/ en Mon, 28 Apr 2025 22:05:07 -0500 Thu, 20 Feb 25 14:55:33 -0600 /fact-sheets/2025-02-20-fact-sheet-facility-fees <div class="container"><div class="row"><div class="col-md-8"><h2><span><em>The Issue</em></span></h2><p>Facility fees are the portion of a health care treatment bill that covers all the costs of delivering patient care, except for those that are billed by physicians and other professionals. Congress has introduced several pieces of legislation that would limit hospitals’ ability to charge these fees in the context of Medicare hospital outpatient payments (also known as “site-neutral” provisions). These proposals would cut anywhere from approximately $3 billion to $180 billion from hospitals over 10 years without providing any alternative mechanism for funding the essential health care services that only hospitals provide. Increasingly, policymakers are also looking at policies to limit facility fees in the context of commercial coverage.</p><h2><span><em>AHA Take</em></span></h2><p>The AHA urges Congress to oppose any legislation that would cut resources to hospitals through the use of facility fees to help finance the care they provide to their communities.</p><h2><span><em>Why?</em></span></h2><ul><li>Facility fees provide hospitals with the resources necessary to make available the high-acuity services only they can provide on a 24/7 basis, such as emergency and trauma care. This includes around the- clock nursing and physician services, medical equipment, drug therapies and maintaining critical building and community infrastructure.</li><li>Hospital outpatient departments and affiliated physician offices are not the same as independent physician offices and other ambulatory sites of care. They care for sicker patients and treat a higher rate of uninsured. They also must meet higher regulatory standards. For example, unlike most independent physician offices or ambulatory surgery centers, hospital outpatient departments and affiliated physician practices do not call 911 if their patient experiences a medical emergency. Instead, they work as an integrated system to immediately transfer the patient to the hospital emergency department or other appropriate care setting.</li><li>Facility fees are increasingly used to cover the true cost of providing physician services, which hospitals do by subsidizing physicians’ pay above the underpayment that they are reimbursed from both public and private payers. These payers have pushed physician compensation so low that many physicians have no choice but to either seek employment or require subsidies from the facilities in which they work.</li><li>Restrictions on the use of facility fees could result in hospitals having to make challenging decisions to end the provision of certain services. This would result not only in a loss of access to care in the community but also in jobs.</li></ul><h2><span><em>Key Facts</em></span></h2><p>Hospital bills cover two types of expenses — professional fees and facility fees. Professional fees cover the cost of the physician providing the care. Facility fees cover everything else — both the direct and indirect costs that allow hospitals to continue to provide comprehensive care to patients and serve the needs of their communities. However, as both Medicare and commercial payers increasingly compensate physicians below the cost of delivering care, hospitals have needed to use a portion of facility fees to subsidize physician practices. These fees may be combined into one bill or separated into multiple bills.</p><img src="/sites/default/files/inline-images/image_45.png" data-entity-uuid="28fe6d72-8d14-4593-9e8e-28274902c28f" data-entity-type="file" alt="Professional fees chart" width="850" height="525"></div><div class="col-md-4"><a href="/system/files/media/file/2025/02/fact-sheet-facility-fees.pdf"><img src="/sites/default/files/inline-images/cover-fact-sheet-facility-fees.png" data-entity-uuid="2fd7d096-f108-4c23-b2c6-8deb529a5869" data-entity-type="file" alt="Cover of Fact Sheet" width="682" height="882"></a></div></div></div> Thu, 20 Feb 2025 14:55:33 -0600 Outpatient Prospective Payment Systems (OPPS) <div class="container"><div class="row"><div class="col-md-8"><p>Below are three spreadsheets, one comparing relative weights and payment rates at the APC level, using the most recent 2025 and 2024 Addendum A spreadsheets, as downloaded from the CMS website. The second spreadsheet makes similar comparisons at the HCPCS level.  The 2025 files are from the 2025 contractor file, dated 1-02-2025 (these are rates for January 1, 2025 through December 31, 2025). The 2024 rates are from the October Addendum contractor files –dated October 2, 2024. The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p><p><strong>The Addendum A spreadsheet contains these 5 tab</strong>s:</p><ul><li><u>2025 Add. A by APC</u>: compares 2024 and 2025 status indicators, relative weights, and payment rates for all APCs in APC order</li><li><u>2025 Add. A sorted</u>: same as previous tab but sorted by percent change in payment rate, from largest percentage loss to biggest percentage gain</li><li><u>2025 New APCs</u>: displays the new APCs</li><li><u>2025 Deleted APCs: displays the APCs deleted from 2025</u></li><li><u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.--OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul><p><strong>The Addendum B spreadsheet contains these 6 tabs:</strong></p><ul><li>­ <u>2025 Add. B by HCPCS</u>: compares 2024 and 2025 status indicators, relative weights, and payment rates for <u>all</u> HCPCS codes included in Addendum B; sorted by HCPCS code</li><li>­ <u>2025 Add. B by APC</u>: same as previous tab but sorted by APC and within APC by HCPCS code</li><li>­ <u>Status codes G and K</u>: comparisons for separately payable drugs and biologicals with status indicator G or K in the 2025 final rule are shown in this tab</li><li><u>2025 Add. M</u>:  as supplied by CMS, HCPCS Codes for Assignment to Composite APCs for CY 2025</li><li><u>2025 Add. O</u>: as supplied by CMS, New CY 2023 Category I and III CPT Codes Effective January 1, 2025</li><li>­ <u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.-- OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul><p><strong>The OPPS APC/HCPCS lookup tool spreadsheet contains the following tabs:</strong></p><ul><li>­ <u>APC Lookup</u>: Allows user to lookup basic information on a given APC. User chooses APC or types in APC in formula bar in cell “B2”. Spreadsheet automatically displays basic descriptive and relevant payment information and the associated HCPCS that belong to that APC. Cells are locked but content can be copied and pasted into another spreadsheet for manipulation.</li><li><u>HCPCS Lookup</u>: Allows user to lookup basic information on a given HCPCS. User chooses HCPCS or types in HCPCS in formula bar in cell “B2”. Spreadsheet automatically displays basic descriptive and relevant payment information and its associated APC.</li><li>­ <u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1. OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul></div><div class="col-md-4"><h4 class="text-align-center"><span>Download the Spreadsheets below.</span></h4><h4><a href="/system/files/media/file/2025/01/comparison-of-final-2025-opps-addendum-a-with-october-2024-addendum-a.xlsx" target="_blank" title="2025 Addendum A Compared to October 2024">Comparison of Final 2025 OPPS Addendum A with October 2024 Addendum A</a></h4><h4><a href="/system/files/media/file/2025/01/comparison-of-2025-opps-addendum-b-with-october-2024-addendum-b.xlsx" target="_blank" title="2025 Addendum A Compared to October 2024">Comparison of 2025 OPPS Addendum B with October 2024 Addendum B</a></h4><h4><a href="/system/files/media/file/2025/01/2025-opps-apc-hcpcs-final-lookup-tool-spreadsheet.xlsx" target="_blank" title="2025 OPPS APC/HCPCS Final Lookup Tool Spreadsheet">2025 OPPS APC/HCPCS Final Lookup Tool Spreadsheet</a></h4></div></div></div> Mon, 06 Jan 2025 13:45:49 -0600 Outpatient Prospective Payment Systems (OPPS) <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare & Medicaid Services (CMS) Nov. 1 released its calendar year (CY) 2025 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) <a href="https://www.federalregister.gov/public-inspection/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical" target="_blank">final rule</a>. The rule increases OPPS rates by a net 2.9% in CY 2025 compared to CY 2024.</p><p>The policies and payment rates in the rule will generally take effect on Jan. 1, 2025.</p><div class="panel module-typeC"><div class="panel-heading"><h3 class="panel-title">Key Highlights</h3></div><div class="panel-body"><p>CMS’ final rule will:</p><ul><li>Increase Medicare hospital OPPS rates by a net 2.9% in CY 2025.</li><li>Pay separately for diagnostic radiopharmaceuticals with per-day costs above $630.</li><li>Exclude qualifying cell and gene therapies from comprehensive ambulatory payment classification (C-APC) packaging.</li><li>As required by law, implement temporary additional payments for certain non-opioid treatments for pain relief dispensed in the hospital outpatient department (HOPD) and ASC settings.</li><li>Adopt three measures related to health equity for the Outpatient, ASC and Rural Emergency Hospital (REH) Quality Reporting Programs (QRP) and extend voluntary data reporting for two hybrid measures in the Inpatient Quality Reporting Program.</li><li>Establish a new Condition of Participation (CoP) for hospitals and critical access hospitals (CAHs) offering obstetrical services, and update quality assessment performance improvement (QAPI), emergency services and discharge planning CoPs.</li><li>Cover and pay for HIV Pre-Exposure Prophylaxis (PrEP) drugs and related services in HOPDs as additional preventive services under the OPPS.</li></ul></div></div><h2>AHA Take</h2><p>According to a statement by AHA Senior Vice President of Public Policy Analysis and Development Ashley Thompson, “Medicare's sustained and substantial underpayment of hospitals has stretched for almost two decades, and today's final outpatient rule only worsens this chronic problem. The agency's final increase of less than 3% for outpatient hospital services will make the provision of care, investments in the health care workforce, and addressing new challenges, such as cybersecurity threats, more difficult. These inadequate payments will have a negative impact on patient access to care, especially in rural and underserved communities nationwide.</p><p>“The AHA fully shares CMS’ goals of improving maternal health outcomes and reducing inequities in maternal care,” said Thompson. “While we appreciate that the final rule provides hospitals with additional implementation time and greater flexibility in how they meet certain requirements, we remain concerned about CMS’ excessive use of Conditions of Participation to drive its policy agenda and the potential risk for these requirements to inadvertently reduce access to maternal care. We believe a less punitive and more collaborative approach would be more effective given that the key drivers of maternal health outcomes are highly complex and involve multiple stakeholders. The AHA remains committed to working with the Administration and other stakeholders to advance a full range of solutions to improve maternal outcomes.”</p><p>Highlights of the CY 2025 OPPS/ASC final rule follow.</p><h2>CY 2025 OPPS Final Rule Changes</h2><h3>Payment Update</h3><p>CMS updates OPPS rates by a net 2.9% for CY 2025. This includes a market-basket update of 3.4% and a statutorily required productivity cut of 0.5 percentage points. These payment adjustments, in addition to other changes in the rule, are estimated to result in a net increase in OPPS payments of 3.2% in CY 2025 compared to CY 2024. For hospitals that do not publicly report quality measure data, CMS will continue to impose the statutory 2.0 percentage point additional reduction in payment, resulting in a 0.9% OPPS update.</p><p>CMS estimates that the total increase in Federal Government expenditures under the OPPS for CY 2025, compared to CY 2024, due to the changes to the OPPS in the final rule, will be approximately $1.98 billion. Taking into account estimated changes in enrollment, utilization and case mix for CY 2025, CMS estimates that OPPS expenditures for CY 2025, including beneficiary cost-sharing, would be approximately $87.7 billion, which is approximately $4.7 billion higher than estimated OPPS expenditures in CY 2024.