CMS proposes 2022 OPPS rates, higher hospital price transparency penalty

July 22, 2021 – CMS is seeking greater hospital price transparency enforcement through the newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year 2022.

The proposed rule would make changes to dozens of health policies, among those changes would be an increase in the monetary penalty CMS can impose on hospitals that fail to comply with the price transparency requirements that took effect January 1, 2021.

Those requirements include publishing payer-specific negotiated rates and other pricing information on the hospital’s public website and providing a consumer-friendly list of prices for shoppable services.

If the rule is finalized as is, the penalties would increase to a minimum civil monetary penalty of $300 per day for smaller hospitals with a bed count of 30 or fewer and $10 per bed per day for hospitals with a bed count greater than 30, up to a daily dollar amount of $5,500.

For a full calendar year of noncompliance, hospitals could be penalized a minimum of $109,500 per hospital and a maximum of $2,007,500.

The CY 2022 OPPS proposed rule would also boost hospital Medicare reimbursement next year by 2.3%. The increase is based on the projected hospital market basket increase of 2.5% reduced by 0.2 percentage points for the productivity adjustment.

Additionally, ambulatory surgical centers (ASCs) will see a 2.3% increase in Medicare reimbursement next year as long as the facilities meet relevant quality reporting requirements.

CMS proposed to maintain the payment rate of average sales price (ASP) minus 22.5% for certain separately payable drugs or biologicals acquired through the 340B Drug Pricing Program. The payment rate was implemented under the Trump administration in 2018 and significantly cut hospital reimbursement for facilities participating in the federal program.

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