The Centers for Medicare & Medicaid Services (CMS) is proposing to expand access to behavioral health services through coverage of intensive outpatient services — an intermediate level of behavioral health care. To support practices to help curtail shortages of essential medicines, CMS is seeking comment in this rule on potential payment adjustments to hospitals for the additional costs of establishing and maintaining a buffer stock of essential medicines. CMS is also taking steps to increase hospital compliance with the requirements, to improve automated access to standard charge information, to further strengthen enforcement, and to improve the ability of the public to understand and meaningfully use hospital charges for items and services. Additionally, CMS is proposing actions to promote health equity for tribal communities. These proposals are included in the calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule released today.
“CMS is taking action to help shape a resilient, equitable, and high-value health care system,” said CMS Administrator Chiquita Brooks-LaSure. “This proposed rule expands access to behavioral health care and supports the Biden-Harris Administration’s priority to remove barriers that limit price transparency with a goal of increasing competition to bring down health care costs.”
Every year, CMS reviews and updates payment rates and policies for the OPPS and the ASC payment system. CMS is proposing to update OPPS payment rates for CY 2024 for hospitals that meet applicable quality reporting requirements by 2.8%. This update is based on the projected hospital market basket percentage increase of 3%, reduced by 0.2 percentage point for the productivity adjustment. Using the proposed hospital market basket update, CMS is also proposing to update the ASC rates for CY 2024 by 2.8% for ASCs that meet relevant quality reporting requirements.
Currently, Medicare covers and pays for various of behavioral health services, including inpatient psychiatric hospitalizations, partial hospitalizations services, and outpatient therapeutic services. However, there is a current gap in coverage when people with Medicare require levels of services more frequent than individual outpatient therapy visits, but less intensive than a partial hospitalization program. The CY 2024 OPPS and ASC Payment System Proposed Rule includes proposals to implement provisions of the Consolidated Appropriations Act, 2023 that created a new benefit category for Intensive Outpatient Program services. CMS is proposing to establish payment and program requirements for the benefit across various settings, including hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers, and Rural Health Clinics effective January 1, 2024. CMS is also proposing to establish payment for intensive outpatient program services provided by Opioid Treatment Programs (OTPs) effective January 1, 2024, and is clarifying that these intensive behavioral health services are available for individuals with mental health conditions and for individuals with substance use disorders.
“This proposed rule reflects CMS’ commitment to ensure Medicare is comprehensive in its ability to address patient needs, filling gaps in the health care system including behavioral health,” said Dr. Meena Seshamani, Deputy Administrator and Director for CMS’ Center for Medicare. “Through these proposals, we will ensure people get timely access to quality care in their communities, leading to improved outcomes and better health.”
Over the past several years, CMS has implemented or is in the process of implementing complementary groundbreaking policies to promote transparency across the health care system. In this rule, CMS proposes to strengthen the hospital price transparency regulations, which require each hospital operating in the United States to make its standard charges public. CMS proposes to make it easier for the public to learn what a hospital charges for items and services and to further enhance the hospital price transparency enforcement process, building on actions taken to streamline enforcement earlier this year. These proposals include new requirements to standardize the hospital’s display of standard charge information in their machine-readable file and new requirements governing how hospitals must publicly post those files on their websites.
Additionally, CMS is proposing new policies to improve and streamline its enforcement capabilities, including certification by hospital officials as to the accuracy and completeness of data, requiring hospital acknowledgement of warning notices, reserving the right for CMS to communicate directly with health system leadership about all of its hospitals, not just one hospital at a time, and publishing other enforcement activities, in addition to civil monetary penalties, on a CMS website.
Furthermore, the Biden–Harris Administration has developed the National Strategy for a Resilient Public Health Supply Chain, which is a roadmap to support reliable access to products for public health in the future, including through prevention and mitigation of medical product shortages. CMS is taking concrete steps to help achieve this goal by seeking comment on a separate payment to hospitals for establishing and maintaining access to a buffer stock of essential medicines to foster a more reliable, resilient supply of these medicines. This builds on similar supply chain resiliency actions in last year’s OPPS rulemaking to create a separate hospital payment for domestic surgical N95 respirators.
In this proposed rule, CMS is also promoting equity and taking actions to support Indian Health Service (IHS) and tribal facilities. CMS is proposing that IHS and tribal facilities that convert to the new Rural Emergency Hospital (REH) provider type may continue to be paid per visit rate, in addition to receiving the monthly facility payment that applies to all REHs.
REHs are a new provider type that started in January 2023 to provide a more sustainable option for rural hospitals facing closure and support access to care in rural and underserved communities. This aligns with CMS’ work to advance health equity to make sure our programs support health for all people we serve, particularly those who are underserved. In addition, CMS is seeking comment on how to pay for high-cost drugs and services, such as oncology drugs, outside of the per visit rate that these facilities receive to provide equitable payment for high-cost drugs and services provided by IHS and tribal facilities.
For a fact sheet on the CY 2024 OPPS/ASC Payment System proposed rule, please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center
For a fact sheet on hospital price transparency, please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2024-hospital-outpatient-prospective-payment-system-opps-policy-changes-hospital-price
For a blog that highlights the recent changes to improve access to behavioral health services, visit: https://www.cms.gov/blog/important-new-changes-improve-access-behavioral-health-medicare
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