In OPPS rule, CMS proposes increasing payment rates by 2.8%; modifying price transparency rules
The Centers for Medicare & Medicaid Services July 13 issued a proposed rule that would increase Medicare hospital outpatient prospective payment system rates by a net 2.8% in calendar year 2024 compared to 2023. This includes a proposed 3.0% market basket update, offset by a 0.2% cut for productivity.
In a statement shared with the media, AHA Executive Vice President Stacey Hughes said, “The AHA is concerned that CMS is proposing an outpatient hospital payment update of only 2.8% in spite of persistent financial headwinds facing the hospital field. Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day. Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized.”
In addition, CMS proposes several changes to the hospital price transparency requirements. These proposals would require that hospitals use one of several standardized formats for the machine-readable files; revise the oversight and enforcement process, including by requiring hospital attestations of compliance; and establish new website requirements intended to ease navigation of hospital price transparency files, among other proposals. In addition, the agency seeks comments on ways it can better align the various hospital and insurer price transparency policies.
“Hospitals remain committed to helping patients access the information they need when planning for their care, including meaningful information about the cost of that care,” Hughes said. “The AHA will be carefully reviewing the proposed changes to the Hospital Price Transparency Rule to ensure they continue to advance our shared objective with CMS of making it easier for patients to access pricing and cost information while reducing unnecessary administrative burden and costs on hospitals and health systems.”
CMS also proposes multiple provisions that would improve access to behavioral health services, including implementation of a statutorily required Medicare benefit for Intensive Outpatient Programs and a new payment code for remote group psychotherapy. The agency also proposes to delay the in-person visit requirement for remote outpatient mental health services until the end of 2024; expand and revise the payment structure for Medicare Partial Hospitalization Program services; and update the Conditions of Participation for Community Mental Health Centers as directed by the Consolidated Appropriations Act of 2023, including coverage for treatment under IOPs and by mental health counselors and marriage and family therapists.
CMS will accept comments on the proposed rule through Sept. 11. AHA members will receive a Special Bulletin with more details tomorrow.