2021 OPPS and ASC Final Rule

The Centers for Medicare and Medicaid Services (CMS) published the Calendar Year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Highlights of the rule include the following:

1. CMS will continue the policy of paying an adjusted amount of the Average Sale Price (ASP) less 22.5 percent for drugs and biologicals acquired under the 340B program. Providers exempt from the 340B payment policy include rural sole community hospitals, PPS-exempt cancer hospitals, and children’s hospitals.
2. CMS also finalized an annual payment adjustment, and estimates an overall OPPS payment increase of 2.4 percent. 
3. CMS will phase out the Inpatient Only (IPO) list over the course of three calendar years, and the IPO will be completely eliminated by 2024.
4. Eleven procedures were added to the ASC covered procedures list (CPL), including total hip arthroplasty. CMS plans to add 267 other procedures to the list in CY 2021.
5. Restrictions on the expansion of physician-owned hospitals were eased. CMS streamlined the expansion request process for hospitals qualifying as “high Medicaid facilities.” 
6. New reporting requirements for hospitals and critical access hospitals were finalized. The requirements pertain to current inventory and usage rates of COVID-19-related therapeutics.
7. CMS is updating certain aspects of the methodology for calculating the Overall Hospital Quality Star Rating for CY 2021 and subsequent years.

Additional resources include the following:

• CMS Press Release
• CMS Fact Sheet

For more information on this topic, please contact Richard Kusserow at [email protected].

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 3,000 health care organizations and entities in developing, implementing and assessing compliance programs.