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CHA Comments on OPPS, Physician Fee Schedule Proposed Rules

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CHA has submitted comments on the calendar year (CY) 2024 outpatient prospective payment system (OPPS) and physician fee schedule (PFS) proposed rules.  

CHA offers the following comments in the CY 2024 OPPS proposed rule letter

  • Provide an Adequate Market Basket Update: CHA asks that CMS use data that better reflect the input price inflation that hospitals have experienced and are projected to experience in 2024 and provide a forecast error adjustment for underestimating the update in CY 2022. Further, as in prior years, CHA asks CMS to eliminate the unjustified reduction to the market basket update as a result of the Affordable Care Act (ACA)-mandated productivity adjustment for any year covered under the COVID-19 public health emergency (PHE). 
  • Preserve Access to Outpatient Services: CHA believes that CMS’ decision in the 2023 final rule to define rural sole community hospital (SCH) off-campus provider-based clinics as “excepted” from its site-neutral clinic visit policy was an important step in preserving access to care for a segment of the underserved population. While we appreciate this bold action, we ask CMS to except all off-campus provider-based clinics from the site-neutral clinic visit policy. Doing so is aligned with CMS’ stated goals of expanding access to underserved populations and reducing inequitable outcomes.  
  • Price Transparency: CHA strongly supports efforts to provide patients with data that will help them make value-based decisions about where to receive their care. We appreciate CMS’ efforts to standardize the machine-readable files. However, we have concerns about the viability of including certain new variables in the machine-readable file and new, duplicative, enforcement requirements. 
  • Support 340B Safety-Net Hospitals: CHA thanks CMS for proposing to pay for separately payable drugs acquired under the 340B program at average sales price (ASP) +6%. Given California’s hospitals’ fragile finances and the crucial role 340B plays in maintaining access to care for underserved and at-risk populations, CHA appreciates CMS’ proposal in CMS-1793-P to repay hospitals in a lump sum. However, we do not share CMS’ belief that this repayment must be done in a budget-neutral manner. Finally, we are deeply concerned that for many of California’s financially challenged 340B hospitals, repayment will come too late. 
  • Partial Hospitalization and Intensive Outpatient Programs: CHA appreciates CMS’ efforts to increase access to these services for Medicare beneficiaries by using an expanded set of claims data to calculate the proposed 2024 PHP and IOP payment rates. CHA asks CMS to use all of the measures at its disposal, including Section 1135 waivers available under the ongoing opioid PHE to ensure that underserved beneficiaries have access to these services.   
  • Packaging Policies and Non-Opioid Treatment Alternatives: CHA appreciates CMS’ request for information regarding separate payment for non-opioid treatment alternatives. While Sections 4135(a) and (b) of the Consolidated Appropriations Act (CAA) are not effective until Jan. 1, 2025, we ask CMS to begin separate payment for non-opioid pain treatment alternatives for services provided on or after Jan. 1, 2024, by issuing a waiver under the opioid PHE. 
  • Essential Medicines: CMS requests feedback on the concept of providing a separate payment for the costs that hospitals incur to build and maintain a stockpile of certain essential medicines. While CHA cautiously supports the separate payment, we are concerned that the need for such payment is symptomatic of the larger issue of inadequate payment updates (discussed in detail below). While we appreciate the proposal, we believe that CMS should first concentrate on providing all hospitals adequate market basket updates that keep pace with input price inflation and allow hospitals to invest in resilient supply chains for pharmaceuticals, PPE, and other supplies. 

CHA offers the following comments in the CY 2024 PFS proposed rule letter

  • Urges CMS to work with Congress to address significant payment reductions to the proposed conversion factor and physician payments. We are concerned that the statutorily required reduction in the conversion factor will exacerbate access issues for Medicare beneficiaries.   
  • Supports the indefinite delay in the appropriate use criteria (AUC) implementation. We greatly appreciate the determination that the policy is unworkable given the current state of revenue cycle systems. Further, CHA continues to believe that it is inappropriate for CMS to penalize facilities that perform imaging services when referring providers to inappropriately order said service.   
  • Supports CMS’ continued delay of the evaluation and management (E/M) “split billing” policy. CHA again encourages the agency to rescind its policy of basing payment in situations where a physician and a non-physician practitioner split a visit based on the preponderance of time only.  
  • Appreciates the multitude of changes proposed to the Medicare Shared Savings Program (MSSP). While these changes are directionally correct, CHA continues to have concerns about the eventual transition to APP eCQMs and the limits on growth in ACO CMS-HCC scores as CMS contemplates attributing larger populations of underserved beneficiaries to ACOs.  
  • Supports CMS’ proposals to extend Medicare telehealth flexibilities, as well as access to virtual hospital outpatient therapy services provided to patients in their homes, through 2024. We urge CMS to work with Congress to permanently expand telehealth and virtual services for Medicare beneficiaries.   

CHA thanks members for their feedback which informed comments.