On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its final hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system final rule for Calendar Year (CY) 2018. On the same day CMS also issued its home health prospective payment system 2018 final rule.
OPPS payment rates will increase 1.35 percent in 2018. CMS will implement its proposal to reduce payments for separately payable, non-pass-through drugs (excluding vaccines) purchased through the 340B Drug Pricing Program from Average Sales Price (ASP) plus 6 percent to ASP minus 22.5 percent, an effective reduction of 26.89 percent in payments for 340B drugs. Rural sole community hospitals are excepted from this payment reduction, as are PPS-excluded children’s hospitals and cancer hospitals. The American Hospital Association, Association of American Medical Colleges, and America’s Essential Hospitals have already announced their intention to file a lawsuit challenging the cut in 340B drug payments on the grounds that CMS has exceeded its statutory authority in implementing the payment reduction. CMS confirms in the preamble to the final rule that the 340B drug payment reduction will not apply to 340B-acquired drugs in non-excepted off-campus provider-based departments in 2018 but may consider extending the payment reduction to these facilities in CY 2019. In this final rule CMS reinstates the non-enforcement of the direct supervision requirement for outpatient therapeutic services for critical access hospitals and rural hospitals having 100 or fewer beds for CYs 2018 and 2019. For ASCs, the final rule includes a CY 2018 Multi-Factor Productivity-Adjusted Consumer Price Index for all urban consumers update of 1.2 percent, which CMS projects will increase total ASC payments by 3 percent. A CMS fact sheet on the OPPS final rule with comment period is available here.
CMS projects that Medicare payments to home health agencies under the CY 2018 rule will be reduced 0.4 percent. A CMS fact sheet on the home health final rule is available here.