CMS Releases Medicare OPPS and ASC Proposed Rule

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The Centers for Medicare and Medicaid Services proposes actions to advance health equity and improve access to care in rural communities by establishing policies for rural emergency hospitals (REHs) and providing payment for certain behavioral health services provided through communications technology.

And in accordance with President Biden’s executive order on promoting competition in the American economy, the Proposed Rule for Prospective Hospital Outpatient Payment System and Ambulatory Surgery Center Payment System 2023 includes enhanced payments offered under OPPS and the Prospective Inpatient Payment System for incremental costs associated with the purchase of domestically manufactured NIOSH-approved N95 surgical respirators. It also seeks comment on competition and transparency in the US healthcare system.

WHAT IS THE IMPACT: THE PROPOSALS

CMS is proposing to establish payment rates for services provided in WERs and provider registration procedures for WERs, a new provider designation established by the Consolidated Appropriations Act.

To advance health equity and improve access to care in rural areas, CMS broadly proposes to consider all covered outpatient services as WER services. The agency offers a higher payment rate for furnished REH services; WERs will receive the standard OPPS payment rate plus 5% for each WER service provided.

In order not to limit the types of services that WERs can provide, CMS is also proposing that WERs can provide certain outpatient services beyond those paid for under the OPPS, and they would be paid according to the applicable fee schedule. without the additional 5% payment.

Additionally, as required by law, CMS proposes that REHs receive a monthly payment for facilities beginning in 2023, which would increase annually by the percentage of the hospital’s basket beginning in 2024. The agency anticipates that these payments would improve access to emergency services, observational care and additional ambulatory services in rural communities whose hospitals are at risk of closing.

REMOTE BEHAVIORAL HEALTH

In response to the COVID-19 public health emergency, CMS has undertaken the development of emergency rules to implement a number of flexibilities to support providers and patient care during the pandemic. Many flexibilities will expire at the end of the PHE, including one that allows clinical staff in hospital outpatient departments to provide behavioral health services remotely to patients at home.

The proposed rule would continue payment for remote behavioral health services provided by clinical staff in hospital outpatient departments after the conclusion of the PHE.

RESPIRATORS

In a future pandemic, or during an increase in the community spread of COVID-19, hospitals must be able to access a reliable supply of NIOSH-approved N95 surgical respirators that are delivered in a timely manner to protect workers from health and their patients,” CMS said.

Maintaining domestic production of these products, according to the agency, is important to help maintain this assurance. CMS recognizes that hospitals may incur additional costs when procuring domestically manufactured NIOSH-approved N95 surgical respirators and is proposing additional hospital payments under IPPS and OPPS that would take these into account. costs.

COMPETITION

The proposed rule includes a request for information on improving transparency and competition in the healthcare system.

In April, CMS attempted to promote competition and transparency by publish data publicly on mergers, acquisitions, consolidations, and ownership changes from 2016 to 2022 for Medicare-enrolled hospitals and nursing homes.

CMS is seeking feedback on how the data can be used more to promote competition and quality improvement, and whether CMS should consider publishing data on mergers, acquisitions, consolidations and ownership changes for further information. other types of providers.

AMBULATORY SURGERY CENTERS

CMS is proposing to update the OPPS payment rates for 2023 for hospitals that meet the applicable quality reporting requirements of 2.7%. This update is based on the projected percentage increase in the hospital market basket of 3.1%, reduced by 0.4 percentage points for the productivity adjustment.

Using the proposed hospital market basket update, CMS proposes to update the ASC rates for CY 2023 by 2.7% for ASCs meeting the relevant quality reporting requirements. This update is based on the projected percentage increase in the hospital market basket of 3.1%, reduced by 0.4 percentage points for the productivity adjustment.

Twitter: @JELagasse
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