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CMS Releases 2012 OPPS Proposed Rule

Michelle Leppert, for HealthLeaders Media, July 6, 2011

In addition, CMS has proposed to decrease the payment for all separately payable drugs and biologicals without pass-through status from the current average sales price (ASP)+5%,to ASP + 4%.

The payment reduction is bad enough, says Shah, and may be due in part to the proposal to increase the drug packaging threshold. It could get worse in the final rule as CMS clearly indicates that the final ASP plus percentage could drop by a percentage point when everything is factored in, she adds. “Therefore hospitals need to take a look at this in the proposed rule, provide comments to CMS, and begin preparing their facilities for this potential payment reduction.”

Supervision requirements for outpatient therapeutic services

For CY 2011, CMS finalized a number of changes to physician supervision requirements for hospitals. Most notably, CMS created a new category of nonsurgical extended duration therapeutic services, which require direct supervision at the initiation of the service but can then be followed by general supervision for the remainder of the service. Furthermore, CMS stated its plan to convene a panel to review the supervision level of additional services that might be added to this category of nonsurgical extended duration services as well as other services. Finally, CMS did not enforce the supervision requirements for CAHs in 2011 but indicated that it would do so in the near future.

In the 2012 OPPS proposed rule, CMS has a lengthy discussion about its proposal to use the existing APC Advisory Panel with some modifications, including the addition of panel members from the CAH and rural hospital community, to review the supervision levels of services brought to its attention. CMS outlines the process it proposes along with its plan on handling requests for services to review and other criteria it expects to use. As a result, CMS also proposes to extend its non-enforcement policy of supervision requirements to CAHs. This means CAHs will be exempt from these requirements for one more year, says Shah.

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