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CMS Announces Proposed Payment Rule for Outpatient Care

By CQ Staff

July 2, 2010 -- Certain preventive services should become more affordable for Medicare beneficiaries under a proposed rule announced Friday by the Centers for Medicare and Medicaid Services governing 2011 payments to hospital outpatient departments and ambulatory surgery centers.

Under the proposal, which would put in place changes made by the new health care law, Medicare enrollees would see their out-of-pocket costs go down for preventive services provided in hospital outpatient departments and ambulatory surgical centers, beginning in January 2011.

The new law (PL 111-148, PL 111-152) waives the 20 percent beneficiary co-pay for initial exams when people first enter Medicare, as well as most other preventive services offered by Medicare.

"Preventing diseases that can be prevented, and detecting others at earlier, more treatable stages, are among the keystones for transforming Medicare," said Jonathan Blum, deputy administrator of the Centers for Medicare and Medicaid Services, in a statement.

"By eliminating the beneficiary's out-of-pocket costs for most preventive services, we are removing a barrier to access and paving the way for improved health for seniors and people with disabilities who rely on Medicare for their health coverage," said Blum.

The proposal includes an 0.25 percentage point reduction to the hospital outpatient department inflation update for next year, as required by the overhaul.

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