CMS Releases Final Hospital Outpatient Prospective Payment Rule for 2008

On November 1, 2007, the Centers for Medicare & Medicaid Services (CMS) released a display copy of the Final Rule (with comment period) updating the hospital outpatient prospective payment system (OPPS) for calendar year 2008. 

According to CMS, Medicare payments (including beneficiary coinsurance) under the OPPS Final Rule will increase by about 10 percent to approximately $36 billion in calendar year (CY) 2008.  CMS also estimates that hospitals will receive an overall average increase of 3.8 percent in Medicare payments for outpatient services in CY 2008.

As part of the OPPS Final Rule, CMS also issues a notice implementing rate changes for the hospital inpatient prospective payment system (IPPS) final rule for FY 2008, which resulted from the TMA, Abstinence Education and QI Programs Extension Act of 2007 (Act).  Specifically, the Act's provisions that reduced the documentation and coding adjustment from -1.2 percent to -0.6 percent for 2008.  In the notice, CMS also changes the IPPS final rule for FY 2008 by retroactively adopting a policy of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare dependent, small rural hospitals and sole community hospitals.

In the OPPS Final Rule, CMS also includes a new interim final rule (with comment period) that, among other things, extends the effective period for emergency Medicare graduate medical education (GME) affiliations from 3 academic years to up to 5 academic years.  For a hospital with a valid emergency Medicare GME affiliation agreement, the interim final rule also provides for extended time frames to meet the regulatory requirement for submitting the written agreement that allows a hospital to count residents training in non-hospital sites.

Finally, the OPPS Final Rule updates the payment rates for the revised ambulatory surgical center payment system beginning in CY 2008. The OPPS Final Rule is scheduled to appear in the Federal Register on November 27, 2007.