Medicare Outpatient Prospective Payment System for Calendar Year 2014

Transcription

1 Final Rule Summary Medicare Outpatient Prospective Payment System for Calendar Year 2014 December P age

2 Table of Contents Overview, Resources and Comment Submission... 2 OPPS Payment Rate... 2 Adjustments to the Outpatient Rate and Payments... 3 Effects of Sequestration... 3 Wage Index and Labor-Related Share... 3 Outlier Payments... 3 Payment Increase for Rural SCHs and EACHs... 4 Hold-Harmless TOPs Payments to Small Rural Hospitals and SCHs... 4 Cancer Hospital Payment Adjustment and Budget Neutrality Effect... 4 Updates to the APC Groups and Weights... 4 Coding and Payment for Clinic and ED Visits... 5 Expansion of the Payment Packaging Policies...6 New Comprehensive APCs for Device-Dependent Procedures... 7 Updates to the Composite APCs... 8 Payment for Drugs, Biologicals, and Radiopharmaceuticals... 9 Payment for Medical Devices... 9 Other OPPS Policies New Data Collection for Services Provided in Provider-Based Outpatient Clinics Updates to the Physician Supervision Policies Updates to the Inpatient List Payment for PHP Services Beneficiary Copayments Updates to the Hospital OQR Program If you have any questions about this summary, contact Kathy Reep, FHA vice president of financial services, by at kathyr@fha.org or by phone at (407)

3 Overview, Resources and Comment Submission On December 10, 2013, the Centers for Medicare & Medicaid Services (CMS) published the calendar year (CY) 2014 final payment rule for the Medicare outpatient prospective payment system (OPPS). The final rule reflects the annual update to the Medicare fee-for-service (FFS) outpatient payment rates and policies based on regulatory changes put forward by CMS and legislative changes previously adopted by Congress. Among other regular updates and policy changes, the rule updates payment rates and policies for ambulatory surgical centers, policies related the Electronic Health Record (EHR) Incentive program, policies for the inpatient hospital value-based purchasing program, and regulations for Quality Improvement Organizations. A copy of the final rule Federal Register and other resources related to the OPPS are available on the CMS Web site at Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS FC-.html. An online version of the final rule is available at The final rule includes a comment period for some limited issues. Comments are due to CMS by Monday, January 27, 2014, and can be submitted electronically at by using the Web site s search feature to search for file code 1601-FC. A brief summary of the major OPPS sections of the final rule is provided below along with Federal Register page references for additional details. Program changes are effective for services provided on or after January 1, 2014, unless otherwise noted. OPPS Payment Rate Federal Register pages Incorporating the adopted updates with the effect of budget neutrality adjustments, the table below lists the conversion factor for CY2014 compared to the rate currently in effect: Final CY2013 Final CY2014 OPPS Conversion Factor $ $ Percent Change +1.9 (proposed at 2.0) The table below provides details of the adopted updates to the outpatient conversion factor for CY2014: 2 P age

4 Market Basket (MB) Update Patient Protection and Affordable Care Act (PPACA)-Mandated Productivity MB Reduction PPACA-Mandated Pre-Determined MB Reduction Overall Rate Update (EXCLUDING BUDGET NEUTRALITY) Final CY2014 OPPS Conversion Factor Updates +2.5 (no change from proposed) -0.5 (proposed at -0.4) -0.3 (no change from proposed) +1.7 Adjustments to the Outpatient Rate and Payments Effect of Sequestration Federal Register page reference not available While the final rule does not specifically address the 2.0 percent sequester reductions to all lines of Medicare payments authorized by the Budget Control Act (BCA) of 2011 and currently in effect through federal fiscal year (FY) 2021, sequester will continue unless Congress intervenes. Sequester is not applied to the payment rate; instead, it is applied to Medicare claims after determining co-insurance, any applicable deductibles, and any applicable Medicare secondary payment adjustments. Other Medicare payment lines such as graduate medical education (GME), bad debt, and EHR incentives are also affected by the sequester reductions. Wage Index and Labor-Related Share Federal Register pages CMS did not put forward any major changes to the calculation of Medicare hospital wage indexes for CY2014. In concert with prior years, CMS will use the most recent federal FY2014) IPPS wage indexes including all reclassifications and add-ons, application of the rural floor, and adjustments for budget neutrality. CMS will continue to apply the wage index to a labor-related share of 60 percent. CMS states in the final rule that it does plan to pursue Core-Based Statistical Area (CBSA) definition changes next year based on newly available census data. Tables that include the wage indexes for payment in CY2014 are available on the CMS Web site at Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS FC-.html. Outlier Payments Federal Register pages To maintain total outlier payments at 1.0 percent of total OPPS payments, CMS is adopting an outlier fixed-dollar threshold of $2,900 for CY2014 (proposed at $2,775). The new threshold represents a 43.2 percent increase compared to the current threshold of $2,025. CMS points to the new packaging policies for 2014 as a factor in the threshold increase. Outlier payments will continue to be paid at 50 percent of the amount by which the cost of furnishing the service 3 P age

