2019-16107: Medicare Program: Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Price Transparency of Hospital Standard Charges; Proposed Revisions of Organ Procurement Organizations Conditions of Coverage; Proposed Prior Authorization Process and Requirements for Certain Covered Outpatient Department Services; Potential Changes to the Laboratory Date of Service Policy; Proposed Changes to Grandfathered Children's Hospitals-Within-Hospitals

Summary

This proposed rule proposes revisions to the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2020 based on our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. In addition, in this proposed rule, we are proposing to establish requirements for all hospitals in the United States for making hospital standard charges available to the public; establish a process and requirements for prior authorization for certain covered outpatient department services; revise the conditions for coverage of organ procurement organizations; and revise the regulations to allow grandfathered children's hospitals-within- hospitals to increase the number of beds without resulting in the loss of grandfathered status. We also solicit comments on potential revisions to the laboratory date of service policy under the Clinical Laboratory Fee Schedule. Finally, we solicit comments on an appropriate remedy in litigation involving our OPPS payment policy for 340B- acquired drugs, which would inform future rulemaking in the event of an adverse decision on appeal in that litigation.

The agency’s own summary, as published.

What this changes

Amends 7 parts of the Code of Federal Regulations — the standing rules this notice rewrites.

• 42 CFR 405 Federal Health Insurance for the Aged and Disabled
• 42 CFR 410 Supplementary Medical Insurance (SMI) Benefits
• 42 CFR 412 Prospective Payment Systems for Inpatient Hospital Services
• 42 CFR 416 Ambulatory Surgical Services
• 42 CFR 419 Prospective Payment Systems for Hospital Outpatient Department Services
• 42 CFR 486 Conditions for Coverage of Specialized Services Furnished by Suppliers
• 45 CFR 180 Hospital Price Transparency