The Centers for Medicare & Medicaid Services has released Outpatient Prospective Payment System and Physician Fee Schedule proposed rules for calendar year 2019 that would expand site-neutral payment policies and continue Medicare Part B drug payment cuts to 304B hospitals.

A new proposed rule for Medicare’s Outpatient Prospective Payment System would broaden the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments; it also contains provisions related to quality reporting and transparency.

The report provides updates on the Hospital Readmissions Reduction Program, off-campus emergency department access, the physician fee schedule, population-based quality measures and incentives, and Medicare accountable care organizations, among other topics.

The plan cites and builds on proposed changes to the 340B Drug Pricing Program in the president’s fiscal year 2019 budget, as well as damaging cuts implemented through the calendar year 2018 Outpatient Prospective Payment System final rule.

On May 4, America’s Essential Hospitals and fellow plaintiffs will make oral arguments in a legal battle to reverse damaging Medicare cuts to hospitals in the 340B Drug Pricing Program; The public can watch via livestream.

The Centers for Medicare & Medicaid Services offers details on how Medicare Advantage plans might be affected by reimbursement reductions in the calendar year 2018 Outpatient Prospective Payment System final rule.

The Centers for Medicare & Medicaid Services will audit mid-build certifications this year and should complete all audits by December 2018.

Tax reform legislation heads to a House-Senate conference committee. Meanwhile, a bill to delay Medicaid disproportionate share hospital payment cuts could be included in year-end legislation.

America's Essential Hospitals urges all association members to call their House delegations today and urge them to cosponsor H.R. 4392, a bill that would halt enforcement of a damaging new Medicare policy that cuts Part B payments for 340B drugs by 27 percent.

America’s Essential Hospitals is closely reviewing the final rules and pursuing strategies to protect our members from these devastating cuts. Key aspects of the recently released final rules are summarized in this Action Update.

The rule cuts 340B Drug Pricing Program payments by $1.6 billion and requires hospitals to use modifiers to identify 340B drugs in Medicare claims.

The harmful payment reduction was included in the 2018 Outpatient Prospective Payment System proposed rule, expected to be finalized this fall.

Unless another delay is secured, Medicaid disproportionate share hospital payments will be cut by $2 billion beginning in fiscal year 2018, escalating to $8 billion by 2024.

The meeting came a day after the association submitted comments to the agency in response to the proposed annual update of the Hospital Outpatient Prospective Payment System.

The proposed rule would further cut payments to non-excepted provider-based departments to 25 percent of the Medicare Outpatient Prospective Payment System rate and change certain quality reporting requirements.

By cutting reimbursement rates for Part B drugs to 340B hospitals, the Centers for Medicare & Medicaid Services would harm essential hospitals, which care for the nation’s poorest, most complex, and costliest patients.

The Medicare Physician Fee Schedule proposed rule for calendar year 2018 includes physician payment and quality program changes.

The proposed rule would increase outpatient payment rates by 1.75 percent and drastically reduce Medicare Part B reimbursement for drugs purchased through the 340B Drug Pricing Program.

Essential hospitals can expect the new Congress' Republican leaders to follow through quickly with their pledge to repeal the Affordable Care Act.

A CMS spokesperson said the project was pulled after the agency reviewed public comments — there were more than 1,300 comments submitted, mostly negative.

The legislation, expected to quickly receive the president's signature, includes two key advocacy goals for the association: risk adjustment of the Hospital Readmissions Reduction Program and partial relief from hospital outpatient department payment cuts.

Congress is poised to pass legislation that would include socioeconomic risk adjustment for the Hospital Readmissions Reduction Program and some relief from payment cuts for new hospital outpatient departments.

Under the rule, CMS would increase the OPPS payment rate by 1.65 percent and provide flexibility in the meaningful use of EHRs, among other things.

CMS provides more flexibility than previously proposed, ensuring non-grandfathered, off-campus hospital outpatient departments will be reimbursed in 2017.