5 exceeds 1.75 times the APC payment amount when both the 1.75 multiple threshold and the fixed-dollar threshold are met. Payment Increase for Rural SCHs and EACHs Federal Register pages CMS will continue the 7.1 percent payment increase provided rural sole community hospitals (SCHs) and essential access community hospitals (EACHs). Since 2006, CMS has provided this adjustment to these hospitals for almost all services and procedures paid under the OPPS. This payment increase is a result of a provision of the Medicare Modernization Act (MMA) of Hold-Harmless TOPs Payments to Small Rural Hospitals and SCHs Federal Register page reference not available Hold-harmless transitional outpatient payments (TOPs) were established when the OPPS was implemented to provide relief to hospitals that would receive less in payments under the OPPS methodology than they would have received under the former payment system. Access to these payments, made available by Congress to small rural hospitals and SCHs, expired in December CMS does not have the authority to extend these payments in future years without authorizing legislation. Cancer hospitals and children s hospitals continue to be permanently held harmless from the impact of OPPS. Cancer Hospital Payment Adjustment and Budget Neutrality Effect Federal Register pages CMS will continue the policy that provides hospital-specific payment increases to the 11 hospitals identified as cancer hospitals exempt from the inpatient prospective payment system (IPPS). This policy will continue to be applied in a budget neutral manner. Because CMS applied a budget neutrality reduction in CY2012 when this adjustment was first implemented, there is no significant year-to-year change in the conversion factor as a result of continuing this policy. Under the updated policy, the minus 0.22 percent budget neutrality factor originally applied will be lessened to minus 0.17 percent for CY2014. A reduction of this level will remain in the conversion factor until CMS makes a substantial change to this policy. This payment policy is the result of a provision of the Patient Protection and Affordable Care Act (PPACA) of A list of exempt cancer hospitals and the CY2014 payment adjustments are available on Federal Register page Updates to the APC Groups and Weights Federal Register pages and As required by law, CMS must revise the ambulatory payment classification (APC) groups each year to take into account drugs and medical devices that no longer qualify for pass-through status, new and deleted Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes, advances in technology, new services, and new cost data. CMS must also review and revise the APC relative payment weights annually. 4 P age

6 For CY2014, in addition to these standard updates, CMS has adopted policy changes that will significantly change how hospitals will code and be paid for evaluation and management (E/M) clinic visits and expand the categories of items/services under the OPPS that are packaged into APCs for payment as opposed to separately paid. These and other adopted policies will not only shift the APC groups and weights for CY2014, but also impact the availability of separate payment for items and services currently available through fee schedules outside of the OPPS. Details on the major APC policy changes are provided below. The table below shows the shift in the number of APCs per category from CY2013 to CY2014. APC Category Status Current Final Indicator CY2013 CY2014 Clinic or Emergency Department Visit V Significant Procedures, Multiple Reduction Applies T Significant Procedures, No Multiple Reduction S Ancillary Services X Pass-Through Devices Categories H 3 1 Non-Pass-Through Drugs/Biologicals K Comprehensive APCs for Device-Dependent Services J1 - - Partial Hospitalization P 4 4 Blood and Blood Products R Brachytherapy Sources U Pass-Through Drugs and Biologicals G New Technology S/T Total Coding and Payment for Clinic and ED Visits Federal Register pages Currently, CMS recognizes five distinct levels of severity and payment for each type of E/M clinic visit, Type A ED visit and Type B ED visit. Since the inception of the OPPS, CMS has instructed hospitals to report facility resources for E/M clinic and ED visits using CPT E/M codes and to develop internal hospital guidelines to determine what level of visit to report for each patient. Due to CMS-noted challenges in developing national guidelines for determining appropriate visit levels, CMS proposed to discontinue the use of five APC levels for each type of E/M clinic visit and ED visit. Under the proposal, CMS sought to use one new APC category for E/M clinic visits and two new APC categories for ED visits (one for Type A visits and Type B visits). Citing stakeholder concerns over its proposal, CMS is not adopting its proposal to consolidate the Type A and Type B ED visit categories and plans to study the policy further. CMS, however, is adopting its proposal to consolidate each type of E/M clinic visit. The payment rate for the new E/M clinic APC (APC 0634) is based on the total mean costs for the associated service levels being adopted for consolidation. Under this policy, hospitals with patients currently coded to the higher visit levels will see a payment reduction while hospitals with patients coded to the lower levels will see a payment increase. The following table describes the adopted CY2014 changes to coding and payment for E/M clinic services under the OPPS (detail on payment rate changes for ED visits is also shown). 5 P age

