CMS Issues FY 2018 OPPS and ASC Payment System Final Rule

PUBLISHED: Nov 3, 2017
Relevant to: Ambulatory Care, Critical Access Hospitals, Hospitals

On November 1, CMS issued the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period, which includes updates to the 2018 rates and quality provisions and other policy changes. CMS adopted a number of policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare.

CMS is increasing the OPPS payment rates by 1.35 percent for 2018. The change is based on the hospital market basket increase of 2.7 percent minus both a 0.6 percentage point adjustment for multi-factor productivity and a 0.75 percentage point adjustment required by law. After considering all other policy changes under the final rule, including estimated spending for pass-through payments, CMS estimates an overall impact of 1.4 percent payment increase for providers paid under the OPPS in CY 2018.

The Final Rule Includes:

  • Patients over Paperwork Initiative
  • Payment for drugs and biologicals purchased through the 340B drug pricing program
  • Supervision of hospital outpatient therapeutic services
  • Packaging of low-cost drug administration services
  • Inpatient only list
  • High cost/low cost threshold for packaged skin substitutes
  • Revisions to the laboratory date of service policy
  • Partial Hospitalization Program rate setting
  • Comment solicitation on ASC payment reform
  • ASC covered procedures list
  • Hospital Outpatient Quality Reporting Program
  • Ambulatory Surgical Center Quality Reporting Program

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