</p><p>CMS increases the conversion factor to $89.169 in CY 2025 compared to $87.382 in CY 2024. This update reflects several factors: the 2.9% OPPS payment update, the wage index budget neutrality adjustment, the 5% annual cap for individual hospital wage index reductions budget neutrality adjustment, the cancer hospital payment budget neutrality adjustment and an increase of 0.10 percentage points for the difference in pass-through spending. CMS will use a reduced conversion factor of $87.439 in the payment calculation for hospitals that fail to meet the Hospital Outpatient QRP.</p><h3>Data Used in CY 2024 OPPS/ASC Rate Setting</h3><p>CMS used the CY 2023 claims data and the most updated cost report extract from the Healthcare Cost Report Information System, which primarily includes cost reports from CY 2022, to set OPPS and ASC payment rates.</p><h3>Packaging Policy for “Threshold-packaged” and “Policy-packaged” Drugs, Biologicals and Radiopharmaceuticals</h3><p>CMS pays for drugs, biologicals and radiopharmaceuticals that do not have pass-through status in one of two ways: packaged payment or separate payment (individual Ambulatory Payment Classifications (APCs)). For CY 2025, CMS maintains the packaging threshold for “threshold-packaged” drugs, including non-implantable biologicals and therapeutic radiopharmaceuticals, of $140 per day. This means that such products with a per-day cost of $140 or less will have their cost packaged in the procedure with which they are billed.</p><p>There are exceptions to this threshold-based packaging policy for certain “policy-packaged” drugs, biologicals and contrast agents. CMS will continue to package the costs of all anesthesia drugs; drugs, biologicals, and contrast agents and other drugs that function as supplies when used in a diagnostic test or procedure; and drugs and biologicals that function as supplies when used in a surgical procedure (e.g., skin substitutes), regardless of whether they meet the $140 per day threshold.</p><h4>Diagnostic Radiopharmaceuticals Separate Payment</h4><p>CMS finalizes its proposal to pay separately for diagnostic radiopharmaceuticals with per-day costs above $630 —approximately two times the volume-weighted average cost amount currently associated with diagnostic radiopharmaceuticals in the Nuclear Medicine APCs. It will update the $630 threshold in CY 2026 and subsequent years by the Producer Price Index for Pharmaceutical Preparations. Finally, CMS will pay for separately payable diagnostic radiopharmaceuticals based on their mean unit cost derived from OPPS claims for CY 2025.</p><h4>Exclusion of Cell and Gene Therapies from C-APC Packaging</h4><p>CMS finalizes its proposal to exclude qualifying cell and gene therapies from C-APC packaging.</p><h4>Add-on Payment for Radiopharmaceutical Technetium-99m (Tc-99m)</h4><p>For CY 2025, CMS will continue its current policy to apply an add-on payment to radiopharmaceuticals that use Tc-99m produced without the use of highly enriched uranium. However, for CY 2026, CMS finalizes its proposal to replace this add-on payment with an add-on payment for radiopharmaceuticals that use Tc-99m derived from domestically produced Mo-99.</p><h4>Payment for HIV PrEP in HOPDs</h4><p>CMS finalizes its proposal to cover and pay for HIV PrEP drugs and related services as additional preventive services under the OPPS, as described by CMS through a National Coverage Determination issued and effective Sept. 30, 2024.<a href="#fn1"><sup>1</sup></a> Covered services include the HIV PrEP drugs, drug administration, HIV and hepatitis B screening, and individual counseling performed by physicians or certain other health care practitioners.</p><h3>Intensive Outpatient and Partial Hospitalization Programs</h3><p>CMS will maintain the existing rate structures for Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP) services as established in the previous rulemaking. The agency will calculate cost information using CY 2023 claims data and the OPPS data set to identify services eligible for payment under the IOP and PHP benefits.</p><h3>Cancer Hospital Payment Adjustment</h3><p>CMS will continue providing additional payments to cancer hospitals so that a cancer hospital’s payment-to-cost ratio (PCR) after the additional payments is equal to the weighted average PCR for the other OPPS hospitals using the most recently submitted or settled cost report data. Current law also requires this weighted average PCR to be reduced by 1.0 percentage points. Therefore, for CY 2025, CMS will use a target PCR of 0.87 to determine the CY 2025 cancer hospital payment adjustment to be paid at cost report settlement. That is, the payment adjustments will be the additional payments needed to result in a PCR equal to 0.87 for each cancer hospital.</p><h3>Quality Reporting Programs</h3><p>For the Inpatient QRP, CMS will continue voluntary reporting of certain data elements for the Hybrid Hospital-wide Mortality and Readmissions measures that will impact the fiscal year (FY) 2026 payment determination as proposed and already communicated to hospitals outside of the rulemaking process; in response to public comment, the agency finalizes an additional year of voluntary reporting of these data elements so that data reporting also will not affect FY 2027 payment.</p><p>For the Hospital Outpatient QRP, CMS finalizes its proposal to adopt a patient-reported outcome measure of the patient’s understanding of information related to recovery after outpatient surgery beginning with voluntary reporting in CY 2025 and mandatory reporting beginning CY 2026. The agency will also remove two measures found to have little to no effect on patient outcomes.</p><p>CMS makes programmatic updates to the ASC QRP and the REH QRP regarding data reporting requirements upon conversion to REH status and the reporting period for one existing quality measure in the program.</p><p>For the Outpatient, ASC and REH QRPs, CMS finalizes the adoption of three measures related to health equity as proposed; these measures have already been adopted in the Inpatient QRP. These include the Hospital Commitment to Health Equity measure, with mandatory reporting beginning CY 2025, Screening for Social Drivers of Health measure and Screen Positive Rate for Social Drivers of Health, with voluntary reporting in CY 2025 and mandatory reporting beginning CY 2026.</p><h3>Remote Outpatient Therapy, Diabetes Self-management Training and Medical Nutrition Therapy</h3><p>Barring congressional action, providers can no longer bill for remote outpatient therapy, diabetes self-management training and medical nutrition therapy beginning Jan. 1, 2025. CMS reiterates that extensions of statutory waivers expanding the list of telehealth-eligible providers are necessary for CMS to update these billing policies.