- Regulation No.
- Hospital Outpatient Prospective Payment- Notice of Proposed Rulemaking (NPRM)
Medicare Program: Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Price Transparency of Hospital Standard Charges; Proposed Revisions of Organ Procurement Organizations Conditions of Coverage; Proposed Prior Authorization Process and Requirements for Certain Covered Outpatient Department Services; Potential Changes to the Laboratory Date of Service Policy; Proposed Changes to Grandfathered Children’s Hospitals-Within-Hospitals
This proposed rule proposes revisions to the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2020 based on our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
In addition, in this proposed rule, we are proposing to establish requirements for all hospitals in the United States for making hospital standard charges available to the public; establish a process and requirements for prior authorization for certain covered outpatient department services; revise the conditions for coverage of organ procurement organizations; and revise the regulations to allow grandfathered children’s hospitals-within-hospitals to increase the number of beds without resulting in the loss of grandfathered status. We also solicit comments on potential revisions to the laboratory date of service policy under the Clinical Laboratory Fee Schedule. Finally, we solicit comments on an appropriate remedy in litigation involving our OPPS payment policy for 340B-acquired drugs, which would inform future rulemaking in the event of an adverse decision on appeal in that litigation.
- CMS-1717-P (PDF) - Opens in a new window
- 2020 NPRM OPPS Cost Statistics Files - Opens in a new window
- 2020 NPRM OPPS “Data Addendum B” and “2 Times Rule” File - Opens in a new window
- 2020 NPRM OPPS Addenda Table of Contents - Opens in a new window
- 2020 NPRM OPPS Addenda - Opens in a new window
- 2020 NPRM OPPS Facility-Specific Impacts - Opens in a new window
- 2020 NPRM OPPS Blood Revenue Code Cost to Charge Ratios - Opens in a new window
- 2020 NPRM OPPS Revenue Code-to-Cost Center Crosswalk - Opens in a new window
- FY 2020 Wage Index Home Page
- Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2020 Payment Rates