The Centers for Medicare & Medicaid Services on July 6 issued calendar year 2013 proposed rules for the outpatient prospective payment system and ambulatory surgical centers, physician fee schedule and home health PPS. The OPPS/ASC rule would increase hospital outpatient payment rates by 2.1%, based on the projected inpatient market basket increase of 3.0% minus a proposed multifactor productivity adjustment of 0.8 percentage points and a 0.1 percentage point adjustment required by the Patient Protection and Affordable Care Act.
The rule also extends through 2013 the direct supervision enforcement delay for critical access hospitals and small rural hospitals, and would pay for drugs and biologicals that do not have pass-through status at the statutory default of average sales price plus 6%. Without congressional action, the PFS rule would reduce Medicare physician payments by an estimated 27% on Jan. 1.
Under the rule, CMS proposes a separate payment for primary care practitioners to assist in transitioning beneficiaries from the hospital back into the community. The home health rule provides a net increase of 0.1% ($20 million) in Medicare payments for home health services over CY 2012 levels.
The increase reflects a 2.5% market basket update which, in addition to other adjustments, is offset by mandatory cuts under the ACA and a 1.32% coding offset, which is part of a multi-year offset. Comments are due Sept 4 for the OPPS/ACS and home health proposed rules, and in 60 days for the physician fee schedule proposed rule.
The American Hospital Association will send members a Special Bulletin with highlights on the rules' key provisions on Monday followed by detailed Regulatory Advisories in the next several weeks.
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