On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1786-P], which includes proposals to update payment rates and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2024.
For CY 2024, CMS proposes to increase payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System by a factor of 2.8%. Hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0% reduction in the CY 2024 fee schedule increase factor.
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Key takeaways from the CY 2024 OPPS and ASC Payment System Proposed Rule:
- CMS proposes to broaden enforcement of the hospital price transparency requirements by requiring hospitals to use a template to submit charge information and by publicizing the enforcement actions it has taken against hospitals.
- CMS outlines plans to implement the Intensive Outpatient Program benefit.
- CMS proposes to not expand the categories of services subject to prior authorization.
- CMS seeks comments from stakeholders on payment alternatives to its current bundling policy for diagnostic radiopharmaceuticals.
- CMS proposes to continue to pay the statutory default rate, average sales price (ASP) plus 6%, for 340B-acquired drugs and biologicals.
- CMS proposes to update the ASC covered procedures list (CPL) by adding 26 dental surgical procedures to the CPL, but proposes no procedure removals from the inpatient only (IPO) list for CY 2024.
- CMS proposes to extend the application of the productivity-adjusted hospital market basket update to ASC payment system rates for an additional two years.
- CMS proposes to maintain its site neutrality policy but proposes to reimburse intensive cardiac rehabilitation provided by an off-campus, non-excepted provider-based department of a hospital at 100% of the OPPS rate.
- CMS solicits feedback via several requests for information, including feedback on what evaluations of health equity should be included in the agency’s economic analysis of OPPS and ASC policies, and on establishing additional payments to hospitals for maintaining access to essential medicines.
Comments on the proposed rule are due September 11, 2023.
- The proposed regulations are available here.
- The press release is available here.
- The fact sheet is available here.