</p><h3>Periodic In-person Visits for Mental Health Services Furnished Remotely by Hospital Staff to Beneficiaries in their Homes</h3><p>In previous rulemaking, CMS finalized a requirement that payment for remote mental health services may only be made if the beneficiary receives an in-person service within six months prior to the provision of remote service and then annually. CMS reiterates that these in-person visit requirements are currently set to take effect for services furnished on or after Jan. 1, 2025. Congress would need to extend previous statutory waivers to continue to waive the in-person visit requirements beyond Jan. 1, 2025.</p><h3>Changes to the Inpatient-only List</h3><p>For CY 2025, CMS finalizes the addition of three liver allograft services to the inpatient-only list. The American Medical Association CPT Editorial Panel for CY 2025 created the CPT codes for these three services. Additionally, CMS finalizes removing a pelvic fixation code from the inpatient-only list for CY 2025.</p><h3>Access to Non-opioid Treatments for Pain Relief</h3><p>As directed by the Consolidated Appropriations Act of 2023, CMS implements temporary additional payments for specific non-opioid treatments for pain relief dispensed in the HOPD and ASC settings from Jan. 1, 2025, through Dec. 31, 2027. CMS finalizes a calculation methodology to determine the payment limitation as required by statute. The agency finalizes six drugs and five devices that qualify for these payments, which will be paid separately.</p><p>The qualifying drugs have FDA-approved indications to reduce post-operative pain or produce postsurgical analgesia, and the qualifying medical devices have demonstrated through evidence that they reduce opioid usage when used in the postoperative setting.</p><h3>Changes to the Review Timeframes for the HOPD Prior Authorization Process</h3><p>CMS reduces the permissible review timeframe for prior authorization requests for relevant covered outpatient department services from 10 business days to seven calendar days for standard reviews.</p><h2>CY 2025 ASC Final Rule Changes</h2><h3>ASC Payment Update</h3><p>For CYs 2019 through 2023, CMS adopted a policy to update ASC payment rates using the hospital market basket. In light of the impact of the COVID-19 public health emergency on health care utilization, the agency extends this policy through CYs 2024 and 2025. As such, it will increase payment rates by 2.9% for ASCs that meet the quality reporting requirements under the ASC QRP.</p><h3>Changes to the List of ASC-covered Surgical Procedures</h3><p>CMS evaluates the ASC-covered procedures list (CPL) each year to determine whether procedures should be added to or removed from the list. For CY 2025, the agency finalized, with modification, the addition of 21 medical and dental procedures to the ASC CPL based on its existing regulatory criteria.</p><h2>other Final Rule Policies</h2><h3>Health and Safety Standards for Obstetrical and Other Services in Hospitals and CAHs</h3><p>CMS finalizes a new obstetrical services CoP for hospitals and CAHs as part of its efforts to improve maternal health outcomes. This new CoP encompasses organization and supervision of services, delivery of care and staff training. CMS also finalized updates to the QAPI and emergency services CoPs. In addition, the final rule includes an update to the hospital discharge planning CoP.</p><h3>Obstetrical Services</h3><h4>Organization, Supervision of Services and Delivery of Care</h4><p>Beginning Jan. 1, 2026, hospitals and CAHs offering obstetrical services must offer such services in a “well-organized” fashion and per “nationally recognized standards of practice” for both physical health and behavioral health (including mental health and substance use disorders). The final CoP also requires that hospitals delineate obstetrical privileges for all practitioners per the competencies of each practitioner and requires all units providing obstetrical services to be supervised by an experienced, trained professional.</p><p>In a departure from the proposed rule, hospitals and CAHs with obstetrical care units must keep certain supplies readily available instead of maintaining equipment for each patient care room. In addition to a call-in system, cardiac monitor, and fetal doppler or monitor, hospitals and CAHs must maintain and keep readily available protocols and provisions, including equipment, supplies and medications necessary to treat obstetric emergencies.</p><h4>Staff Training</h4><p>Beginning Jan. 1, 2027, hospitals and CAHs offering obstetrical services must train relevant staff on selected topics that reflect the services’ scope and complexity, including facility-identified evidenced-based protocols to improve care delivery in the hospital or CAH.</p><h4>QAPI</h4><p>Under the final rule, hospitals and CAHs offering obstetrical services must regularly assess and work to improve maternal health disparities and outcomes among patients. Effective Jan. 1, 2027, hospitals and CAHs must track and analyze maternal health data, quality indicators and outcomes as part of their QAPI plans and use these findings to inform and update the staff training required under the obstetrical services CoP. CMS also requires the leadership of hospital obstetrical services to engage in QAPI activities, including data collection and monitoring. Finally, hospitals and CAHs must conduct at least one QAPI project focused on improving maternal health outcomes and disparities each year. Hospitals and CAHs in state, tribal or local jurisdictions with a maternal mortality review committee must also maintain a process to incorporate publicly available data into the hospital or CAH’s QAPI program.</p><h4>Emergency Services Readiness</h4><p>CMS has also finalized updates to the existing emergency services CoP for all hospitals and CAHs that offer emergency services, regardless of whether such hospital or CAH offers obstetrical services. Effective July 1, 2025, hospitals and CAHs must maintain adequate provisions and protocols to meet the emergency needs of patients per the offered emergency services’ complexity and scope, including but not limited to obstetrical emergencies. For hospitals, these provisions must include readily available equipment, supplies and medication necessary for treating emergency cases and a call-in system for each patient; no changes were made to existing requirements for equipment, supplies and medications for CAHs. For both hospitals and CAHs, applicable staff must be trained on these protocols and provisions annually, and findings from the hospital or CAH’s QAPI program should inform training topics and updates or other revisions to the training program.