December 4, 2020
Outpatient Prospective Payment System Final Rule Released
CMS has finalized the 2021 Outpatient Prospective Payment system rule, which contains policies impacting outpatient payments and services provided in the outpatient setting. Key finalized policies include the elimination of the Inpatient Only List by January 2024, the addition of five new procedures requiring prior-authorization, the addition of eleven new procedures to the Ambulatory Surgical Center covered list and changes to the Overall Hospital Star Ratings. CMS is continuing the current 340B payment policy of paying ASP minus 22.5% for 340B-acquired drugs and will continue to consider “the appropriateness of using 340B hospital survey data to set future payment rates for 340B drugs.” An outline of the rule will be included in the next Policy Brief.