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On July 13, the Centers for Medicare and Medicaid Services (CMS) issued its calendar year (CY) 2024 outpatient prospective payment system (OPPS) proposed rule. CMS estimates that Medicare expenditures under OPPS will increase by $6 billion relative to estimated current year payments based on changes in the proposed rule.
Key provisions of the rule are summarized below:
- Payment Update: CMS updates OPPS and ambulatory surgical center (ASC) payment rates for entities that meet quality reporting requirements by 2.8%. The proposed payment update reflects a market basket increase of 3%, reduced by 0.2% productivity adjustment.
- Price Transparency Requirements: For CY 2024, CMS proposes the following changes to the hospital price transparency requirements. If finalized, the changes would be effective on Jan. 1, 2024. However, CMS proposes providing a two-month enforcement grace period that would end on March 1, 2024.
- Use one of several standardized formats for the machine-readable file (MRF) that — to date — have been voluntary.
- Attest to the completeness and accuracy of the data included in the MRF.
- Revise and expand the data elements included in the MRF.
- Take steps to make the files easy to locate by including certain footers on the hospital website.
- Revise 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 Acquired Under the 340B Program: CMS proposes a payment rate of average sales price plus 6% for drugs and biologicals acquired through the 340B Program.
- Inpatient-Only List: CMS does not propose removing procedures from the inpatient-only list.
- ASC Covered Procedures List: CMS proposes adding 26 dental procedures to the ASC covered procedures list.
