Law and Policy
Law and Policy
Text of the Law
Open Payments is defined in Section 6002 of the Patient Protection and Affordable Care Act (Public Law No. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law No. 111-152) and the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the “SUPPORT for Patients and Communities Act” (Public Law No. 115-271).
Read the current rule.
SUPPORT for Patients and Communities Act – Impact on Open Payments
On October 24, 2018, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). This Act impacts Open Payments in the following ways:
- Expands the Open Payment’s definition of a covered recipient to include five additional provider types:
- Physician Assistants
- Nurse practitioners
- Clinical nurse specialists
- Certified registered nurse anesthetists
- Certified nurse midwives
- Phases out the exclusion from making National Provider Identifiers (NPIs) publicly available
On Friday November 1, 2019, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020. The final rule also included several changes to the Open Payments Program.
Under this Final Rule the Open Payments program is impacted in the following ways:
- In response to the statutory changes included in the SUPPORT Act the definition of a “covered recipient” is expanded to include five additional provider types.
The added provider types are:
- Physician assistants,
- Nurse practitioners,
- Clinical nurse specialists,
- Certified registered nurse anesthetists, and
- Certified nurse midwives. This is in response to statutory changes included in the SUPPORT Act
- The Nature of Payment categories are updated to include three new categories:
- debt forgiveness,
- long term medical supply or device loan, and
In addition, the two categories related to education programs will be combined into one.
- Standardizing data on reported products
- added reporting requirements for the ‘device identifier’ component of the unique device identifier for devices and medical supplies.
Per the SUPPORT Act, the changes listed above apply to information required to be submitted on or after January 1, 2022.
This will be effective for data collection beginning in calendar year 2021 as this is the data that will be reported to CMS in 2022.