In the rule, CMS revised its earlier position not to direct any physician fee schedule payments to non-grandfathered, off-campus hospital clinics in 2017 and, instead, established a 50 percent interim rate.

The proposed rule updates the payment rate for services provided in hospital outpatient departments and provisions relating to quality reporting.

The proposed rule would implement Section 603 of the Bipartisan Budget Act, which reduced payments for new, off-campus hospital outpatient departments.

America's Essential Hospitals denounces the Centers for Medicare & Medicaid Services decision to limit flexibility and withhold hospital payments for new, off-campus hospital outpatient departments.

A 2015 budget law that creates site-neutral payment for off-campus hospital outpatient departments does not directly affect 340B Drug Pricing Program eligibility, but changes to how hospitals report Medicare costs does raise concerns.

In letter to CMS, association raises issues of payment, definition of off-campus outpatient department of a provider, and 340B eligibility.

Changes include reducing OPPS payment by 0.3 percent, relaxing two-midnight policy requirements, and updating OQR measures.

In comments on the CY 2016 OPPS proposed rule, the association calls on CMS to consider the unique challenges of caring for the most vulnerable, including in relation to the two-midnight policy and ambulatory payment classification.

RACs will not conduct postpayment reviews of patient status for Medicare claims with an inpatient admission between Oct. 1 and Dec. 31, 2015.

Agency proposes to reduce slightly payment rates for hospital outpatient services, relax some provisions of the two-midnight policy, and update quality reporting measures.

In a new policy brief, America's Essential Hospitals describes how billions of dollars in reductions to Medicaid and Medicare funding threaten care at essential hospitals.

Topics of member interest include payment updates, the OQR Program, and the MSSP.

The rules, released Oct. 31, finalized a number of provisions regarding payments, data collection in outpatient departments, quality programs, and the MSSP.

The association urged CMS to revise its C-APC proposal and opposed its proposal to add a claims-based modifier for every outpatient service provided in off-campus provider-based departments.

The agency proposes to increase payment rates by an outpatient department fee schedule increase factor of 2.1 percent for CY 2015. CMS also proposes to collect data on services provided in off-campus provider-based departments by requiring hospitals and physicians to identify these services using a modifier on hospital and physician claims.

CMS released the rule July 3. The agency proposes to increase payment rates by an outpatient department fee schedule increase factor of 2.1 percent for CY 2015. In addition, CMS proposes to collect data on services provided in off-campus provider-based departments by requiring hospitals and physicians to identify these services using a modifier on hospital and physician claims.

The measure, OP-31/ASC-11, is part of the ASC Quality Reporting Program and the OQR Program. Data collection, which was scheduled to begin April 1, will now begin Jan. 1, 2015. America's Essential Hospitals successfully encouraged CMS to delay the measure, arguing the measure was not properly tested for the ASC and outpatient settings.

Voted unanimously to recommend Congress increase Medicare payments rates for FY 2015 OPPS

The rule replaces outpatient visit codes with a single code describing all clinic visits

On November 27, the Centers for Medicare & Medicaid Services (CMS) issued the Outpatient Prospective Payment System (OPPS) final rule for calendar year (CY) 2014. Included in the rule are provisions related to the following: payment for hospital outpatient visits data collection in off-campus, provider-based departments Hospital Outpatient Quality Reporting (OQR) Program Hospital Value-Based Purchasing

Rule finalizes several Outpatient Prospective Payment System provisions

OPPS is used by CMS for hospital outpatient services under Medicare

The final rule was delayed due to the partial government shutdown

Suggests CMS convene hospital industry work group to better understand off-campus outpatient care

Rule proposes several outpatient prospective payment system provisions

Agency seeks to understand type and frequency of, and payment for, services furnished in off-campus outpatient departments

Commissioners vote unanimously to recommend 1 percent increases for fiscal year 2014