CMS releases Medicare OPPS and ASC proposed rule

CMS releases Medicare OPPS and ASC proposed rule

Picture: John Fedele/Getty Photos

The Facilities for Medicare and Medicaid Providers is proposing actions meant to advance well being fairness and enhance entry to care in rural communities by establishing insurance policies for Rural Emergency Hospitals (REH) and offering for fee for sure behavioral well being providers furnished by way of communications know-how. 

And consistent with President Biden’s Government Order on Selling Competitors within the American Economic system, the 2023 Hospital Outpatient Potential Cost System and Ambulatory Surgical Middle Cost System proposed rule consists of proposed enhanced funds underneath the OPPS and the Inpatient Potential Cost System for the extra prices of buying domestically made NIOSH-approved surgical N95 respirators. It additionally seeks feedback on competitors and transparency within the U.S. healthcare system.

WHAT’S THE IMPACT: THE PROPOSALS

CMS is proposing to ascertain fee charges for providers furnished at REHs and supplier enrollment procedures for REHs, a brand new supplier designation established by the Consolidated Appropriations Act. 

To advance well being fairness and enhance entry to care in rural areas, CMS is broadly proposing to contemplate all coated outpatient division providers as REH providers. The company is proposing the next fee charge for furnished REH providers; REHs will obtain the usual OPPS fee charge plus 5% for every REH service offered. 

With a purpose to not restrict the varieties of providers that REHs can present, CMS can be proposing that REHs could present sure outpatient providers past these paid underneath the OPPS, and they might be paid the relevant price schedule with out the extra 5% fee.

Additionally, as required by statute, CMS is proposing that REHs would obtain a month-to-month facility fee starting in 2023 that will enhance yearly by the hospital market basket proportion beginning in 2024. The company anticipates these funds would enhance entry to emergency providers, commentary care and extra outpatient providers in rural communities whose hospitals are prone to closing.

REMOTE BEHAVIORAL HEALTH

In response to the COVID-19 public well being emergency, CMS undertook emergency rulemaking to implement numerous flexibilities to help suppliers and affected person care throughout the pandemic. Lots of the flexibilities will expire on the conclusion of the PHE, together with one that permits scientific employees of hospital outpatient departments to supply distant behavioral well being providers to sufferers of their houses. 

The proposed rule would proceed fee for distant behavioral well being providers offered by scientific employees of hospital outpatient departments after the conclusion of the PHE.

RESPIRATORS

In a future pandemic, or throughout a rise in neighborhood unfold of COVID-19, hospitals want to have the ability to entry a dependable provide of NIOSH-approved surgical N95 respirators which might be delivered on a well timed foundation with a purpose to defend healthcare employees and their sufferers, CMS stated. 

Sustaining home manufacturing of those merchandise, the company maintained, is vital for serving to to keep up that assurance. CMS acknowledges that hospitals could incur extra prices when buying domestically made NIOSH-approved surgical N95 respirators and is proposing extra hospital funds underneath IPPS and OPPS that will account for any such prices.

COMPETITION

The proposed rule features a Request for Details about enhancing transparency and competitors within the healthcare system. 

In April, CMS tried to advertise competitors and transparency by releasing knowledge publicly on mergers, acquisitions, consolidations and modifications of possession from 2016-2022 for hospitals and nursing houses enrolled in Medicare. 

CMS is in search of suggestions on how knowledge will be additional utilized to advertise competitors and high quality enchancment, and whether or not CMS ought to contemplate releasing knowledge on mergers, acquisitions, consolidations and modifications in possession for different supplier sorts.

AMBULATORY SURGICAL CENTERS

CMS is proposing to replace OPPS fee charges for 2023 for hospitals that meet relevant high quality reporting necessities by 2.7%. This replace is predicated on the projected hospital market basket proportion enhance of three.1%, diminished by 0.4 proportion factors for the productiveness adjustment. 

Utilizing the proposed hospital market basket replace, CMS is proposing to replace the ASC charges for CY 2023 by 2.7% for ASCs assembly related high quality reporting necessities. This replace is predicated on the projected hospital market basket proportion enhance of three.1%, diminished by 0.4 proportion factors for the productiveness adjustment.
 

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