In OPPS rule, CMS increases payment rates by 3.1%, modifies price transparency rules
The Centers for Medicare & Medicaid Services Nov. 2 issued a final rule that increases Medicare hospital outpatient prospective payment system rates by a net 3.1% in calendar year 2024 compared to 2023. This includes a 3.3% 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 has again finalized an inadequate update to hospital payments. Today's increase for outpatient hospitals of only 3.1% comes in spite of persistent financial headwinds facing the 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. Hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be in jeopardy, which is why the AHA is urging Congress for additional support by the end of the year.”
The rule also finalizes several changes to the hospital price transparency rule, including requiring a new standard format with an additional data element and a completeness and accuracy affirmation statement. CMS also makes updates to streamline the enforcement process. Compliance dates for the changes range from Jan. 1, 2024 to Jan. 1, 2025. Most formatting changes take effect July 1, 2024.
Hughes said, "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. The AHA will be carefully reviewing the 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.”
In addition, CMS finalizes multiple provisions that will 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 delays the in-person visit requirement for remote outpatient mental health services until the end of 2024; expands and revises the payment structure for Medicare Partial Hospitalization Program services; and updates 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.
Finally, the agency did not adopt its proposal to pay hospitals under the IPPS or OPPS for establishing and maintaining access a buffer stock of essential medicines. Instead, the agency states that a more multifaceted approach is necessary to improve the resilience of the pharmaceutical supply chain and notes that it intends to propose new CoPs in forthcoming rulemaking addressing hospital processes for pharmaceutical supply.
The final rule takes effect on Jan. 1, 2024. AHA members will receive a Special Bulletin with more details on Nov. 3.