ACCC Testifies at HOP Panel Meeting
By Sydney Abbott, JD, Manager, Provider Economics and Public Policy
On Tuesday, August 27, ACCC testified on the CY 2014 Hospital Outpatient Department (HOPD) proposed rule at the Centers for Medicare & Medicaid Services (CMS) Advisory Panel on Hospital Outpatient Payment (HOP). As you know, each year CMS releases the HOPD proposed rule and then allows 60 days for public comment. During this 60-day window, the HOP Panel meets to hear statements from the public and make recommendations based this testimony to CMS for the final rule.
Each year when the proposed rule is released various stakeholders and consultants feverishly work to model the proposed payment rates so that they can appropriately comment on CMS’s proposal. This year, however, for the first time since 2000, no one was able to mimic CMS’s proposal. As a result, ACCC and other stakeholders have been unable to comprehensively analyze the full implications of many of the proposals for 2014. Therefore, stakeholders testifying at the HOP Panel meeting largely spoke in unison asking CMS to not implement many of its proposals, at least until adequate time is given to analyze all data. Specifically, ACCC asked the panel to:
- Finalize the agency’s proposal to reimburse separately payable drugs at ASP+ 6%;
- Continue to make separate payment at ASP+ 6% for drugs without pass-through status that function as supplies when used in diagnostic procedures/tests or surgical procedures, restore separate payment for diagnostic radiopharmaceuticals and contrast agents without pass-through status, and to not increase the packaging threshold;
- Continue to make separate payment for all drug administration add-on codes;
- Continue to make separate payment for certain clinical diagnostic laboratory tests; and
- Continue to use five levels of HCPCS codes, assigned to five levels of APCs, to pay for clinic and ED visits.
We are pleased to report that the Panel listened to ACCC and others. The HOP Panel is recommending that CMS delay implementation of the 2014 proposals for comprehensive APC, expanded packaging, visit, and cost-center-based reimbursement changes for CT/MRI until data can be reviewed by the Panel at the Spring 2014 meeting that will look at the interaction between the proposals and their potential cumulative impact. The Panel also recommended that CMS postpone moving forward with collapsing the existing E/M visit CPT codes.
ACCC is thankful for the HOP Panel’s recommendations and will continue to work with CMS on these issues. CMS is expected to release the final 2014 Hospital Outpatient Department rule on November 1. The rule will become effective starting January 1, 2014. ACCC will keep members updated.