7 E/M Clinic Visit Type A ED Visit Type B ED Visit Current CY2013 Final CY2014 Change HCPCS APC Payment Payment in Rate HCPCS APC Rate Rate (percent) $ $ $ $ $ G $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ G $67.78 G $ G $54.12 G $ G $89.89 G $ G $ G $ G $ G $ Expansion of the Payment Packaging Policies Federal Register pages The OPPS was designed to package payment for multiple interrelated items/services into a single payment to create incentives for hospitals to furnish outpatient care efficiently. When first implemented in 2000, 12 categories of items/services defined by law were packaged for payment under the OPPS. In CY2008, CMS used its regulatory authority to expand its packaging policy to items/services in another seven categories. For CY2014, CMS is using its regulatory authority once again to package payment for a series of items/services in five new categories (proposed at seven categories). Because the OPPS is budget neutral, the monies currently paid for the items/services adopted for packaging will be redistributed to all other services for CY2014. However, the impact of these adopted changes will vary by hospital and hospital type. Of most significance, CMS will package payment under the OPPS for nearly 1,100 outpatient laboratory services (accounting for about 68 percent of the items/services adopted for packaging) currently paid separately under the Clinical Lab Fee Schedule (CLFS). On average, CMS estimates that this change will decrease outpatient payments to rural hospitals by -0.8 percent and increase payments to urban hospitals by +0.2 percent. The following details the items/services CMS will package for CY2014: o Laboratory tests 1,086 items/services: 1,085 of which are currently paid separately under CLFS, one of which is currently paid separately under the OPPS (proposed at 1,096 items/services); 6 P age

8 o Procedures described by add-on codes 243 items/services: 94 of which are already packaged, 149 of which are currently paid separately under the OPPS (proposed at 272 items/services); o Device removal procedures 68 items/services currently paid separately under the OPPS and adopted for packaging or separate payment based on certain conditions (proposed at 71 items/services); o Drugs that function as supplies or devices when used in a surgical procedure 46 items/services: two of which are already packaged, 26 of which are currently paid separately under the OPPS, six of which were previously not paid by Medicare when submitted on outpatient claims, and 12 of which the HCPCS code(s) did not exist in CY2013 (proposed at 30 items/services); and o Drugs that function as supplies when used in a diagnostic test or procedure four items/services: two of which are already packaged, two of which are currently paid separately under the OPPS (no change from proposed). CMS is also adopting its proposal to package payment for 150 items/services currently paid separately under the Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule (DMEPOS) fee schedule (proposed 147 items/services). CMS did not adopt its proposal to package items/services in the following two categories: ancillary services (425 proposed items/services) and diagnostic tests on the bypass list (103 proposed items/services). The complete list of items/services that will be packaged beginning CY2014, by category, is available in Addendum P on the CMS Web site at for-service-payment/hospitaloutpatientpps/hospital-outpatient-regulations-and-notices- Items/CMS-1601-FC-.html. New Comprehensive APCs for Device-Dependent Procedures Federal Register pages Further pursuing its desire to create larger payment bundles under the OPPS, CMS is using its regulatory authority to move forward on a policy that will create 29 device-dependent comprehensive APCs for use in CY2015 (proposed to begin in CY2014). CMS is adopting, with modification, its proposal to define a comprehensive APC as a classification for the provision of a primary service and all adjunctive services provided to support the delivery of the primary service. A list of the 29 comprehensive APCs (subject to update for CY2015) is available in Table 8 on Federal Register pages Subject to final configuration in next year s rulemaking process, CMS will make a single allinclusive prospective payment for the service and will package into the comprehensive APC payment all other services and supplies. This will encompass diagnostic procedures, lab tests, and treatments that assist in the delivery of the primary procedure, visits and evaluations performed in association with the procedure, coded and un-coded services and supplies used during the service, outpatient department services delivered by therapists as part of the comprehensive 7 P age

