Law and Policy
Open Payments Program Year 2017 Report to Congress
- The Open Payments Annual Report to Congress is now available. Read the full report here.
- This annual report outlines the program timeline, key activities, and the Program Year 2018 data publication. The report also includes aggregated information about applicable manufacturers and group purchasing organizations (GPOs).
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
- CMS is proposing changes to the Open Payments rule within the 2020 Physician Fee Schedule proposed rule. In addition to the changes outlined in the SUPPORT Act, CMS proposes the following items:
- Updates to the Nature of Payment categories
- Proposal to add three new nature of payment categories:
- Debt forgiveness
- Long term medical supply or device loan
- Proposal to consolidate the medical education program nature of payment categories into one
- Standardizing data on reported products
- Proposal to add a reporting requirements for the ‘device identifier’ component of the unique device identifier for devices and medical supplies
- The expanded definition of a covered recipient implemented in the SUPPORT Act applies to information required to be submitted on or after January 1, 2022. CMS proposes that this, as well as the other changes listed above, be effective for data collected beginning in calendar year 2021 as this is the data that will be reported to CMS in 2022.
Feedback on the Proposed Rule
The provisions of the SUPPORT Act that impact the Open Payments program appears as a rider to the 2020 Physician Fee Schedule.
- CMS is formally soliciting feedback via comments on the Physician Fee Schedule, which is available now through September 27, 2019. Further instructions for submitting public comments are included on page two (2) of the proposed rule. Please note that CMS will not respond to comments individually, but will give feedback in aggregate once the comment period is complete.
- Page last Modified: 07/30/2019 12:21 PM
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