CMS Issues Proposed Rule for Hospital Outpatient and ASC Payments

Editor's Note

The Centers for Medicare & Medicaid Services on July 1 issued a proposed rule for CY 2016 for the hospital outpatient prospective payment (OPPS) and ambulatory surgical center (ASC) payment systems.

CMS proposes an OPPS decrease of .01%. The change is based on a projected hospital market basket increase of 2.7% minus a 0.6% adjustment for multi-factor productivity and a 0.2% adjustment required by law. An additional 2% adjustment will be included to account for inflation in OPPS payments resulting from an increase in payments for laboratory tests that were previously paid under the Clinical Laboratory Fee Schedule. Considering all policy changes, CMS estimates a -0.2% cut for hospitals paid under the OPPS in CY 2016.

In addition, CMS plans to reduce payments by 2.0% to hospitals that failed to meet the Hospital Outpatient Quality Reporting Program requirements. The agency also plans to reduce ASCs’ annual payments by the same amount for failure to meet similar reporting requirements.

Date 2015-07-01 Title CMS Proposes Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes, Including Proposed Changes to the Two-Midnight Rule, and Quality Reporting Changes for 2016 Contact go.cms.gov/media CMS Proposes Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes, Including Proposed Changes to the Two-Midnight Rule, and Quality Reporting Changes for 2016 The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule [CMS-1633-P] on July 1, 2015.