CMS proposes major Hospital Outpatient and Ambulatory Surgical Center policy and payment changes

July 2, 2015

The Centers for Medicare & Medicaid Services (CMS) released the calendar year 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.

The 2016 OPPS/ASC proposed rule proposes updates to Medicare payment policies and rates for hospital outpatient departments (HOPDs), ASCs, and partial hospitalization services provided by community mental health centers (CMHCs), and refinements to programs that encourage high-quality care in these outpatient settings.  Approximately 3,800 hospitals and 60 CMHCs are paid under the OPPS, while approximately 5,300 ASCs are paid under the ASC payment system.  The OPPS provides payment for most HOPD services, including partial hospitalization services furnished by HOPDs and CMHCs.  OPPS payment amounts vary according to the Ambulatory Payment Classification (APC) group to which a service or procedure is assigned.

The proposed rule also includes important proposed changes to the Two Midnight Rule for the calendar year 2016.  See related fact sheet for detailed information:  http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-01-2.html

The OPPS/ASC proposed rule is one of several rules for calendar year 2016 that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.

Click here to view the full detailed fact sheet:  http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-01.html

The proposed rule can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-16577.pdf

On July 8, 2015, the rule will be available online at http://federalregister.gov/a/2015-16577

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