</p><h4>Transfer Protocols</h4><p>Beginning July 1, 2025, CMS will require hospitals to develop and maintain policies for transferring patients to the appropriate level of care, including among units within a facility and transfers to other hospitals. Relevant staff must receive annual training on these protocols. CMS did not change discharge planning requirements for CAHs.</p><h3>Changes to Medicaid Clinic Services Four Walls Exceptions</h3><p>CMS finalizes its proposal to add three exceptions to the four walls requirements for Medicaid clinic services: a mandatory exception for Indian Health Service (IHS) and Tribal clinics and optional exceptions for behavioral health clinics and clinics located in rural areas. Medicaid clinic services are distinct and separate from services provided in a Federally-Qualified Health Center (FQHC) or FQHC look-alike. In finalizing provisions related to clinics in rural areas, CMS allows states to adopt a definition of rural in use by certain federal agencies or a state’s rural policy-making agency and requires the state to attest that the definition best captures the rural population.</p><h3>IHS and Tribal Hospitals All-inclusive Rate</h3><p>Currently, IHS and tribal outpatient departments are excluded from the Medicare OPPS and are paid the Medicare outpatient hospital all-inclusive rate (AIR). IHS determines the AIR from cost reports and updates these rates annually. IHS and tribal hospitals have increasingly provided higher-cost drugs along with more complex and expensive services, such as cancer-related services. CMS believes that the AIR may no longer be adequate for these hospitals’ costs to provide these complex services and finalizes its proposals to pay an add-on to the AIR for certain high-cost drugs for people with Medicare who receive care at IHS or tribal hospitals.</p><h2>Further Questions</h2><p>The policies and payment rates in the final rule will take effect Jan. 1, 2025. Watch for a more detailed analysis of the final rule in the coming weeks.</p><p>If you have further questions, contact Roslyne Schulman, AHA’s director of outpatient payment policy, at <a href="mailto:rschulman@aha.org?subject=RE: Special Bulletin: CMS Outpatient PPS and ASC Final Rule for CY 2025 ">rschulman@aha.org</a>.</p><hr><ol><li id="fn1">The final National Coverage Determination can be found at <a href="https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=310&fromTracking=Y&" target="_blank">NCA - Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus (HIV) Infection (CAG-00464N) - Decision Memo</a>.</li></ol></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/11/Special-Bulletin-CMS-Issues-Hospital-Outpatient-Ambulatory-Surgical-Center-Final-Rule-for-CY-2025.pdf" target="_blank" title="Click here to download the Special Bulletin: CMS Outpatient PPS and ASC Final Rule for CY 2025 PDF."><img src="/sites/default/files/inline-images/Page-1-Special-Bulletin-CMS-Issues-Hospital-Outpatient-Ambulatory-Surgical-Center-Final-Rule-for-CY-2025.png" data-entity-uuid="350cb966-8e0d-481d-b427-38503d8bfd7f" data-entity-type="file" alt="Special Bulletin: CMS Issues Hospital Outpatient, Ambulatory Surgical Center Final Rule for CY 2025 page 1." width="696" height="900"></a></p></div></div></div> Mon, 04 Nov 2024 15:20:37 -0600 Outpatient Prospective Payment Systems (OPPS) /press-releases/2024-11-01-aha-statement-cy-2025-opps-final-rule <p class="text-align-center"><strong>Ashley Thompson</strong><br><strong>Senior Vice President, Public Policy Analysis and Development</strong><br><strong>���������� Association</strong></p><p class="text-align-center"><strong>November 1, 2024</strong></p><p>Medicare's sustained and substantial underpayment of hospitals has stretched for almost two decades, and today's final outpatient rule only worsens this chronic problem. The agency's final increase of less than 3% for outpatient hospital services will make the provision of care, investments in the health care workforce, and addressing new challenges, such as cybersecurity threats, more difficult. These inadequate payments will have a negative impact on patient access to care, especially in rural and underserved communities nationwide.</p><p>The AHA fully shares CMS’ goals of improving maternal health outcomes and reducing inequities in maternal care. While we appreciate that the final rule provides hospitals with additional implementation time and greater flexibility in how they meet certain requirements, we remain concerned about CMS’ excessive use of Conditions of Participation to drive its policy agenda and the potential risk for these requirements to inadvertently reduce access to maternal care. We believe a less punitive and more collaborative approach would be more effective given that the key drivers of maternal health outcomes are highly complex and involve multiple stakeholders. The AHA remains committed to working with the Administration and other stakeholders to advance a full range of solutions to improve maternal outcomes.</p><p class="text-align-center"><br>###</p> Fri, 01 Nov 2024 16:57:13 -0500 Outpatient Prospective Payment Systems (OPPS) /news/headline/2024-11-01-opps <p>The Centers for Medicare & Medicaid Services Nov. 1 issued a <a href="https://www.federalregister.gov/public-inspection/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical" target="_blank">final rule</a> that increases Medicare hospital outpatient prospective payment system rates by a net 2.9% in calendar year 2025 compared to 2024. This includes a 3.4% market basket update, offset by a 0.5 percentage point cut for productivity. <br><br>In a <a href="/press-releases/2024-11-01-aha-statement-cy-2025-opps-final-rule" target="_blank">statement</a> shared with the media, AHA Senior Vice President Ashley Thompson said, “Medicare's sustained and substantial underpayment of hospitals has stretched for almost two decades, and today's final outpatient rule only worsens this chronic problem. The agency's final increase of less than 3% for outpatient hospital services will make the provision of care, investments in the health care workforce, and addressing new challenges, such as cybersecurity threats, more difficult. These inadequate payments will have a negative impact on patient access to care, especially in rural and underserved communities nationwide.