CMS Releases CY 2022 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule

On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1753-P], which includes proposals to update payment rates and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2022.

For CY 2022, CMS proposes to increase payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System by a factor of 2.3%. Hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0% reduction in the CY 2022 fee schedule increase factor, in continuation of existing policy.

CMS estimates, based on the proposed policies, 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 $82.704 billion and $2.5 billion, respectively. This represents an increase of approximately $10.757 billion and a decrease of $20 million, respectively, from CY 2021 payment levels.

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

• Withdrawal of previous plans to eliminate the inpatient only list and expand the ASC covered procedures list
• Increased penalties for hospitals to drive compliance with the recently established hospital price transparency program
• Continued emphasis on health equity and how to address it in the hospital quality programs
• A request for information about a soon to be established Rural Emergency Hospital designation
• Plans to implement the Radiation Oncology Alternative Payment Model as of January 1, 2022

Comments on the proposed rule are due September 17, 2021.

• The proposed regulations are available here.
• The press release is available here.
• The fact sheet is available here.

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For more information, contact Jennifer Archer, Aaron Badida, Paul Gerrard, Deborah Godes, Sheila Madhani, Kristen O’Brien, Jennifer Ohn or Devin Stone.