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July 19, 2021

CMS Releases Proposed Outpatient Prospective Payment System Rule, Continuing Several Controversial Policies

The Centers for Medicare & Medicaid Services (CMS) has released its proposed outpatient prospective payment system (OPPS) rule for calendar year 2022. To the disappointment of many in the hospital industry, the rule proposes to continue a pair of controversial policies initiated under the prior administration. Specifically, CMS proposes to continue steep reimbursement cuts of 30% for 340B hospitals, paying ASP minus 22.5% for drugs acquired through the 340B program rather than the historical rate of ASP plus 6%. This policy has been the subject of litigation, which is now before the Supreme Court and will be addressed in the Court’s next term. CMS also doubled down on its policy to require public reporting of standard charges, proposing to increase the penalty for non-compliance from $300/day to a maximum of $5,500/day (on a sliding scale basis by bed size), which would make the maximum penalties for a year approximately $2 million.