The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) proposed rule. The proposed rule would revise the Medicare hospital OPPS and the Medicare ambulatory surgical center (ASC) payment system for calendar year 2019. Included are proposed changes to the amounts as well as factors used to determine the payment rates and update and refine the requirements for the quality reporting programs (QRP). Some of the proposed highlights include a proposal to pay for visits at excepted off-campus provider-based departments at a Physician Fee Schedule (PFS) equivalent payment rate, which would result in lower copayments for beneficiaries and a savings to the Medicare program; reduction to the number of measures required to report under their quality reporting programs; and modifying the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience of care survey measure by removing the three recently revised pain communication questions beginning with January 1, 2022 discharges, which would avoid any potential unintended consequences of possible opioid overprescribing.

The proposed rule will be published in the July 31, 2018 Federal Register. Comments will be accepted through September 24, 2018. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.