SHARE

October 14, 2021

Once Again, CMS Retracts Major Policy Decision

You've Reached Your
Free Article Limit This Month
Register for free to get unlimited access to all Law.com OnPractice content.
Register Now

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, or Brianna J. Santolli

CMS Continues to Reverse Some Policy Decisions With Its Release of the Outpatient Prospective Payment System Proposed Rule

Centers for Medicare & Medicaid Services ("CMS") released its Outpatient Prospective Payment System ("OPPS") proposed rule for 2022, which reverses some of last year's major policy changes that were applauded by ambulatory surgery centers ("ASCs"). Significantly, CMS proposes reinstatement of the inpatient‑only ("IPO") list. Under the proposed rule, the 298 services removed from the IPO list this year would be added back to the IPO list in 2022. CMS also proposes eliminating the 258 procedures added to the ASC covered procedures list in January 2021.

The proposed rule continues with more bad news for hospitals. For example, CMS decided to increase the penalties for failure to comply with its price transparency rule. Hospitals with more than 30 beds in violation of the rule would pay $10 per day for each bed, up to $5,500 per day. Hospitals with 30 beds or fewer would continue to pay up to $300 per day. This would make the annual penalty at least $109,500.  The penalties could go as high as $2 million a year for large hospitals. Making matters worse, the proposed rule is continuing its lower payment rates for 340B drugs by proposing to pay hospitals 22.5 percent less than the average sales price for 340B-acquired drugs. 

The proposed rule is set to increase the OPPS rates by 2.3 percent in 2022, which would yield an estimated $82.7 billion in payments to providers, up about $10.8 billion from 2021. 

Comments are due September 17, 2021.

CMS Releases Physician Fee Schedule Proposed Rule

86 FR 39104 - CMS released its Physician Fee Schedule ("PFS") proposed rule for 2022. Controversially, at a time where physicians' practices have been severely impacted by the COVID‑19 pandemic, resulting in a logjam of patients in need of surgical care, the proposed rule decreases the conversion factor to $33.58, down from $34.89 in 2021. CMS also noted that the 3.75 percent payment increase from the Consolidated Appropriations Act of 2021 is set to expire at the end of this year, which will result in reduced payments to physicians.

The rule proposes further expansion of telehealth, including, but not limited to, reimbursing providers for certain mental and behavioral healthcare services, allowing Medicare patients to access telehealth services from their homes, eliminating certain geographic restrictions, and using audio‑only communication technology for the diagnosis, evaluation, or treatment of mental health disorders. Additionally, CMS proposes extending coverage of certain services added to the Medicare telehealth list during the pandemic through December 31, 2023, to give CMS more time to evaluate whether the services should be permanently added to the telehealth list.

CMS also proposes increasing the Merit-based Incentive Payment System performance threshold score, allowing physician assistants to bill Medicare directly, and giving accountable care organizations more time to transition to electronic reporting.

Comments are due September 13, 2021.

ALM expressly disclaims any express or implied warranty regarding the OnPractice Content, including any implied warranty that the OnPractice Content is accurate, has been corrected or is otherwise free from errors.

More From Riker Danzig Scherer Hyland & Perretti LLP

SEC May Require Advisers and Funds to Draft Cybersecurity Policies and Disclose Incidents

By Michael P. O'Mullan Riker Danzig Scherer Hyland & Perretti LLP February 11 , 2022

Following the rise of cybercrime and on the coattails of the Federal Trade Commission (FTC), the Office of the Comptroller of the Currency (OCC), the Board of Governors of the Federal Reserve System (FRB) and the Federal Deposit Insurance Corporation (FDIC) promulgating final rules concerning cybersecurity requirements for the financial services sector, we knew that the U.S. Securities and Exchange Commission (SEC) was not far behind.

New York Insurance Disclosure Act May Cause Significant Changes In New York State Court Lawsuits

By Brian E. O’Donnell Riker Danzig Scherer Hyland & Perretti LLP February 10 , 2022

On December 31, 2021, New York Governor Kathy Hochul signed into law the Comprehensive Insurance Disclosure Act (the “Act”)

FINRA to Prioritize Cryptocurrency, Options Account Paperwork, and Expungement Reform in 2022

By Michael P. O'Mullan Riker Danzig Scherer Hyland & Perretti LLP January 24 , 2022

During a January 19, 2021, webinar with the SIFMA Compliance & Legal Society, FINRA president and CEO Robert Cook discussed with participants FINRA’s priorities for 2022.

More From Health Care Law

CY 2023 Physician Fee Schedule Proposed Rule

By McDermott Will & Emery attorneys McDermott Will & Emery September 28 , 2022

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B Proposed Rule, which was published in the Federal Register on July 29, 2022.

Want to Provide Abortion Travel Benefits at Your Company? Here's How to Protect Employees

By Sarah G. Raaii McDermott Will & Emery September 01 , 2022

Companies that have come forward to offer travel benefits to employees going out of state to obtain an abortion face a vexing question: How can they avoid creating a paper trail that law enforcement could access to confirm that an individual has received an abortion?

Status Update: Federal Contractor Vaccine Mandate Injunction Narrowed

By Lila A. Sevener Ballard Spahr August 29 , 2022

On August 26, 2022, the United States Court of Appeals for the Eleventh Circuit narrowed the nationwide injunction of Executive Order 14042, which requires federal contractors and employees who work on or in connection with a covered federal contract, or share a workplace with another employee who works on or in connection with such contracts, to be fully vaccinated against COVID-19.

Featured Stories
Closeclose
Search
Menu

Working...