</p><p>The AHA fully shares CMS’ goals of improving maternal health outcomes and reducing inequities in maternal care. While we appreciate that the final rule provides hospitals with additional implementation time and greater flexibility in how they meet certain requirements, we remain concerned about CMS’ excessive use of Conditions of Participation to drive its policy agenda and the potential risk for these requirements to inadvertently reduce access to maternal care. We believe a less punitive and more collaborative approach would be more effective given that the key drivers of maternal health outcomes are highly complex and involve multiple stakeholders. The AHA remains committed to working with the Administration and other stakeholders to advance a full range of solutions to improve maternal outcomes.”<br><br>In addition, CMS finalized its proposals to adopt three measures related to health equity for the outpatient, ambulatory surgical center and rural emergency hospital quality reporting programs and to extend voluntary data reporting for two hybrid measures in the Inpatient Quality Reporting Program.</p><p>The rule also finalizes several changes to payment for drugs. These include providing separate payment for diagnostic radiopharmaceuticals with per-day costs above a threshold of $630, excluding certain qualifying cell and gene therapies from packaging under the comprehensive ambulatory payment classification policy, and paying for HIV pre-exposure prophylaxis drugs and related services in hospital outpatient departments.</p><p>CMS also finalized new and updated Medicare Conditions of Participation for hospitals and critical access hospitals, including new standards focused on obstetrical services and maternal health care. Beginning January 2026, CMS will phase in certain requirements for hospitals and CAHs that offer maternal health services, including standards for the availability of certain obstetric equipment and staff training. In addition to the maternal care requirements, CMS finalized a discharge planning standard for transfer protocols and established new emergency services requirements for certain types of equipment and supplies and staff training. The discharge planning and emergency services requirements will also be phased beginning in July 2025.</p><p>The final rule goes into effect Jan. 1. AHA members will receive a Special Bulletin Nov. 4 with more details.</p> Fri, 01 Nov 2024 15:08:36 -0500 Outpatient Prospective Payment Systems (OPPS) /lettercomment/2024-09-09-aha-comments-cms-outpatient-ambulatory-surgery-center-cy-2025-proposed-payment-rule <div class="container"><div class="row"><div class="col-md-8"><p>September 9, 2024</p><p>The Honorable Chiquita Brooks-LaSure<br>Administrator<br>Centers for Medicare & Medicaid Services<br>Hubert H. Humphrey Building<br>200 Independence Avenue, S.W., Room 445-G<br>Washington, DC 20201</p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2024/09/AHA-Comments-on-CMS-Outpatient-Ambulatory-Surgery-Center-CY-2025-Proposed-Payment-Rule.pdf" target="_blank" title="Click here to download the AHA Comments on CMS Outpatient, Ambulatory Surgery Center CY 2025 Proposed Payment Rule letter PDF.">Download the Full Letter PDF</a></div></div></div><div class="row"><div class="col-md-8"><p><em><strong>Re: CMS–1809–P: Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities (Vol. 89, No. 140), July 22, 2024.</strong></em></p><p>Dear Administrator Brooks-LaSure:</p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2025.</p><p>We support many of the OPPS proposed rule provisions, including unpackaging and paying separately for certain high-cost diagnostic radiopharmaceuticals, unpackaging from the comprehensive ambulatory payment classifications (C-APCs) and paying separately for certain cell and gene therapy products, and establishing new add-on payment for hospitals that use Technetium-99m (Tc-99m) derived from domestically produced Molybdenum-99 (Mo-99). We also appreciate that in response to comments from AHA and its members, the agency is considering reducing the reporting burden of its policy that helps offset the marginal costs that hospitals face in procuring domestically made surgical N95 respirators.</p><p>At the same time, the AHA continues to have strong concerns about the shortcomings in the annual payment update for hospital outpatient departments (HOPDs), in particular the market basket forecast and update. This is especially concerning considering past underwhelming market basket increases, specifically from CYs 2022 through 2024. Indeed, the forecasts on which CMS relies have consistently under-predicted cost growth, and the actual market basket increases are falling well short of inflation. <strong>Therefore, AHA urges CMS to consider whether adjustments are necessary in its approach to annual market basket updates to ensure that beneficiaries continue to have access to high-quality outpatient care. We also urge CMS to eliminate the productivity cut for CY 2025, as detailed below.</strong></p><p><strong>Further, the AHA shares CMS’ commitment to improving maternal health outcomes. However, we are concerned that CMS’ proposed CoPs fail to address the root causes behind poor maternal outcomes and may further reduce access to safe, high-quality obstetric care.</strong> Any potential solution to this crisis must consider the entire maternal health continuum and should prioritize the needs of pregnant and postpartum women. Instead of issuing duplicative and unnecessary regulations, the AHA urges CMS to partner with patients and the hospitals and health systems that serve them to address maternal morbidity and mortality causes. We believe a collaborative approach focused on patients not facilities will lead to meaningful patient outcome improvements while preserving access to safe, high-quality maternal health care.