Access, Payment & Reimbursement Reform

Coalition Letters

ACCC joined with 240 signers in the September 12, 2018, Part B Access for Seniors and Physicians (ASP) Coalition letter to Congressional leaders. The coalition letter voices stakeholder concerns over the August 7, 2018, memo from the Centers for Medicare and Medicaid Services (CMS) that rescinds long-standing policy and allows Medicare Advantage (MA) plans to implement step therapy to manage Part B drugs in circumstances where applicable starting in 2019.
Read the Letter

CMS CY 2018 OPPS Final Rule

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period (CMS-1678-FC), which includes updates to the 2018 rates and quality provisions, and other policy changes. The final rule contains significant provisions that reduce payments to hospitals participating in the 340B Drug Pricing Program. Read the rule.

CMS CY 2018 Physician Fee Schedule Final Rule

On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released the calendar year 2018 Physician Fee Schedule (PFS) rule. Read the final PFS rule.

Archived Webinar: What You Need to Know about CMS' Final 2018 OPPS & PFS Rules

Legal experts present a one-hour (ACCC members-only) discussion about the Centers for Medicare & Medicaid (CMS) final 2018 OPPS and PFS rules. The agency's proposals under the OPPS will bring significant changes to 2018 payments for 340B hospitals and new outpatient facilities. ACCC members can access the recorded webinar, presentation slides, and rule summaries  for in-depth analysis of the final rule. [Login Required] Webinar originally presented on November 29, 2017.

Quality Payment Program (QPP)

• CMS CY 2018 QPP final rule.
• Read CMS fact sheet on the final rule here.
• Read ACCC comment letter to CMS on proposed CY 2018 QPP rule (August 21, 2017) on proposed rule updating CY 2018 QPP.
• Access ACCC webinar and summary [login required] of final QPP rule.  Webinar originally presented on December 6, 2017.
• Information on the Quality Payment Program is available here.

PQRS

• Physician Quality Reporting System
  Note: 2016 was the last program year for the Physician Quality Reporting System (PQRS). PQRS transitioned to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program. The final data submission time frame for reporting 2016 PQRS quality data to avoid the 2018 PQRS downward payment adjustment was January through March 2017.

Inpatient Prospective Payment System

• ACCC analysis of 2018 Inpatient Prospective Payment System (IPPS) final rule. Log in required.
  

Archive of ACCC Comment Letters on CMS Physician Fee Schedule:

• ACCC Comments on Proposed 2017 Physician Fee Schedule
• ACCC Comments on Proposed 2016 Physician Fee Schedule

Archive of ACCC Comment Letters to CMS on Recent OPPS Proposed Rules:

• ACCC Comments on Proposed 2018 OPPS Rule
• ACCC Comments on Proposed 2017 OPPS Rule