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| 2 minutes read

Calendar year 2022 HOPPS Proposed Rule released

Yesterday, July 19, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. The 60-day comment period for the proposed payment rule and rates runs until September 17.

The American College of Radiology has released an excellent preliminary summary of provisions within the HOPPS proposed rule that may impact radiology or radiation oncology.

For example, the proposed rule addresses the “Radiation Oncology (RO) Model.” For background, last September, CMS published in the Federal Register a final rule entitled “Specialty Care Models to Improve Quality of Care and Reduce Expenditures,” which codified payment policies at 42 CFR part 512. Included was the RO Model, which was designed to test whether prospective episode-based payments for radiation therapy services would reduce Medicare program expenditures and preserve or enhance the quality of care for Medicare beneficiaries. The RO model would provide compensation for 90-day episodes for traditional Medicare beneficiaries diagnosed with certain types of cancers. Under the RO model, Medicare would pay for the technical and professional components of radiation oncology services performed in hospital outpatient departments, physician group practice offices, and freestanding radiation therapy centers on a site-neutral, episode-based payment basis. 

The Consolidated Appropriations Act, 2021 (CAA) delayed implementation of the RO Model until at least January 1, 2022. ACR's summary notes that CMS's HOPPS proposals include provisions related to the delayed implementation of the RO Model due to the CAA, 2021, but the proposed rule also contains various modifications to RO Model policies that are not related to the Congressionally-enacted delay.

The HOPPS proposed rule also contains several modifications designed to increase compliance with the Hospital Price Transparency final rule. (The Hospital Price Transparency final rule took effect on January 1 this year, but compliance has been spotty.) The modifications would go into effect beginning January 1, 2022, and would:  

(1) Increase the penalties for noncompliance based on hospital bed count. There would be a minimum civil monetary penalty of $300/day for smaller hospitals with a bed count of 30 or fewer and a penalty of $10/bed/day for hospitals with a bed count greater than 30. Penalties would not exceed a maximum daily dollar amount of $5,500; 

(2) Deem that state forensic hospitals that meet certain requirements must be in compliance with the Hospital Price Transparency final rule’s requirements; 

(3) Prohibit certain conduct that CMS concludes act as barriers to accessing the standard charge information that hospitals must share for certain required shoppable services. CMS is also clarifying the expected output of hospital online price estimator tools, which some hospitals are choosing to use in lieu of posting their standard charges for the required shoppable services in a consumer-friendly format. 

Additionally, CMS is seeking comment on a variety of issues that it may consider to improve the standardization of the data disclosed by hospitals.

Finally, a most discouraging aspect of the proposed rules is what can only be characterized as inadequate pricing for low-dose CT scanning services, as noted in the call-out quote below. I'm pleased that ACR has raised concerns about the inadequate payments based on flawed hospital data for CT lung screening.

In the CY 2022 HOPPS Proposed Rule, CMS proposes to place 71271 (Low Dose CT for Lung Cancer Screening) in the lowest Imaging without Contrast APC (5521), with payment rate of $83.01. In addition, CMS proposes to place G0296 (visit to determine lung LDCT eligibility) in APC 5822, with a payment rate of $76.73. The ACR has raised concerns about the inadequate payments for CT lung screening based on flawed hospital data.


health care & life sciences, medicare, hopps, radiation oncology, low-dose ct, price transparency