CMS Releases CY 2019 OPPS Rule

On November 2, the Centers for Medicare & Medicaid Services (CMS) released the final calendar year (CY) 2019 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule.

Download the final 2019 OPPS rule from the Federal Register here.

Highlights from the CMS fact sheet on the final rule include:

• CMS is exercising its authority by applying a Physician Fee Schedule (PFS)-equivalent payment rate for the clinic visit service when provided at an off-campus provider-based department that is paid under the OPPS. The agency will phase this change in over two years.

   

• In the 2019 OPPS final rule, CMS finalizes a policy to pay ASP minus 22.5 percent for 340B-acquired drugs furnished by non-excepted off-campus PBDs paid under the Physician Fee Schedule.

   

• For 2019, CMS is not finalizing its proposed policy that off-campus PBDs excepted from Section 603 of the Bipartisan Budget Act of 2015 could continue to be paid at OPPS rates for items and services in each of 19 proposed “clinical families of services” if a PBD furnished and billed for a service in that clinical family of services prior to November 2, 2015. CMS notes the agency will continue to monitor the expansion of services in excepted off-campus PBDs.

For more information, access the CMS fact sheet on the final CY 2019 OPPS rule here.

ACCC is currently reviewing the final 2019 OPPS rule and will provide an in-depth analysis to membership shortly.

Posted 11/2/18