Medicare Program: Hospital Outpatient Prospective Payment System and CY 2012 Payment Rates; Ambulatory Surgical Center Payment System and CY 2012 Payment Rates; Additional Changes to the Hospital Value-Based Purchasing Program

Title

Medicare Program: Hospital Outpatient Prospective Payment System and CY 2012 Payment Rates; Ambulatory Surgical Center Payment System and CY 2012 Payment Rates; Additional Changes to the Hospital Value-Based Purchasing Program

This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. These proposed changes would be applicable to services furnished on or after January 1, 2012. In addition, this proposed rule would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we set forth the proposed relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these proposed changes would apply, and other proposed ratesetting information for the CY 2012 ASC payment system. These proposed changes would be applicable to services furnished on or after January 1, 2012. We are proposing to revise the requirements for the Hospital Outpatient Quality Reporting (IQR) Program, add new requirements for ASC Quality Reporting System, and make additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are proposing to allow eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. In addition, we are proposing to make changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

Posted

Jul 1, 2011

Comment period

Jul 18, 2011 – Aug 31, 2011

Agency

Centers for Medicare & Medicaid Services (CMS)

Topics

• Medicare & Medicaid

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