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医疗保险计划:医院门诊前瞻性支付和门诊手术中心支付系统及质量报告计划;器官采购组织报告与沟通;移植结果衡量与文件要求;电子健康记录(EHR)激励计划;向医院非豁免校外基于提供者的科室付款;医院基于价值的采购(VBP)计划;确定医疗保险医师费率表下医院校外基于提供者的科室提供的非豁免项目和服务的支付费率。带有意见征求期的最终规则和带有意见征求期的暂行最终规则。

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

出版信息

Fed Regist. 2016 Nov 14;81(219):79562-892.

Abstract

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the 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 final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

摘要

本带有意见征求期的最终规则修订了2017财年的医疗保险医院门诊前瞻性支付系统(OPPS)和医疗保险门诊手术中心(ASC)支付系统,以实施适用的法定要求以及源于我们在这些系统方面持续经验所产生的变化。在本带有意见征求期的最终规则中,我们描述了用于确定按OPPS支付的医疗保险服务以及按ASC支付系统支付的服务的支付费率的金额和因素的变化。此外,本带有意见征求期的最终规则更新并完善了医院门诊质量报告(OQR)计划和ASC质量报告(ASCQR)计划的要求。此外,在本带有意见征求期的最终规则中,我们正在对实体器官移植计划的临床结果容忍阈值、器官采购组织(OPO)的定义、结果指标和器官运输文件以及医疗保险和医疗补助电子健康记录激励计划进行更改。我们还将从医院基于价值的采购(VBP)计划中删除HCAHPS疼痛管理维度。此外,我们正在实施2015年两党预算法案第603节,该节涉及由提供者的某些校外基于提供者的部门提供的某些项目和服务的支付。在本文件中,我们还发布了一项带有意见征求期的临时最终规则,以根据第603节的规定确定由医院的非豁免校外基于提供者的部门开具账单的非豁免项目和服务的医疗保险医师费率表支付费率。

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