</p><p>We appreciate your consideration of these issues. Our detailed comments are attached. Please contact me if you have questions or feel free to have a member of your team contact Roslyne Schulman, AHA’s director for policy, at <a href="mailto:rschulman@aha.org?subject=RE: AHA Comments on CMS Outpatient, Ambulatory Surgery Center CY 2025 Proposed Payment Rule">rschulman@aha.org</a>.</p><p>Sincerely,</p><p>/s/</p><p>Ashley B. Thompson<br>Senior Vice President<br>Public Policy Analysis and Development</p><p><a href="/system/files/media/file/2024/09/AHA-Comments-on-CMS-Outpatient-Ambulatory-Surgery-Center-CY-2025-Proposed-Payment-Rule.pdf" target="_blank" title="Click here to download the AHA Comments on CMS Outpatient, Ambulatory Surgery Center CY 2025 Proposed Payment Rule letter PDF.">Download the complete letter PDF.</a></p></div><div class="col-md-4"><div class="external-link spacer"><a href="/system/files/media/file/2024/09/AHA-Comments-on-CMS-Outpatient-Ambulatory-Surgery-Center-CY-2025-Proposed-Payment-Rule.pdf" target="_blank" title="Click here to download the AHA Comments on CMS Outpatient, Ambulatory Surgery Center CY 2025 Proposed Payment Rule letter PDF."><img src="/sites/default/files/inline-images/Page-1-AHA-Comments-on-CMS-Outpatient-Ambulatory-Surgery-Center-CY-2025-Proposed-Payment-Rule.png" data-entity-uuid="3db1f84b-c317-425e-aa5a-f5e73a1f41b2" data-entity-type="file" alt="AHA Comments on CMS Outpatient, Ambulatory Surgery Center CY 2025 Proposed Payment Rule letter page 1." width="761" height="900"></a></div></div></div></div> Mon, 09 Sep 2024 15:07:48 -0500 Outpatient Prospective Payment Systems (OPPS) Thu, 29 Aug 2024 15:16:09 -0500 Outpatient Prospective Payment Systems (OPPS) <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare & Medicaid Services (CMS) July 10 released its calendar year (CY) 2025 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) <a href="https://public-inspection.federalregister.gov/2024-15087.pdf" target="_blank" title="Federal Register: Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities">proposed rule</a>. The rule would increase OPPS rates by a net 2.6% in CY 2025 compared to CY 2024. The rule also includes proposals for new conditions of participation (CoPs) focused on obstetrical services and maternal care, separate payment for high-cost diagnostic radiopharmaceuticals and three years of separate payment for certain non-opioid drugs and devices that provide pain relief.</p><p>The final rule will be published on or around Nov. 1 and take effect Jan. 1, 2025. CMS will accept comments on the proposed rule through Sept. 9.</p><div class="panel module-typeC"><div class="panel-heading"><h2>Key Highlights</h2><p>CMS’ proposed rule would:</p><ul><li>Increase Medicare hospital OPPS rates by a net 2.6% in CY 2025.</li><li>Pay separately for diagnostic radiopharmaceuticals with per-day costs above $630.</li><li>Exclude qualifying cell and gene therapies from comprehensive ambulatory payment classification (C-APC) packaging in CY 2025.</li><li>As required by law, implement temporary additional payments for certain non-opioid treatments for pain relief dispensed in the hospital outpatient department (HOPD) and ASC settings.</li><li>Adopt three new measures related to health equity for the Outpatient, ASC and rural emergency hospital (REH) Quality Reporting Programs.</li><li>Establish a new obstetrical services CoP and update existing quality assessment performance improvement (QAPI), emergency readiness and discharge planning CoPs for hospitals and critical access hospitals.</li><li>Extend virtual direct supervision of cardiac rehabilitation (CR), intensive cardiac rehabilitation (ICR) and pulmonary rehabilitation (PR) services and diagnostic services furnished to hospital outpatients through Dec. 31, 2025.</li><li>Remove barriers to providing certain clinic services outside the four walls of a clinic, which could improve access for some Medicaid beneficiaries.</li></ul></div></div><h2>AHA Take</h2><p>We are disappointed that CMS again proposed an inadequate update to hospital payments. This increase for outpatient hospital services of only 2.6% would come despite the fact that many hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging. Hospitals and health systems’ ability to continue caring for patients and providing essential services for their communities may be in jeopardy, and we urge CMS to provide additional support in the final rule.</p><p>In addition, we fully share CMS’ goals of improving maternal health outcomes and reducing inequities in maternal care. However, we are deeply concerned by CMS’ continued and excessive use of CoPs to drive its policy agenda. We believe a less punitive and more collaborative and flexible approach is far superior. We will carefully review CMS’ proposals to determine whether they are feasible, sufficiently flexible for the wide variety of hospitals to which they would apply and do not inadvertently exacerbate maternal care access challenges.</p><h2>What You Can Do</h2><ul><li><strong>Participate in an AHA members-only webinar on Aug. 6 at 2:30 p.m. ET</strong> to share your questions and feedback on this regulation for AHA’s comment letter to CMS. <a href="https://aha.adobeconnect.com/cy2025oppsasc/event/registration.html" target="_blank" title="AHA: Members-ONLY Webinar for the CY 2025 OPPS/ASC Proposed Rule">Register for this 90-minute webinar.</a></li><li><strong>Share this advisory with your senior management team</strong> and ask your chief financial officer to examine the impact of the proposed payment changes on your Medicare revenue for CY 2025. Spreadsheets comparing the proposed changes in the APC payment rates and weights from 2024 to 2025 are available on the <a href="/topics/outpatient-pps">AHA’s OPPS webpage</a>. To access these, you must be logged on to the website.</li><li><strong>Share this advisory with your billing, medical records, quality improvement and compliance departments and your clinical leadership team</strong> to apprise them of the proposals around the APCs, CoPs and quality measurement requirements.</li><li><strong>Submit comments to CMS with your specific concerns by Sept. 9 at </strong><a href="https://www.regulations.gov" target="_blank" title="Regulations.gov homepage"><strong>www.regulations.gov</strong></a><strong>.</strong></li></ul><p><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf">View the full Regulatory Advisory PDF</a> or use the table of contents below to navigate to specific sections.