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CMS Publishes OPPS Proposed Rule 2021

July 29, 2021

CMS published an OPPS proposed rule in the Federal Register which contains important information for several different programs, including OAS CAHPS and the Radiation Oncology (RO) Model. They also propose establishing a new provider type—a Rural Emergency Hospital (REH).

If you have suggestions or feedback for CMS on any of these topics, please submit them via http://www.regulations.gov. We anticipate seeing a final rule in November 2021.


After a successful mode experiment in 2019, CMS is proposing to approve two mixed-modes of survey administration that include a web component (web-mail and web-telephone) as of January 1, 2022. Both modes would use email invitations to contact patients initially and then follow up with non-respondents by mail or phone, respectively. They intend that these methodologies would place a lower financial burden on hospitals and ambulatory surgery centers.

CMS is also proposing to continue with voluntary reporting for CY2023 OAS CAHPS data and begin mandatory reporting for CY2024 (affecting reimbursement for the CY2026 payment determination). They believe that information gathered from the existing National OAS CAHPS voluntary reporting program has been able to address previous concerns about patient response rates and data reliability.

Radiation Oncology (RO) Model

After delays due to the pandemic, CMS has proposed the RO model to begin January 1, 2022, which would include the CAHPS® Cancer Care Radiation Therapy Survey as part of an aggregate quality score that would drive pay-for-performance for this service.

Radiation oncology providers should not experience any additional cost as a result of implementation of the survey—CMS will pay to pull the sample and conduct the surveys through a selected contractor, so at this time, PRC (as well as other survey vendors) will not be approved survey vendors as CMS is conducting the surveys.

This model is designed for physician group practices (PGPs), freestanding radiation therapy centers, or Hospital Outpatient Departments (HOPDs), and participation is required for providers within randomly selected areas. CMS has provided a list of the zip codes required to participate here. The newly published proposed rule excludes particular facilities from the model, such as:

  • HOPDs participating in (Pennsylvania Rural Health Model) PARHM. The proposal suggests including HOPDs eligible to participate in PARHM that are not actively participating in PARHM.
  • HOPDs of any hospital in the Community Transformation Track of the Community Health Access and Rural Transformation (CHART) Model.

The types of cancer included in the model are commonly treated with radiation therapy and have pricing stability. The rule proposes removing liver cancer from the RO Model because evidence-based clinical treatment guidelines do not support its treatment with radiation.

The rule also proposes removing brachytherapy as a modality of delivering radiation from the model, but CMS intends to continue to monitor its use and potentially include it in the RO model in the future.

For more information, please reference the CMS website for this model.

Rural Emergency Hospitals

CMS is proposing to establish a new provider type that does not provide acute care inpatient services, and instead provides 24/7 emergency department services, observation care, and, at the election of the REH, other medical and health services on an outpatient basis, starting January 1, 2023. These facilities must either be a critical access hospital, or a rural subsection (d) hospital with fewer than 51 beds.

CMS also wants to determine quality measurement reporting requirements for these facilities, such as claims-based measures or patient experience surveys.

CMS requests stakeholder feedback on many questions related to the certification of REHs to participate in Medicare. Please refer to the proposed rule itself to review this lengthy list of topics such as type and scope of services, health and safety standards, health equity, collaboration and care coordination, quality measurement, payment provisions, and the enrollment process.