News: CY 2024 OPPS final rule released, focus on changes to address health inequities

CDI Strategies - Volume 17, Issue 50

On November 2, 2023, CMS finalized Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year (CY) 2024. The final rule includes updates to the Outpatient Prospective Payment System (OPPS) and ASC payment rates, establishing payment for intensive outpatient program services under Medicare, changes to community mental health centers conditions of participation, and finalization of changes to the Hospital Outpatient Quality Reporting, Ambulatory Surgical Center Quality Reporting, and Rural Emergency Hospital Quality Reporting programs.

In accordance with Medicare law, CMS is finalizing OPPS payment rates for hospitals and ASCs that meet applicable quality reporting requirements by 3.1%. These payment policies will affect approximately 3,500 hospitals and approximately 6,000 ASCs. The hospital price transparency policies impact more than 7,000 institutions licensed as hospitals.

In the fact sheet released with the final rule, CMS said,

In addition to finalizing payment rates, this year’s rule includes policies that align with several key goals of the Biden-Harris Administration, including promoting health equity, expanding access to behavioral health care, improving transparency in the health system, and promoting safe, effective, and patient-centered care. The final rule advances the Agency’s commitment to strengthening Medicare. It uses the lessons learned from the COVID-19 PHE to inform the approach to quality measurement, focusing on changes that will help address health inequities.

CMS also made a request for comments on the following topics:

  • Potential Inpatient Prospective Payment System and OPPS payment adjustments for the additional costs of establishing and maintaining a buffer stock of essential medicines
  • Payment for high-cost drugs and services outside of the Indian Health Service all-inclusive rate
  • How the OPPS packaging policy for diagnostic radiopharmaceuticals may have impacted beneficiary access

Editor’s note: To read CMS’s OPPS final rule fact sheet, click here. To download the full final rule, click here

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