9 service, durable medical equipment as well as the supplies to support that equipment, and any other components reported by HCPCS codes that are provided during the comprehensive service. CMS will not pay for services that cannot be covered by Medicare Part B or that are not payable under the OPPS. CMS states that the change will be budget neutral for CY2015, noting that the comprehensive APCs will be entirely derived from existing services currently reported in Medicare claims. Citing stakeholder concerns regarding potential cost-variation within the comprehensive APCs, CMS modified its proposal to include a complexity-reassignment when particular combinations (more than 140) of these device-dependent procedures which would initiate a comprehensive APC are on the same claim. Under this policy, these claims will be reassigned to a higher level comprehensive APC within an appropriate, clinically-similar, family of comprehensive APCs. A listing of the device-dependent procedures currently constituting comprehensive APCs, as well as the current assessment of procedure combinations that would warrant a complexity reassignment (both subject to final configuration for CY2015), are available in Tables 9 and 10 on Federal Register pages and Updates to the Composite APCs Federal Register pages CMS is adopting changes to the composite APCs for CY2014 to align the composites with the changes to consolidate the coding and payment levels for E/M clinic services (described above), while delaying the shift of several procedures which were otherwise payable under a composite APC to payment under CMS new comprehensive APC policy. This delay coincides with CMS decision to delay the creation of comprehensive APCs to CY2015. CMS uses composite APCs to provide a single payment, rather than paying for each service individually, when specified combinations of procedures are performed during a single encounter. o CMS will continue to identify Cardiac Resynchronization Therapy as a composite APC for CY2014 (composite APC 0108). This service was expected to be absorbed under the comprehensive APC policy. As a result of CMS delay in creating comprehensive APCs to CY2015, this service will continue to be paid under composite APC 0108 for CY2014. o CMS will continue to identify and pay Cardiac Electrophysiologic Evaluation and Ablation as a composite APC for CY2014 (composite APC 8000). CMS noted that the impact of comprehensive APCs on this particular composite APC was left out of the proposed rule. As such, this service will also be absorbed under a comprehensive APC when this policy is implemented in CY2015. o CMS has adopted its proposal to modify the Extended Assessment and Management (EAM) composite to accommodate the new coding scheme for E/M clinic visits (proposed to also accommodate Type A and Type B ED visits). As adopted, CMS will replace the current EAM composite APCs 8002 and 8003 with new composite APC Payment for these services will change from $ (APC 8002) and $ (APC 8003) in CY2013 to $1, (APC 8009) in CY P age

