Hospital Outpatient Regulations and Notices

Medicare Program: Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2009 Payment Rates; Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2009 Payment Rates

This proposed rule, in part, would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes would be applicable to services furnished on or after January 1, 2009.

In addition, this proposed rule, in part, would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we propose the applicable relative payment weights and amounts for services furnished in ASCs, specific Health Care Procedure Coding System codes to which these proposed changes would apply, and other pertinent rate-setting information for the CY 2009 ASC payment system. These changes would be applicable to services furnished on or after January 1, 2009.

This proposed rule was put on display at the Federal Register on July 3, 2008, prior to the enactment of the H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), on July 15, 2008.  Because certain provisions of MIPPA supersede certain CY 2009 proposals included in this proposed rule, the Final Changes to the Hospital Outpatient Prospective Payment System and CY 2009 Payment Rates will implement the changes required by MIPPA, even though these changes are not reflected in the CY 2009 proposal.  The following proposed CY 2009 provisions are impacted by MIPPA:

• Section II. D. "Proposed Wage Index Changes." Section 124 of MIPPA extends through September 30, 2009 the reclassification of certain hospitals that was previously extended by section 117 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). It also extends certain special exception wage indices referenced in the FY 2005 inpatient prospective payment system (IPPS) final rule (69 FR 49105 and 49107) through the last date of the extension of the reclassification under 106(a) of the Medicare Improvement and Extension Act of under Division B, Title I of the Tax Relief Health Care Act 2006.
• Section II.E. "Proposed OPPS Payments to Certain Rural Hospitals". Section 147 of MIPPA extends transitional outpatient payments (TOPs) to small rural hospitals through CY 2009 and expands transitional outpatient payments (TOPs) to include small sole community hospitals for CY 2009.
• Section V. B. "Proposed OPPS Payment for Drugs, Biologicals and Radiopharmaceuticals without Pass-Through Status." Section 142 of MIPPA amends section 1833(t)(16)(C) of the Act, as amended by section 106 of MMSEA, to extend for an additional 18 months, through January 1, 2010, payment for therapeutic radiopharmaceuticals at hospitals' charges adjusted to cost.
• Section VII. "Proposed OPPS Payment for Brachytherapy Sources. "Section 142 of MIPPA amends section 1833(t)(16)(C) of the Act, as amended by section 106 of MMSEA, to extend for an additional 18 months, through January 1, 2010, payment for brachytherapy sources at hospitals' charges adjusted to cost.
• Section XV.D. "Proposed ASC Payment for Covered Surgical Procedures and Covered Ancillary Services." Because section 142 of MIPPA requires OPPS payment for brachytherapy sources at charges adjusted to cost for CY 2009, ASCs will be paid at contractor-priced rates in CY 2009 for brachytherapy sources since prospective OPPS rates are not available. Section 131 of MIPPA provides a 1.1 percent increase in the physician payment update for CY 2009. Therefore, this change to physician payment may affect CY 2009 ASC payment for covered ancillary radiology services and covered office-based surgical procedures, where rates are capped at the Medicare Physician Fee Schedule (MPFS) nonfacility practice expense relative value unit amounts.

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Downloads
Median Files [ZIP 558KB] Addenda [ZIP 11KB] 2009 OPPS Facility-Specific Impacts [ZIP 597KB] Blood Revenue Code Cost to Charge Ratios [ZIP 162KB] 2009 RTI Crosswalk [ZIP 36KB] Excel Version of Attachments 4a and 4b of RTI Final Report [ZIP, 97KB] FY2009 IPPS Wage Index, Tables 4A, 4B, 4C, 4F, 9A, and 9C [ZIP, 460KB] 2009 OPPS Claims Accounting [PDF, 92KB] 2009 OPPS Without Cost or With Credit Device Information [ZIP, 29KB] 2009 OPPS Preamble Tables [ZIP, 109KB]
Related Links Inside CMS
CMS-1404-P: Ambulatory Surgical Center Proposed Rule and Documentation
Related Links Outside CMS
CMS-1404-P (PDF version) CMS-1404-P (HTML version) Link to RTI Final Report on Refining Cost to Charge Ratios - July 2008