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Now available to APTA members: context and details to help you understand final 2018 rules from the Centers for Medicare and Medicaid Services (CMS) on the home health (HH PPS) and outpatient (OPPS) prospective payment systems.

The final OPPS rule includes provisions that APTA supported—particularly moves toward reimbursement for outpatient-based total knee arthroplasty (TKA) and "non-enforcement" of direct supervision requirements for outpatient therapeutic services delivered in designated critical-access hospitals and rural hospitals with fewer than 100 beds. The rule also includes an overall 2% payment increase for outpatient hospitals and a 1.9% boost for ambulatory surgical centers. To access the fact sheet, visit the APTA Medicare Payment and Policies for Hospital Settings webpage. Scroll to the "Outpatient Care" area and look under "APTA Fact Sheets and Summaries."

After receiving significant opposition from APTA, the APTA Home Health Section, and other professional and consumer advocacy organizations, CMS backed off on a proposed rule to adopt a payment system that, among other changes, would have removed therapy service-use thresholds from the payment mix. For now, CMS plans to leave the payment system as-is for the most part, but the agency will use 2018 as an opportunity to explore changes with stakeholders. In terms of payment amounts, CMS will enact an $80 million reduction in 2018, a cut mandated by the Affordable Care Act. The APTA fact sheet can be accessed on the association's Medicare Payment and Policies for Home Health webpage, under "APTA Fact Sheets and Summaries."

Want even more information on CMS-related changes in store for 2018? Don't miss the December 13 Insider Intel call-in program that will include information on HH PPS and OPPS provisions. The program is available at no cost to APTA members.


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