Open Payments Law and Policy
Law and Policy
Open Payments is a federally mandated program that collects and publishes information about payments reporting entities make to covered recipients. The Open Payments database is publicly accessible.
Reporting entities submit information annually to the Centers for Medicare & Medicaid Services (CMS). CMS is required to publish this information on or by June 30 each year and submit an annual report to Congress.
Please note that if you have policy questions, CMS cannot comment on individual circumstances. You may wish to consult legal counsel specializing in federal compliance.
Originally enacted in 2013, the policies governing Open Payments continue to evolve. The final rule that determines Open Payments requirements is updated occasionally through official rule making.
Find more information on the following policies that impact Open Payments:
- Read the current final rule
- Section 6002 of the Patient Protection and Affordable Care Act (Public Law No. 111-148)
- Health Care and Education Reconciliation Act of 2010 (Public Law No. 111-152)
- SUPPORT for Patients and Communities Act (Public Law No. 115-271)
Read the Open Payments Fiscal Year 2021 Annual Report to Congress (PDF).
Open Payments expanded in 2021 to include five new covered recipient types. Learn more on the Newly Added Covered Recipients page.
For information about changes that will affect Applicable Manufacturers and Group Purchasing Organizations, visit the Changes for Reporting Entities page.
Open Payments Final Rule Changes
On Tuesday, November 2, 2021, CMS finalized the Calendar Year 2022 Medicare Physician Fee Schedule (PFS) Final Rule. This Final Rule includes changes to the Open Payments program to support the usability and integrity of the data for the public, researchers and reporting entities.
The Open Payments updates included in the CY2022 PFS will be effective for data collection beginning in Calendar Year 2023 and applicable to data reported in Calendar Year 2024.
A summary of the changes is available below. CMS will offer further details in the coming months as information becomes available. Please subscribe to the Open Payments email list and check back to stay up to date with the Open Payments Program.
Open Payments Through the Years
Original Final Rule
First rule change
Read the first rule change in the 2015 Physician Fee Schedule (PDF).
Second rule change
Read the second rule change in the 2020 Physician Fee Schedule (PDF).
2022 Physician Fee Schedule and Open Payments
In the Calendar Year 2022 PFS, CMS finalized the proposed changes to the Open Payments program to support the usability and integrity of the data for the public, researchers, and reporting entities. The following is a summary of the changes finalized for the Open Payments Program:
- Addition of a mandatory payment context field for records attributed to teaching hospitals
- Addition of the option for reporting entities to recertify annually even when no records are being reported by the reporting entity
- Disallowing record deletions without a substantiated reason
- Added definition for physician – owned distributorship(s) (PODs) as a subset of applicable manufacturers and group purchasing organizations as well as an updated definition of ownership interest
- Requirement for reporting entities to update their contact information
- Disallowing publication delays for general payment records
- Clarifying the exception for short-term loans; adding clarification that the exception for short term loan applies for 90 total days in in a calendar year, regardless of whether the 90 days were consecutive
- Removal of the option to submit and attest to general payment records with an “Ownership” Nature of Payment category.
The updates to the Open Payments program will be effective for data collection beginning in Calendar Year 2023 and applicable to data reported in Calendar Year 2024.
SUPPORT Act and Open Payments
The Support Act:
- Enabled Open Payments to expand the definition of a covered recipient to include five additional provider types:
- Physician Assistants
- Nurse practitioners
- Clinical nurse specialists
- Certified registered nurse anesthetists and anesthesiologist assistants
- Certified nurse midwives
- Allows CMS to publish National Provider Identifiers (NPIs) within the Open Payments Data
2020 Physician Fee Schedule and Open Payments
In addition to the changes outlined in the SUPPORT Act above, the 2020 Physician Fee Schedule Final Rule includes:
- Updates to the Natures of Payment categories to add debt forgiveness, long term medical supply or device loan, and acquisitions
- Consolidation of the Continuing Medical Education and Natures of Payment into one category
- Additional reporting requirements for the ‘device identifier’ component of the unique device identifier for devices and medical supplies, which will help standardize data
Changes enacted by the SUPPORT Act and the 2020 Physician Fee Schedule applies to Open Payments data collected in calendar year 2021. This is the data that reporting entities will submit to CMS in 2022.