CMS Proposes OPPS Changes; Two-Midnight Rule Affected

The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 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 CY 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 group to which a service or procedure is assigned.

The proposed rule also includes important proposed changes to the Two Midnight Rule for CY 2016. See related fact sheet for detailed information.

The OPPS/ASC proposed rule is one of several rules for CY 2016 that reflect a broader administrationwide strategy to create a health care system that results in better care, smarter spending, and healthier people. View the full detailed fact sheet.

The proposed rule can be downloaded from the Federal Register.

On July 8, 2015, the rule will be available online.

Source: Centers for Medicare & Medicaid Services