Skip to Main Content
Regulation No.
CMS-1525-P
Title
Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2012 Payment Rates
Year
2012

Title: Medicare Program: Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2012 Payment Rates; Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2012 Payment Rates; Proposed Additional Changes to the Hospital Inpatient Quality Reporting Program and the Hospital Value-Based Purchasing Program

Medicare and Medicaid Programs: Proposed Changes to Physician Self-Referral Rules and Provider Agreement Regulations on Patient Safety

Publication Date: July 18, 2011

Summary: This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. These proposed changes would be applicable to services furnished on or after January 1, 2012.

In addition, this proposed rule would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we set forth the proposed relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these proposed changes would apply, and other proposed ratesetting information for the CY 2012 ASC payment system. These proposed changes would be applicable to services furnished on or after January 1, 2012.

We are proposing to revise the requirements for the Hospital Outpatient Quality Reporting (IQR) Program, add new requirements for ASC Quality Reporting System, and make additional changes to provisions of the Hospital Inpatient Quality Reporting (IQR) Program and the Hospital Inpatient Value-Based Purchasing (VBP) Program.

We also are proposing to allow eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot.

In addition, we are proposing to make changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreements relating to patient safety.