserve adequate reimbursement rates for essential hospitals’ excepted and non-excepted PBDs;
• halt elimination of the IPO list, add back the services removed in 2021, and further engage stakeholders in the development of a strategy for future removal of procedures from the IPO list;
• further refine the penalty formula for noncompliance with the hospital price transparency requirements and delay implementation of increased penalties;
• incentivize use of non-opioid alternatives by paying for them separately;
• provide clear definitions and measure specifications before requiring reporting of the COVID-19 vaccination among health care personnel (HCP) measure; and
• streamline vaccination-related reporting by hospitals and seek National Quality Forum endorsement of the HCP measure.

Further, the administration requested comments on health equity, specifically related to data collection and measure reporting. The association urged CMS to further examine ways to address health equity in the Hospital Outpatient Quality Reporting Program, including stratifying measure performance by social risk factors beyond dual eligibility, refraining from the public reporting of results that use indirect estimation for race and ethnicity, and supporting existing best practices demographic data collection.