Proposed 2022 CMS Outpatient Rule Includes Higher Fines for Price Transparency Rule Violations

July 22, 2021

On July 19, the Centers for Medicare & Medicaid Services (CMS) introduced its proposed 2022 Outpatient Prospective Payment System (OPPS) Rule with a 2.3% overall rate increase.
Among the notable concerning changes proposed in this year's annual update is a dramatic increase in fines for hospitals CMS deems noncompliant with its hospital price transparency rule. Specifically, CMS proposes raising penalties from $300 per day to another $10 per bed per day for hospitals with more than 30 beds, with a maximum fine of $5,500 per day.
Unfortunately, CMS is also proposing to continue its policies from recent rules of lower reimbursements for 340B hospitals and site-neutral payment policies for clinic visit services at off-campus hospital outpatient departments.
On a more positive note, CMS is proposing reversing two policies that were scrutinized in the 2021 outpatient rule. The agency is rolling back proposals to eliminate the inpatient-only list and expand procedures eligible to be done in ambulatory surgical centers (ASCs)—two policies finalized in last year's rule. WHA had cautioned CMS in its comment letter last year to be cognizant of how these policies could impact the patient mixes hospitals serve and the potential for ASCs to cherry-pick the easiest and best paying patients and procedures if these policies were finalized without adjusting hospital reimbursements.
The rule also includes a number of proposed changes to the outpatient quality reporting program, including requiring hospitals to report vaccination rates on health care personnel, as previously proposed in the inpatient rule.
CMS also asks for comments on the rural emergency hospital model, a new Medicare provider type that was included in the 2020 year-end Consolidated Appropriations Act, 2021. This model would allow hospitals with fewer than 50 beds to continue providing emergency and outpatient services without needing to offer inpatient services, and would include a new reimbursement model with fixed payments.
WHA is continuing to analyze this rule in anticipation of the Sept. 17 comment deadline. Please contact WHA Vice President of Federal and State Relations Jon Hoelter with questions.

This story originally appeared in the July 22, 2021 edition of WHA Newsletter