CMS Proposes Even Deeper 340B Cuts in 2021 Outpatient Rule

August 06, 2020

On August 4, the Centers for Medicare and Medicaid Services (CMS) released its 2021 Outpatient Prospective Payment System (OPPS) Rule. Like previous rules, the agency proposes to continue reimbursement cuts to certain 340B hospitals. However, in response to its Spring 2020 Hospital Acquisition Cost Survey, it is proposing a net payment rate of Average Sale Price (ASP) minus 28.7%. CMS also seeks comment on whether it should continue its current payment policy first suggested in the 2018 OPPS rule of ASP minus 22.5%.
In addition to the 340B cuts, CMS proposes the following policy changes for 2021:
  • A net increase in OPPS payments of 2.6% from 2020.
  • Adding cervical fusion with disc removal and implanted spinal neurostimulators to the prior authorization list.
  • Removing the inpatient-only list of procedures over the course of three years.
  • Changing the level of supervision required for certain outpatient therapeutic services from direct, to general.
  • Making changes to the Hospital Outpatient Quality Reporting and Star Ratings.
  • Removing certain restrictions on the expansion of physician-owned hospitals that qualify as “high Medicaid facilities.”
 WHA is continuing to review the proposed rule in advance of the October 5 comment deadline. Please contact WHA’s Director of Federal and State Relations, Jon Hoelter, for more information.

This story originally appeared in the August 06, 2020 edition of WHA Newsletter