7.17.23
Additional Details
Payment Updates
- OPPS Rate: CMS提议到2020年更新符合适用质量报告要求的医院的OPPS支付率.8%, which is based on a projected hospital market basket update of 3.0% and a 0.2 percentage point reduction for the productivity adjustment. CMS is also proposing to maintain the statutory 2.对未达到医院门诊质量报告要求的医院,减少支付0个百分点.
- ASC Rate: In CY 2019, CMS最终确定了将生产力调整后的医院市场篮子更新应用于除OPPS系统外的ASC支付系统的建议,为期五年(2019年至2023年). In this rule, CMS建议将这一市场篮子继续适用于ASC支付率,再延长两年. As such, CMS is proposing a CY 2024 payment update for ASC rates of 2.8%.
- 农村急救医院(REHs)、印第安人保健云顶集团设施(IHS)和部落设施: For tribal and IHS hospitals that convert to an REH, CMS提议按照适用于非REH的IHS和部落设施的相同的全包费率(AIR)方法向提供者支付费用. CMS还提议,转换为REH的IHS和部落设施将获得REH每月的设施付款. CMS intends that these proposed changes, if finalized, 将有助于稳定转化为REHs的IHS设施,并促进部落医院和IHS医院的准入.
- 340B Drugs: CMS提议继续按法定违约率向符合条件的340b医院支付费用, generally ASP plus 6%, for 340B-acquired drugs and biologicals.
- Of note, CMS issued a related proposed rule on July 7, 2023, 讨论2018年至2022年期间向符合340b标准的医院支付340b标准药品的建议补救措施. This remedy would include an estimated $9 billion lump sum payment for roughly 1,600 hospitals, 在未来的15年期间,所有医院的OPPS付款将被削减,这将为其提供资金. See ECG’s summary of that release here.
Behavioral Health Programmatic Changes and Proposals
- Changes to PHP: 公共云顶集团计划是一项密集门诊方案,旨在作为精神病住院的替代方案,根据公共云顶集团计划按日支付费用. CMS建议通过为每种提供者类型增加两个动态支付分类(apc)来扩展PHP现有的费率结构. 这将包括每天提供三种云顶集团的天数的一个费率,以及每天提供四种或更多云顶集团的天数的一个费率. CMS还建议使用OPPS数据计算这些费率,包括PHP和非PHP天数. The current methodology only uses PHP data. This payment structure would also apply to the newly proposed IOP outlined below.
- Proposed IOP: CMS is proposing to establish the IOP under Medicare. 该提案旨在解决医疗保险中行为健康覆盖的差距,并促进获取. IOP是为患有急性精神疾病或物质使用障碍的个体提供的一种独特的精神病学门诊云顶集团项目.
- CMS is proposing that IOP services may be furnished in hospital outpatient departments, Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs).
- CMS提议将这些行为健康云顶集团的每日支付作为PHP福利的一部分,或者更普遍地在OPPS下. As reflected in the proposed PHP changes above, CMS is proposing to establish two APCs (one rate for days with three services, 以及使用更广泛的OPPS数据集(包括PHP日和非PHP日)以每天的成本为基础的支付费率.
- For CY 2024, CMS还提议将IOP覆盖范围扩大到阿片类药物治疗项目(otp)。. To support this, CMS建议通过一个附加代码,为校外云顶集团提供者提供的IOP云顶集团建立每周的付款调整.
- Changes to CMHC Condition of Participation (CoP): 执行《云顶集团40011官网》(CAA)的规定, CMS建议修改cmhc的要求,在整个CoP中包括IOP云顶集团. Finally, CMS提议修改人员资格,包括心理健康咨询师的修订定义,并增加婚姻和家庭治疗师.
Quality Programs
- CMS is proposing to modify, add, 并删除医院门诊质量报告(OQR)和门诊外科中心质量报告(ASCQR)计划中的一些措施, as follows:
- Proposed Measures for Adoption:
- 风险标准化患者报告的选择性原发性全髋关节和/或全膝关节置换术后的结果测量,以提供对普通手术护理质量的具体见解
- 选定门诊手术措施的医院门诊/ASC设施数量数据,对以前采用的措施版本进行了修改,从计划中删除,以增加测量粒度
- [Proposed for adoption in Hospital OQR Only] 电子临床质量测量(eCQM)促进患者安全
- Proposed Measure to Be Removed:
- Left without Being Seen measure, 因为它没有提供足够详细的可操作信息来改善质量或患者预后
- Proposed Measures for Modification:
- 卫生保健人员COVID-19疫苗接种覆盖率(HCP)措施与最新的疾病控制和预防中心(CDC)国家卫生保健安全网措施规范保持一致
- 白内障术后90天内患者视功能的改善,进一步规范测量仪器, improve data collection, and reduce facility burden
- 测量平均风险患者正常结肠镜检查的适当随访间隔,以符合最新的临床指南
- Proposed Measures for Adoption:
- Within the Rural Emergency Hospital Quality Reporting (REHQR) Program, CMS is proposing the adoption of four initial measures, including three claims-based measures and one chart-abstracted measure as follows:
- Abdomen CT: Use of Contrast Material
- 出院急诊科患者从急诊室到达到急诊室离开的平均时间
- Facility 7‑Day Risk‑Standardized Hospital Visit Rate after Outpatient Colonoscopy
- Risk-Standardized Hospital Visits within Seven Days after Hospital Outpatient Surgery
Other Updates
- To strengthen compliance around use of hospital price transparency data, CMS is proposing to modify the standard charge display requirements at 45 CFR 180.50. Additionally, CMS is proposing to update the enforcement provisions at 45 CFR 180.70 to streamline and improve the transparency of the enforcement process.
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Edited by: Matt Maslin