CMS-1736-P

Medicare Program:  Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Addition of New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule:  Potential Revisions to the Laboratory Date of Service Policy; Proposed Overall Hospital Quality Star Rating Methodology for Public Release in CY 2021 and Subsequent Years; and Physician-owned Hospitals

This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2021 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.  Also, 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, this proposed rule would establish and update the Overall Hospital Quality Star Rating beginning with the  CY 2021; remove certain restrictions on the expansion of physician-owned hospitals that qualify as “high Medicaid facilities,” and clarify that certain beds are counted toward a hospital’s baseline number of operating rooms, procedure rooms, and beds; and add two new service categories to the OPD Prior Authorization Process.

The proposed rule (CMS-1736-P) is available in the "Related Links" section below. The supporting files are located in the "Downloads" section below: