Medicare beneficiaries would see a decline in their out-of-pocket costs for services they receive in hospital outpatient departments (HOPDs) in calendar year (CY) 2011 under provisions in a proposed rule issued today by the Centers for Medicare & Medicaid Services (CMS).  

The proposed rule implements changes required by the Affordable Care Act (ACA), which waives beneficiary cost-sharing for most Medicare-covered preventive services, including the Initial Preventive Physical Examination.

The waiver applies not only to the 20 percent coinsurance for the physician’s service, but also to any cost-sharing relating to the separate payment to the facility when the service is furnished in an HOPD. 

“Preventing diseases that can be prevented, and detecting others at earlier, more treatable stages, are among the keystones for transforming Medicare,” said Jonathan Blum, CMS deputy administrator and director of the Center for Medicare. 

“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.”

The proposed change updates policies and payment rates for covered outpatient department services furnished on or after Jan. 1, 2011, by HOPDs in more than 4,000 hospitals that are paid under the Outpatient Prospective Payment System (OPPS). 

The proposed rule also includes proposals to implement the graduate medical education (GME) provisions of the Affordable Care Act, requiring CMS to identify unused residency slots and redistribute them to certain hospitals with qualified residency programs, with a special emphasis on increasing the number of primary care physicians.