Proposed CMS Outpatient Rule Includes Changes to Inpatient-Only List, 340B Hospital Payment

August 12, 2020

August 4, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2021 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) proposed rule. Major provisions of the proposed rule include:

  • An overall update to OPPS payment rates of 2.6 percent in CY 2021;
  • Elimination of the inpatient-only list over three years, beginning with the removal of 266 musculoskeletal-related services, including total hip arthroplasty (THA);
  • Payment reduction to 340B hospitals for 340B drugs to a net payment rate of Average Sales Price minus 28.7%.

Comments on the proposed rule are due October 5.  WSHA will comment and will make draft comments available to members prior to the due date. WSHA will also be sending a detailed analysis of the proposed rule and estimated hospital-specific impacts to hospital CFOs and designated finance staff within the next few weeks. (Andrew Busz,




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