10 The list of HCPCS codes for assignment to the composite APCs for CY2014 is available in Addendum M of the final rule on the CMS Web site at Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS FC-.html. Payment for Drugs, Biologicals, and Radiopharmaceuticals Federal Register pages CMS pays for drugs, biologicals, and radiopharmaceuticals that do not have pass-through status in one of two ways: packaged payment into the APC for the associated service, or separate payment (individual APCs). Generally, for items not specified for packaging by CMS, packaging status is based on a comparison of CMS-calculated per-day cost of the item to a packaging threshold. For CY2014, CMS is adopting its proposal to increase the packaging threshold to $90, a 12.5 percent increase compared to the current threshold of $80. Drugs, biologicals, and radiopharmaceuticals that are above the $90 threshold and paid separately using individual APCs will generally be paid at a rate of average sales price (ASP) +6 percent in CY2014 (no change from the current rate). A complete discussion of payment for drugs, biologicals, and radiopharmaceuticals can be found on the Federal Register pages referenced above. Payment for Medical Devices Federal Register pages CMS pays for most medical devices by packaging payment into the APC for the associated service. Devices that meet certain criteria receive pass-through payment. The pass-through payment equals the amount by which the hospital s charges, adjusted to cost, exceed the OPPS payment rate associated with the device. CMS deducts from the pass-through payment amount the portion of the APC payment that the agency determines to be the cost associated with the device. There are currently four device categories eligible for pass-through payment: 9 P age o C1830: Powered bone marrow biopsy needle; o C1840: Lens, intraocular (telescopic); o C1841: Retinal prosthesis, includes all internal and external components; and o C1886: Catheter, extravascular tissue ablation, any modality (insertable). In prior rulemaking, CMS adopted a pass-through payment expiration date of December 31, 2013, for the devices identified by HCPCS codes C1830, C1840, and C1886. This leaves only one device that is eligible for pass-through payment in CY2014 (described by HCPCS code C1841 above). CMS can establish a new device category for pass-through payment in any quarter. CMS is updating the list of APCs (29) and devices (32) that will apply to the no cost/full credit and partial credit device payment policy in CY2014. The lists are available in Tables 30 and 31 on Federal Register pages Under this policy, CMS reduces APC payment by 100 percent of the device offset amount (the device cost) when a hospital furnishes a specified device with no cost or with a full credit from the manufacturer and 50 percent when a hospital receives partial credit of 50 percent or more. CMS also adopted its proposal to require hospitals to report the amount of the credit received when it is 50 percent or greater of the cost of the device.

11 Complete details of the APC group and weight changes adopted for CY2014 can be found on the Federal Register pages and The APC relative weights and payment rates for CY2014 are available in Addenda A and B of the final rule on the CMS Web site at Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS FC-.html. A comparison of the current APC payment rates to the newly adopted rates, including all adopted changes for CY2014, shows that the rates for 29 percent of the 767 APCs with corresponding payment rates in each year will change by plus 10 percent or more. The payment rates for 8.0 percent of the APCs with payment weights will change by minus 10 percent or more. The remaining 63 percent have payment rates that change by less than +/-10 percent when compared to the current rates. Other OPPS Policies New Data Collection for Services Provided in Provider-Based Outpatient Clinics Federal Register pages In the proposed rule, CMS solicited comment on its desire to collect new data from hospitals that would differentiate between outpatient services provided directly in a hospital and services provided in off-campus provider-based outpatient clinics. CMS cited the growing trend toward hospital acquisition of physician offices and subsequent treatment of those locations as offcampus provider-based outpatient departments along with the current reimbursement differentials between the two settings as the basis and need for data collection. CMS noted an interest in data that will allow for the analysis of the frequency, type, and payment for services provided in these off-campus provided-based clinics. A full discussion of comments received and CMS responses is available on the Federal Register pages referenced above. CMS states that they will take the comments into consideration as they continue to consider approaches to collecting data on services furnished in off-campus provider-based clinics. Updates to the Physician Supervision Policies Federal Register page CMS is adopting its proposal to begin applying the direct supervision requirements related to outpatient therapeutic services for Critical Access Hospitals (CAHs) and small rural hospitals in CY2014. A non-enforcement policy for these supervision requirements has been in place since CY2011 when CMS adopted policies that revised and further defined several policies related to the physician supervision of outpatient services. As adopted, all outpatient therapeutic services furnished in hospitals and CAHs will require a minimum of direct supervision unless the service is on the list of services that may be furnished under general supervision or is designated as a nonsurgical extended duration therapeutic service. A list defining these exempt services is available on the CMS Web site at Payment/HospitalOutpatientPPS/Downloads/CY2013-OPPS-General-Supervision.pdf. 10 P age

