The Centers for Medicare & Medicaid Services (CMS) has issued a final rule with comment period that updates payment policies and rates for both hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for calendar year (CY) 2010. CMS projects that total payments for services furnished to people with Medicare in HOPDs during CY 2010 under the Outpatient Prospective Payment System (OPPS) will be $32.2 billion, and total projected CY 2010 payments under the ASC payment system will be approximately $3.4 billion.

The final rule has several expansions of Medicare coverage that were required in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), including kidney disease education. This will be established payment to rural providers under the Medicare Physician Fee Schedule (MPFS) for education services furnished on or after Jan. 1, 2010 for Medicare beneficiaries diagnosed with Stage IV chronic kidney disease. There will also be OPPS payment for pulmonary and cardiac rehabilitation services furnished to beneficiaries with chronic obstructive pulmonary disease, cardiovascular disease, and related conditions, effective Jan. 1, 2010.

Next, CMS will reduce the CY 2010 annual inflation update factor by two percentage points for most services furnished by hospitals that failed to meet the CY 2009 reporting requirements of the HOP Quality Data Reporting Program (QDRP). The reduction will not apply to payments for separately payable pass-through drugs, biologicals and devices. CMS will continue to require hospitals subject to HOP QDRP requirements to provide quality data for the current seven chart-abstracted emergency department and surgical care measures and four claims-based imaging efficiency measures for CY 2011 payment determinations, and will implement a HOP QDRP validation requirement to ensure that hospitals are accurately reporting measures using chart-abstracted data. CMS is working to make HOP QDRP quality measure data publicly available as early as June 2010.

CMS will also be revising or further defining several current policies for the supervision of outpatient services. This includes allowing certain non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and licensed clinical social workers) to provide direct supervision for all hospital outpatient therapeutic services that they are authorized to personally perform according to their state scope of practice rules and hospital-granted privileges.

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