MHA Submits Comments Regarding Medicare OPPS Proposed Rule

Posted on September 21, 2018

On Sept. 20, the MHA submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding the proposed rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) effective Jan. 1, 2019. Overall, this proposal is estimated to decrease Medicare FFS OPPS payments to Michigan hospitals by $17 million, further threatening the financial viability necessary for hospitals to continue providing access to services. The MHA’s comments focus on the CMS’s proposed changes related to:

  • Payment cuts for all clinic visits provided at off-campus hospital outpatient departments (HOPDs) from 100 percent of the OPPS rate to 40 percent, regardless of the facilities’ grandfathered status under Section 603 of the Bipartisan Budget Act of 2015. This cut is estimated to reduce payments to Michigan hospitals for clinic visits provided at off-campus HOPDs by nearly $42 million in 2019.
  • Payments cuts for new families of clinical services provided in grandfathered off-campus HOPDs from 100 percent of the OPPS rate to 40 percent.
  • Expansion of the nearly 30 percent payment cut for drugs purchased through the 340B drug discount program and provided in nongrandfathered off-campus HOPDs.
  • Payment cuts for new drugs until average sales price data becomes available.
  • Hospital outpatient quality reporting program.
  • Addition of 12 procedures to the covered procedures list for ambulatory surgical centers.
  • The CMS’s request for information on promoting interoperability and price transparency.

The MHA encourages hospitals to submit comments to the CMS regarding the proposed rule by 5 p.m. EDT Sept. 24. Following release of the final rule, expected by Nov. 1, the MHA will provide an updated impact analysis. Members with questions should contact Vickie Kunz at the MHA.

Tags: Medicare, OPPS, proposed rule, CMS, FFS, comments

Posted in: Member News

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