12 CMS also used the 2014 rulemaking process to clarify the general supervision requirements for observation care. The clarification is an attempt to address questions related to the need to further assess patients in observation once the supervising physician or appropriate non-physician practitioner transitions the beneficiary to general supervision and documents the transition in the medical record. CMS is clarifying that if the supervising physician or appropriate non-physician practitioner determines and documents in the medical record that the beneficiary is stable and may be transitioned to general supervision, general supervision may be furnished for the duration of the service and additional initiation period(s) of direct supervision during the service are not required. Updates to the Inpatient List Federal Register page For CY2014, CMS will not remove any procedures from the current inpatient list. The inpatient list specifies services that are only paid when provided in an inpatient setting because of the nature of the procedure and the need for at least 24 hours of post-operative recovery time and/or monitoring before the patient can be safely discharged. Based on comment, CMS will add four laparoscopy surgical procedure codes to the inpatient list for CY2014 (CPT codes 44206, 44207, 44208, and 44213). The list of procedures that will be paid as only inpatient procedures for CY2014 is available in Addendum E of the final rule on the CMS Web site at Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS fc-.html. Payment for PHP Services Federal Register pages Each year, CMS updates the payment rates for partial hospitalization program (PHP) services. The intensive outpatient psychiatric program of services may be provided to patients in place of inpatient psychiatric care and may be provided in either a hospital outpatient setting or by a freestanding Community Mental Health Center (CMHC). Under the OPPS, providers are paid on a per diem basis for PHP services and the payment rates for these services are calculated for CMHCs based only on CMHC data and hospital-based rates based only on hospital-based data. The table below compares the newly adopted payment rates for PHP services to the rates currently in effect. APC 11 P age Group Title Current CY2013 Payment Rate Final CY2014 Payment Rate Percent Change 0175 Hospital-Based PHPs-Level I PHP (three services) $ $ Hospital-Based PHPs-Level II PHP (four or more) $ $ CMHCs-Level I PHP (three services) $84.96 $ CMHCs-Level II PHP (four or more) $ $ For CMHCs, CMS will continue to make outlier payments at 50 percent of the amount by which the cost for the PHP services exceed 3.40 times the payment rate for APC 0173.

13 In the proposed rule, CMS solicited comment on potential future changes to payment for PHP services to ensure the sustainability of PHP benefit. A full discussion of comments and received and CMS responses is available on Federal Register pages CMS states that they will take the comments into consideration to strengthen the PHP benefit and payment structure. Beneficiary Copayments Federal Register pages The national unadjusted copayment amount for Medicare beneficiaries cannot be less than 20 percent of the outpatient fee schedule amount and is limited to the amount of the inpatient deductible. Beginning January 1, 2011, provisions of the PPACA eliminated the copayment for preventive services that meet certain requirements, including screening flexible sigmoidoscopies and screening colonoscopies, and waived the Part B deductible for screening colonoscopies that become diagnostic during the procedure. The final national unadjusted copayment amounts for CY2014 are available in Addenda A and B of the final rule on the CMS Web site at Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS fc-.html. Updates to the Hospital OQR Program Federal Register pages As previously adopted, for CY2014 payment determinations under the Outpatient Quality Reporting (OQR) program, hospitals were required to report on a total of 25 quality measures. Hospitals that do not successfully participate in the OQR program are subject to a 2.0 percentage point reduction to the OPPS market basket update for the applicable year the reduction factor has not changed. For CY2015 payment determinations, hospitals are required to report on 23 of the same quality measures reported on for CY2014 payment determinations. CMS has adopted a policy to remove two of the previously adopted chart-abstracted measures for CY2015 (NQF# s 0649 and 0643). A table that lists the measures CMS will collect for CY2015 payment determinations is available on Federal Register page (note that CMS table includes the two chart-abstracted measures removed for CY2015 payment determinations). For CY2016 payment determinations, CMS will require hospitals to report on a total of 27 measures. CMS is adopting its proposal to remove two chart-abstracted measures from the program (the same measures removed for CY2015 determinations). Also, CMS will add one new healthcare-associated infection (HAI) measure (NQF# 0431) and three new chart-abstracted measures (NQF# s 0658, 0659, and 1536). CMS did not adopt a fourth chart-abstracted measure proposed for CY2016 determinations (NQF# 0564). A table that lists the measures CMS will collect for CY2016 payment determinations is available on Federal Register pages As it does each year, CMS uses the rulemaking process to update the OQR program data submission deadlines and procedures, chart validation requirements and methods, and other 12 P age

14 OQR-related procedures and processes. Complete detail on these updates, including a new reporting extension or waiver process to account for extraordinary circumstances, is available on Federal Register pages P age