CMS NEWS
FOR IMMEDIATE RELEASE
July 25, 2018
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS Empowers Patients and
Ensures Site-Neutral Payment in Proposed Rule
Outpatient Prospective Payment System (OPPS) & Ambulatory
Surgical Center (ASC) proposed rule advances CMS commitment to increasing
transparency and lowering drug prices
Today, the Centers for Medicare & Medicaid Services (CMS) took steps
to strengthen the Medicare program with proposed changes to ensure that
seniors can access the care they need at the site of care that they choose.
In addition, as part of the agency’s ongoing efforts to lower drug prices
as outlined in the President’s Blueprint, CMS included a Request for
Information on how best to develop a model leveraging authority provided to
the agency under the Competitive Acquisition Program (CAP) to strengthen
negotiations for prescription drugs.
“Our healthcare system should always put patients first, and CMS today
is taking important steps to empower patients and provide more affordable
choices and options,” said CMS Administrator Seema Verma. “In line with
President Trump and Secretary Azar’s priority to lower drug prices, today’s
proposed rule is also an important step towards expanding competition for
drug payment in Medicare, in order to get the best deal for patients.”
The proposed policies in the CY 2019 Medicare Hospital Outpatient
Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment
System proposed rule would help lay the foundation for a patient-driven
healthcare system. To increase the sustainability of the Medicare program
and improve quality of care for seniors, CMS is moving toward site neutral
payments for clinic visits (which are essentially check-ups with a
clinician). Clinic visits are the most common service billed under the
OPPS. Currently, CMS often pays more for the same type of clinic visit in
the hospital outpatient setting than in the physician office setting.
If finalized, this proposal is projected to save patients about $150
million in lower copayments for clinic visits provided at an off-campus
hospital outpatient department. CMS is also proposing to close a potential
loophole through which providers are billing patients more for visits in
hospital outpatient departments when they create new service lines.
Additionally, CMS is giving patients more options on where to obtain
care, in order to improve access and convenience and ensure that CMS
policies are not favoring any particular provider type from the start. The
proposed rule aims to address other payment differences between sites of
service, so that patients can choose the setting that best meets their
needs among safe and clinically appropriate options. For 2019, CMS is
proposing to:
·
Expand
the number of procedures payable at ASCs to include additional procedures
that can safely be performed in that setting;
·
Ensure
ASC payment for procedures involving certain high-cost devices parallels
the payment amount provided to hospital outpatient departments for these
devices; and
·
Help
ensure that ASCs remain competitive by stabilizing the differential between
ASC payment rates and hospital outpatient department payment rates.
As part of active efforts to reduce the cost of prescription drugs, CMS
is issuing a Request for Information to solicit public comment on how best
to leverage the authority provided under the Competitive Acquisition
Program (CAP) to get a better deal for beneficiaries as part of a CMS
Innovation Center model. We believe a CAP-based model would allow CMS to
introduce competition to Medicare Part B, the part of Medicare that pays
for medicines that patients receive in a doctor’s office. Currently, CMS
pays the average sales price for these therapies plus an extra add-on
payment. A CAP-based model would allow CMS to bring on vendors to negotiate
payment amounts for Part B drugs, so that Medicare is no longer merely a
price taker for these medicines. We are seeking public comment on how the
vendors that CMS brings on could help the agency structure value-based
payment arrangements with manufacturers, especially for high-cost products,
so that seniors and taxpayers will know that medicines are working before
they have to pay.
In 2018, CMS implemented a payment policy to help beneficiaries save on
coinsurance on drugs that were administered at hospital outpatient
departments and that were acquired through the 340B program—a program that
allows hospitals to buy certain outpatient drugs at a lower cost. Due to CMS’s
policy change, Medicare beneficiaries are now benefiting from the discounts
that 340B hospitals enjoy when they receive 340B-acquired drugs. In 2018
alone, beneficiaries are saving an estimated $320 million on out-of-pocket
payments for these drugs. For 2019, CMS is expanding this policy by
proposing to extend the 340B payment change to non-excepted off-campus
departments of hospitals that are paid under the Physician Fee Schedule.
In response to recommendations from the President’s Commission on Combatting
Drug Addiction and the Opioid Crisis, CMS also is proposing to pay
separately for certain non-opioid pain management drugs in ASCs; is seeking
feedback on evidence to support that other non-opioid alternative
treatments for acute or chronic pain warrant separate payment under the
OPPS or ASC payment systems; and is proposing to eliminate questions
regarding pain communication from the hospital patient experience survey.
As part of its commitment to price transparency, CMS is seeking comment
through a Request for Information asking whether providers and suppliers
can and should be required to inform patients about charge and payment
information for healthcare services and out-of-pocket costs, what data
elements would be most useful to promote price shopping, and what other
changes are needed to empower healthcare consumers.
In the proposed rule, CMS is releasing a Request for Information to
welcome continued feedback on the Medicare program and interoperability.
CMS is gathering public feedback on revising the CMS patient health and
safety standards that are required for providers and suppliers
participating in the Medicare and Medicaid programs to further advance
electronic exchange of information that supports safe, effective
transitions of care between hospitals and community providers.
For a fact sheet on the CY 2019 OPPS and ASC Payment System proposed
rule (CMS-1695-P), please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-25.html.
The proposed rule can be downloaded from the Federal Register
at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-15958.pdf
Across all the Fiscal Year and CY proposed Medicare payment rules, we
have proposed the elimination of reporting requirements for over 100
measures across the health care delivery system, saving providers more than
$175 million over the next two years.
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