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CMS Releases Proposed Rule for OPPS

July 27, 2012:

Deborah C. Hall, Clinical/Technical Editor

Medicare payment rates for hospital outpatient departments (HOPD) would increase by 2.1 percent in fiscal 2013 if a proposed rule the Centers for Medicare & Medicaid Services (CMS) placed on display July 6 becomes final.

The outpatient prospective payment system rule also proposes simplifying the operations of the quality improvement organizations (QIOs) and making them more responsive to patient complaints about quality-of-care issues. If no revisions are made, the rule would at least allow patients to receive more information about the QIOs’ review process and would create an “Immediate Advocacy” to resolve beneficiary complaints. The proposed rule also authorizes QIOs to send and receive secure transmissions of electronic versions of health information and allows QIOs to release more information about the results of their reviews to affected patients.

The proposed rule also makes several changes to the quality reporting programs (QRP) for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASCs) as well as inpatient rehabilitation facilities (IRFs). Specifically, CMS is not proposing to add measures for the payment determinations for calendar years 2014 and 2015, which means that the agency is proposing reporting for 23 measures for 2014 and2015. The proposed rule also contains proposals for procedures related to retirement and retention of HOPD measures.

CMS is not proposing to add additional measures to the HOPD and ASC quality reporting programs, but it does propose the following revisions to the IRF QRP for 2014 and 2015:

  • Adopt updates on a previously adopted measure that will affect annual prospective payment amounts in fiscal 2014
  • Establish a policy that would provide that any measure that has been adopted for use in the IRF QRP will remain in effect until the measure is actively removed, suspended, or replaced
  • Adopt policies regarding when notice-and-comment rule making will be used to update existing IRF QRP measures

The proposed rule will appear in the July 30, 2012, Federal Register. CMS will accept comments on the proposed rule until September 4, 2012, and will respond to all comments in a final rule to be issued by November 1, 2012. The proposed rule is on display and can be located here.


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