HOPPS Final Rule Released

November 3, 2005 – The Hospital Outpatient Prospective Payment System final rule has been released, with publication in the Federal Register expected later this month. Acute care hospitals will receive a 3.7 percent inflation update, with sole community hospitals receiving an additional 7.1 percent payment adjustment. Beneficiary coinsurance will decrease for another 31 medical and surgical Ambulatory Payment Classifications. The maximum coinsurance for any service will decrease to 40 percent of the total payment, down from 45 percent.

Most Part B drugs and biologicals administered in hospital outpatient departments will be reimbursed based on 106 percent of the Average Sales Price (ASP). Blood and blood products will be paid under a separate methodology based on blood-specific cost-to-charge ratios. CMS will limit decreases in payment rates to 95 percent of 2005 rates.