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Outpatient PPS rule proposed

July 23, 2012


The Centers for Medicare & Medicaid Services (CMS) July 6 issued calendar year 2013 proposed rules for the outpatient prospective payment system (PPS) and ambulatory surgical centers that would increase payments by 2.1%.

The proposed payment increase is based on a statutory formula that equals the projected hospital market basket – an inflation rate for goods and services used by hospitals for hospital inpatient services paid under the hospital inpatient PPS – of 3% less statutory reductions totaling 0.9% percent, including a productivity adjustment, according to CMS.

The rule also extends through 2013 the direct supervision enforcement delay for critical access hospitals and small rural hospitals (see story at left), and would pay for drugs and biologicals that do not have pass-through status at the statutory default of average sales price plus 6%. The rule proposes to continue the statutory 2 percentage point reduction in payments for hospitals failing to meet the hospital outpatient quality reporting requirements.

More payment rules. The agency also issued on July 6 the 2013 pro­posed rules for the physician fee schedule (PFS) and home health PPS. Without congressional action, the PFS rule would reduce Medicare physician payments by an estimated 27% on Jan. 1. Under the rule, CMS proposes a separate payment for primary care practitioners to assist in transitioning beneficiaries from the hospital back into the community.

The home health rule provides a net increase of 0.1% ($20 million) in Medicare payments for home health services over this year’s levels.

The increase reflects a 2.5% market basket update which, in addition to other adjustments, is offset by mandatory cuts under the “Patient Protectin and Affordable Care Act” and a 1.32% coding offset, which is part of a multi- year offset. Comments are due Sept 4 for all three proposed rules. The regulations are scheduled to be published in the July 30Federal Register.

AHA members can learn more about the proposed rules by reading the AHA’s July 9 Special Bulletin. Go to “Advocacy Issues” at http://www.aha.org and click on “Special Bulletins” under “Tools & Resources.”