</p><h2>Contents</h2><ol><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=5">OPPS Proposed Rule Changes</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=5">OPPS Update and Linkage to Hospital Quality Data Reporting</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=5">Data Proposed for Use in CY 2025 OPPS and ASC Rate Setting</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=5">Proposed Site-neutral Payment Policies for Off-campus Provider-based Departments (PBDs)</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=6">Proposed Payments for Drugs, Biologicals and Radiopharmaceuticals</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=7">Proposed Payment Change for Diagnostic Radiopharmaceuticals</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=8">Add-on Payment for Radiopharmaceutical Technetium-99m</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=9">Request for Information on Cardiac computerized tomography Services</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=9">Proposed Recalibration and Scaling of APC Relative Weights</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=10">Area Wage Index</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=10">Rural Sole Community Hospital Adjustment</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=11">Cancer Hospital Adjustment</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=11">Comprehensive APCs</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=12">Proposed Non-Opioid Policy for Pain Relief Under the OPPS and ASC Payment System</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=13">Proposed Changes to the Inpatient-Only List</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=14">Hospital Outpatient Outlier Payments</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=14">Transitional Pass-through Payments</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=14">Beneficiary Coinsurance</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=14">Outpatient Quality Reporting Program 14</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=19">Proposed Payment for Intensive Outpatient and Partial Hospitalization Programs</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=20">Remote Services</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=20">Outpatient Therapy, Diabetes Self-management Training, and Medical Nutrition Therapy</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=21">Proposed Health and Safety Standards for Obstetrical Services in Hospitals and critical access hospitals</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=21">New and Updated CoPs Related to Maternal Health</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=22">ASC Proposed Rule Changes</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=22">ASC Payment Update</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=23">Proposed Changes to ASC Covered Procedures List</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=23">ASC Quality Reporting Program</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=26">REH Quality Reporting Program</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=27">Other Quality-Related Provisions</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=29">Other Issues</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=29">All-Inclusive Rate Add-on for High-Cost Drugs Provided by the Indian Health Service and Tribal Hospitals</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=29">RFI: Paying all IHS and Tribally Operated Clinics the IHS Medicare Outpatient AIR</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=30">Coverage Changes for Colorectal Cancer Screening Services</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=30">Request for Comment on Payment Adjustments under the Inpatient PPS and OPPS for Domestic Personal Protective Equipment</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=31">Payment for HIV Pre-Exposure Prophylaxis in HOPDs</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=31">Proposed Payment Policy for Devices in Category B Investigational Device Exemption, Clinical Trials Policy and Drugs with Medicare Coverage with Evidence Development Designation</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=32">Proposed Changes to Medicaid Clinic Services Four Walls Exceptions</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=32">Proposed Changes to the Review Timeframes for the HOPD Prior Authorization Process</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=33">Next Steps</a></li><li><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf#page=33">Further Questions</a></li></ol></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.pdf" target="_blank" title="Click here to download the Regulatory Advisory: Hospital Outpatient, Ambulatory Surgical Center Proposed Rule for CY 2025 PDF."><img src="/sites/default/files/inline-images/Page-1-Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2025.png" data-entity-uuid="297c2a11-29ab-4be0-9750-bb2378d95325" data-entity-type="file" alt="Regulatory Advisory: Hospital Outpatient, Ambulatory Surgical Center Proposed Rule for CY 2025 page 1." width="695" height="900"></a></p></div></div></div> Tue, 23 Jul 2024 13:55:59 -0500 Outpatient Prospective Payment Systems (OPPS) <div class="container"><div class="row"><div class="col-md-8"><p>Lookup Tool: The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 NPRM Addendum A Compared to July 2024">2025 NPRM Addendum A Compared to July 2024</a></p><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 NPRM Addendum B Compared to July 2024">2025 NPRM Addendum B Compared to July 2024</a></p></div></div></div> Fri, 19 Jul 2024 05:27:25 -0500 Outpatient Prospective Payment Systems (OPPS) <div class="container"><div class="row"><div class="col-md-8"><p>The Addendum A spreadsheet compares relative weights and payment rates at the APC level, using the 2025 proposed rule Addendum A compared to 2024 Addendum A.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 Addendum B Compared to July 204">2025 NPRM Addendum B Compared to July 2024</a></p><p><a href="/dataset/2024-07-19-2025-nprm-opps-lookup" target="_blank" title="2025 NPRM OPPS Lookup">2025 NPRM OPPS Lookup</a></p></div></div></div> Fri, 19 Jul 2024 05:07:46 -0500 Outpatient Prospective Payment Systems (OPPS)