The Centers for Medicare & Medicaid Services (“CMS”) has published the Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgery Center (“ASC”) final rule for CY 2021.  CMS finalized an annual increase OPPS and ASC rates of 2.4 percent for CY 2021, based on a 2.4 percent market basket update and without a cut for productivity.  CMS will begin eliminating the inpatient-only list of procedures in 2021 and completely eliminate inpatient only procedures by CY 2024.

CMS again finalized reimbursement for drugs acquired under the 340B program at the average sales price (ASP) minus 22.5 percent.  This policy does not apply to PPS-exempt cancer hospitals, children’s hospitals, and rural sole community hospitals.  This follows the D.C. Circuit Court upholding HHS’s authority to reduce reimbursements to specified covered outpatient drugs.  (American Hospital v. Azar Case. No. 19-5048).  CMS also finalized the policy to remove certain restrictions on the ability to expand physician owned hospitals that qualify as high-Medicaid facilities.  Beginning July 1, 2021, prior authorization will be required for cervical fusion with disc removal and implanted spinal neurostimulators.

CMS also finalized a requirement for hospital and critical access hospitals to report on (1) information about their inventory of COVID-19 therapeutics; and (2) the impact of acute respiratory illnesses.

A fact sheet about the final rule may be accessed here.

Norton Rose Fulbright attorneys are continuing to review the final rule and consider its impact on the health care industry.  Please contact members of the Norton Rose Fulbright healthcare team if we can assist with your evaluation of the OPPS/ASC final rule and its impact on your operations.