CMS releases Medicare OPPS and ASC proposed rule
It includes proposed enhanced payments for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators.
Photo: John Fedele/Getty Images
The Centers for Medicare and Medicaid Services is proposing actions meant to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology.
And in line with President Biden's Executive Order on Promoting Competition in the American Economy, the 2023 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule includes proposed enhanced payments under the OPPS and the Inpatient Prospective Payment System (IPPS) for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators. It also seeks comments on competition and transparency in the U.S. healthcare system.
THE IMPACT: THE PROPOSALS
CMS is proposing to establish payment rates for services furnished at REHs and provider enrollment procedures for REHs, a new provider designation established by the Consolidated Appropriations Act.
To advance health equity and improve access to care in rural areas, CMS is broadly proposing to consider all covered outpatient department services as REH services. The agency is proposing a higher payment rate for furnished REH services; REHs will receive the standard OPPS payment rate plus 5% for each REH service provided.
In order not to limit the types of services REHs can provide, CMS is also proposing that REHs may provide certain outpatient services beyond those paid under the OPPS, and they would be paid the applicable fee schedule without the additional 5% payment.
Also, as required by statute, CMS is proposing that REHs would receive a monthly facility payment beginning in 2023 that would increase annually by the hospital market basket percentage starting in 2024. The agency anticipates these payments would improve access to emergency services, observation care and additional outpatient services in rural communities whose hospitals are at risk of closing.
REMOTE BEHAVIORAL HEALTH
In response to the COVID-19 public health emergency, CMS undertook emergency rulemaking to implement a number of flexibilities to support providers and patient care during the pandemic. Many of the flexibilities will expire at the conclusion of the PHE, including one that allows clinical staff of hospital outpatient departments to provide remote behavioral health services to patients in their homes.
The proposed rule would continue payment for remote behavioral health services provided by clinical staff of hospital outpatient departments after the conclusion of the PHE.
RESPIRATORS
In a future pandemic, or during an increase in community spread of COVID-19, hospitals need to be able to access a reliable supply of NIOSH-approved surgical N95 respirators that are delivered on a timely basis to protect healthcare workers and their patients, CMS said.
Sustaining domestic production of these products, the agency maintained, is important for helping maintain that assurance. CMS recognizes that hospitals may incur additional costs when purchasing domestically made NIOSH-approved surgical N95 respirators and is proposing additional hospital payments under IPPS and OPPS that would account for any such costs.
COMPETITION
The proposed rule includes a Request for Information about enhancing transparency and competition in the healthcare system.
In April, CMS attempted to promote competition and transparency by releasing data publicly on mergers, acquisitions, consolidations and changes of ownership from 2016-2022 for hospitals and nursing homes enrolled in Medicare.
CMS is seeking feedback on how data can be used further to promote competition and quality improvement, and whether CMS should consider releasing data on mergers, acquisitions, consolidations and changes in ownership for other provider types.
AMBULATORY SURGICAL CENTERS
CMS is proposing to update OPPS payment rates for 2023 for hospitals that meet applicable quality reporting requirements by 2.7%. This update is based on the projected hospital market basket percentage increase of 3.1%, reduced by 0.4 percentage points for the productivity adjustment.
Using the proposed hospital market basket update, CMS is proposing to update the ASC rates for CY 2023 by 2.7% for ASCs meeting relevant quality reporting requirements. This update is based on the projected hospital market basket percentage increase of 3.1%, reduced by 0.4 percentage points for the productivity adjustment.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
