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September 24, 2019 (Cleveland)

The Center Submits Comments Requesting Changes to the CY 2020 OPPS Proposed Rule

2020 OPPSThe Center for Health Affairs submitted comments this week advocating for changes to the calendar year (CY) 2020 Medicare hospital outpatient prospective payment system (OPPS) proposed rule. The 2020 OPPS rule, published by the Centers for Medicare and Medicaid Services (CMS), contains several provisions that are troubling to hospitals, especially in the areas of price transparency, the 340B drug pricing program and site-neutral payments for off-campus hospital outpatient departments (HOPDs).


The rule expands on requirements that went into effect Jan. 1 regarding the posting of charge information on hospital websites. Under the proposed rule, hospitals would be required to post gross charges and payer-specific charges for all items and services in a machine-readable format. They would also be required to post negotiated rates for 300 “shoppable” bundles of services in a consumer-friendly format. 

In comments, The Center emphasized that while hospitals are committed to ensuring patients have the information needed to make informed decisions about their care, this rule would not provide information that’s understandable and meaningful for patients, would severely disrupt contract negotiations between providers and health plans, and would be excessively burdensome for hospitals. 


The 2020 OPPS proposed rule also includes provisions extending the nearly 30% cut in reimbursement for drugs purchased under the 340B drug pricing program. Formerly under this program, drugs for 340B participating providers were paid at a rate of average sales price (ASP) plus 6%. In 2018, this was cut to ASP minus 22.5%. This reduced rate was maintained in 2019 and CMS is also planning to extend it into 2020. This is in spite of court decisions that have determined CMS exceeded its legal authority in implementing these cuts. In comments, The Center urged CMS to restore and preserve funding under this program, emphasizing the negative impact these cuts have had on hospitals serving the most vulnerable communities.


Also in the proposed rule, which was published this summer, are provisions to complete the phase-in of site-neutral payments to off-campus HOPDs, including those specifically exempted from this policy by Congress. On Sept. 17, a federal district court judge found that CMS had exceeded its authority when it finalized the site-neutral payment policy in last year’s hospital outpatient rule. At this time, it is unknown whether CMS will pursue further legal action regarding the judge’s decision. The Center is urging CMS to comply with congressional intent, which was to extend grandfathered status to off-campus HOPDs that were operating or under construction at the time the policy was enacted. 

The 2020 OPPS proposed rule was released in July and published Aug. 9 in the Federal Register, with comments accepted through Sept. 27. The final rule is expected before the end of the year.

MORE: For more on the 2020 outpatient prospective payment system proposed rule, contact us.

TWEETABLE: .@neohospitals submits comments asking @CMSgov to revise its proposed rule on hospital outpatient reimbursement in 2020. #pricetransparency #drugpricing