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CY 2022 OPPS Proposed Rule

On July 19th the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Outpatient Prospective Payment System (OPPS) proposed rule. [1] After a comment period, the final rule will be published in November 2021.

Notable changes proposed for CY 2022 include:

  1. A net increase in OPPS payment rates of 2.3% over CY 2021
  2. Reversing the intent to entirely eliminate the inpatient only procedure list and restore almost 300 procedures that were removed from the list in the CY 2021 final rule. They also propose to exempt these nearly 300 procedures from medical review for 2 years.
  3. Increase in civil monetary penalties, based on the size of the hospital, for noncompliance with the hospital price transparency rule
  4. Adjustments to the measures included in the outpatient quality reporting program, replacing manual measures with electronic clinical quality measures (eCQMs) and adding a measure assessing COVID-19 vaccination rates of health care personnel.

As usual, CMS poses questions for commenters in each section of the CY 2022 OPPS Proposed Rule. CMS is accepting comments through September 17th.

Regarding the COVID-19 public health emergency (PHE), CMS is seeking comments on the temporary policies that were implemented. Most policies will expire when the PHE concludes, but there could be reason to extend or make permanent several services.

  1. Will there be a continued demand for mental health services when the PHE is over?
  2. What role will technological communication with medical personnel have when the PHE ends?
  3. Will free specimen collection and testing retire at the end of the COVID-19 PHE?

End Note:

  1. CY 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS-1753-P) | CMS