CMS Releases 2012 OPPS Proposed Rule

The increase would be equal to percentage difference between the cancer hospital’s individual PCR and the weighted average PCR of other OPPS hospitals. This must be done in a budget neutral manner according to the Affordable Care Act. Therefore CMS indicates in the proposed rule that this provision will cause a 0.6% reduction to the payment rates for non-cancer OPPS hospitals.

Another payment adjustment that will impact final payment rates is due to CMS’ proposal to complete its transition to using full community mental health centers (CMHC) data to set the CMHC partial hospitalization program (PHP) APC per diem payment rates. However, if finalized, this proposal will result in a 0.2% payment increase for all other hospitals. These are two examples of adjustments to the final conversion factor that impact it going up and down.

Payment for partial hospitalization services

CMS proposed to continue with its methodology for creating separate APCs for partial hospitalization when provided in the hospital setting vs. in a CMHC despite the lawsuit that was brought against the agency earlier this year. CMS has proposed to update the existing four CMHC PHP APC payment rates—two for freestanding community mental health center (CMHC) PHPs, and two for hospital-based PHPs. Under the proposal, CMS would pay:

• $97.78 for APC 0172 (level 1 partial hospitalization for CMHC)
• $113.62 for APC 0173 (level II partial hospitalization CMHC)
• $162.34 for APC 0175 (level 1 partial hospitalization for hospital-based PHPs)
• $189.87 for APC 0176 (level II Partial Hospitalization for hospital-based PHPs)

Drugs and pharmacy costs

CMS has proposed to increase the drug packaging threshold from $70 today to $80 for CY 2012, which means that more drugs are likely to be packaged.