CMS Releases CY 2022 Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule

On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule [CMS-1753-F], finalizing payment rates and policy changes affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings for CY 2022.

For CY 2022, CMS increased payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System by a factor of 2%. Hospitals and ASCs that fail to meet their respective quality reporting program requirements will be subject to a 2% reduction.

Based on the finalized policies, CMS estimates that total payments to OPPS and ASC providers (including beneficiary cost-sharing and estimated changes in enrollment, utilization and case-mix) for CY 2022 will be approximately $82.078 billion and $5.41 billion, respectively, for an increase of approximately $5.9 billion and $40 million, respectively, from CY 2021 program payments.

The finalized regulations are available here. The press release and accompanying fact sheet are available here and here, respectively.

Key takeaways from the CY 2022 OPPS and ASC Payment System Final Rule:

• CMS finalized, with modification, the proposal to halt the elimination of the inpatient only (IPO) list and to add back the vast majority of procedures removed from the list in 2021.
• To drive compliance with the recently established hospital price transparency program, CMS will increase the potential size of civil monetary penalties (CMP) for noncompliance.
• The Biden Administration continues to focus on health equity and how to appropriately address it in the hospital quality programs.
• The Radiation Oncology Alternative Payment Model will be effective as of January 1, 2022, unless congressional action further delays the model.

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For more information, contact Jennifer Archer, Aaron Badida, Deborah Godes, Sheila Madhani, Kristin O’Brien, Jennifer Ohn and Devin Stone.