On July 25, 2018, the Centers for Medicare & Medicaid Services (CMS) released the CY 2019 Outpatient Prospective Payment System (OPPS) proposed rule, and we are seeing several efforts to continue the push towards “site neutral” payments in off-campus provider-based departments (PBDs). This rule was issued weeks after the CY 2019 Physician Fee Schedule (PFS) proposed rule, and the atypical lag time between the two rules' release had stakeholders wondering how impactful these policies would be.
As important background to this year’s proposed OPPS rule, in 2015, Congress passed a provision that started to distinguish off-campus PBDs: those that were billing under OPPS prior to November 2015 (“excepted” or old PBDs) and those that began billing under OPPS after November 2015 (“non-excepted” or new PBDs). Currently, CMS is reimbursing “non-excepted” PBDs at 40 percent of the OPPS rate as a part of a longer-term effort by the agency to equalize payments between the outpatient and physician office settings. For 2019, CMS is proposing several policies that will bring payment rates for excepted (old) PBDs in line with the lower rates at non-excepted (new) PBDs.
While ACCC staff continues to analyze the CY 2019 proposed OPPS rule, below are top-line takeaways that we think are most important for ACCC members and their patients:
ACCC is continuing to analyze both the CY 2019 OPPS and PFS proposed rules for how they will impact ACCC cancer programs and their patients.
ACCC will host a webinar for members on the proposed rules on Wednesday, August 8, 2018, from 4:00 -5:00 PM EDT. For more information and to register click here. ACCC will be submitting comments on the proposed rules and encourages our members to do the same.
Public comments are due on Monday, September 10 for the CY 2019 PFS Proposed Rule, and on Monday, September 24 for the CY 2019 OPPS Proposed Rule. ACCC members are encouraged to contact the ACCC policy team with any questions or concerns.