CHA News

CMS Finalizes Inadequate Outpatient Payment Update

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What’s happening: The Centers for Medicare & Medicaid Services (CMS) has finalized the calendar year (CY) 2024 outpatient prospective payment system rule.  

What else to know: It includes a net market basket update of 3.1%, which is a slight increase over the proposed 2.8%.  

Key provisions of the final rule include: 

  • Price Transparency Requirements: CMS finalizes changes to the machine-readable file (MRF) and enforcement provisions. While changes are effective on Jan. 1, 2024, the final rule provides a staggered enforcement delay, depending on the specific requirement, for most provisions. Finalized changes include: 
    • Using one of several standardized formats for the MRF that includes revised and expanded data elements  
    • Attesting to the completeness and accuracy of the data included in the MRF 
    • Taking steps to make the files easy to locate by including certain footers on the hospital website 
    • Enhancing the enforcement process by updating methods to assess hospital compliance, requiring hospitals to acknowledge receipt of warning notices, and publicizing more information about CMS enforcement activities related to individual hospital compliance 
  • Payment for Separately Payable Drugs: CMS finalizes a payment rate of average sales price plus 6% for drugs and biologicals, including those acquired through the 340B Program. 
  • Inpatient-Only List: CMS does not remove procedures from the inpatient-only list.  
  • Medicare Payment for Intensive Outpatient Programs: CMS establishes payment for intensive outpatient programs. The rule finalizes the scope of benefits, physician certification requirements, coding and billing requirements, and payment rates. 
  • Outpatient Quality Reporting Program: CMS finalized modifications to three measures, including updates to the COVID-19 Healthcare Personnel Vaccination measure, to align with the Centers for Disease Control and Prevention National Healthcare Safety Network measure specifications. CMS also finalized extended voluntary reporting periods for two measures and did not finalize proposals to re-adopt a volume measure or to remove an emergency department measure.  
  • Ambulatory Surgery Center (ASC) Covered Procedures List: CMS adds 37 procedures, including dental services and total shoulder arthroplasty, to the ASC covered procedures list.  

CHA is currently reviewing the rule and will make a detailed summary available to members soon.