/ en Tue, 29 Apr 2025 23:12:02 -0500 Mon, 09 Sep 24 16:04:23 -0500 /news/headline/2024-09-09-aha-comments-opps-proposed-rule-cy-2025 <p>The AHA Sept. 9 <a href="/lettercomment/2024-09-09-aha-comments-cms-outpatient-ambulatory-surgery-center-cy-2025-proposed-payment-rule">commented</a> on the Centers for Medicare & Medicaid’s <a href="https://public-inspection.federalregister.gov/2024-15087.pdf">outpatient prospective payment system</a> proposed rule for calendar year 2025, expressing concerns about shortcomings in the market basket forecast and update for hospital outpatient departments. Medicare hospital OPPS rates would increase by a net 2.6% in CY 2025 compared to 2024. This includes a proposed 3.0% market basket update, offset by a 0.4 percentage point cut for productivity. AHA urged CMS to consider whether adjustments are necessary to the agency’s approach to annual market basket updates and to eliminate the productivity cut for CY 2025. AHA also shared concerns about CMS’ proposed conditions of participation for obstetrical services.</p> Mon, 09 Sep 2024 16:04:23 -0500 Prospective Payment Systems (PPS) <p>In this webinar, AHA staff discussed the recently released <a href="https://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://public-inspection.federalregister.gov/2024-14828.pdf">CY 2025 Physician Fee Schedule proposed rule.</a> This rule proposes updates to physician fee schedule rates, changes to telehealth services, updates for behavioral health and opioid use disorder, and other aspects of physician payment. The rule also proposes changes to the Medicare Shared Savings Program (MSSP) and Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. <br> </p><p>See the <a href="/2024-07-31-medicare-physician-fee-schedule-proposed-rule-cy-2025">AHA Regulatory Advisory</a> for a summary of the rule.</p><p><br>Members can <a href="https://aha-org.zoom.us/rec/share/Ozc6eCdUVw5YQz3c3Mnwjt9iQWektk9lsKKRQJMQHdjjoxJ1f_EKjKU-T_TW1JKw.yyusAHVAqgI0hus4?startTime=1723222710000">view the recording of the session </a>and download slides below for further review.</p> Mon, 12 Aug 2024 17:57:51 -0500 Prospective Payment Systems (PPS) /news/headline/2024-07-30-aha-files-amicus-brief-supporting-reviewability-certain-cms-determinations <p>The AHA along with the Federation of ����������s, America’s Essential Hospitals and the Association of American Medical Colleges July 29 filed an <a href="/amicus-brief/2024-07-30-amicus-brief-aha-others-file-amicus-brief-challenging-reviewability-certain-cms-determinations">amicus brief</a> in the U.S. Court of Appeals for the District of Columbia in support of hospitals’ continued right to seek immediate review of any Centers for Medicare & Medicaid Services determination that could impact Medicare payments for providers. These determinations include those made under CMS’ disproportionate share hospital formula, which can have profound impacts on hospitals’ Medicare payment amounts even with minimal adjustments, and for which a months- or yearslong process to correct mistakes could have substantial and even irreparable consequences.  <br> <br>Congress granted providers the ability to immediately challenge final determinations governing future payments when it enacted Medicare’s current prospective payment system, but CMS has since sought to arbitrarily narrow the category of determinations considered final, effectively insulating its decision making from review. As the brief makes clear, this effort by the government is untenable for hospitals. "Hospitals seeking to preserve their rights in the face of the government’s indeterminate reviewability test should not be forced to risk violating agency rules or be left relying on administrative grace," the brief states. "They should be able to take a statutory provision specifically designed to make immediate review broadly available at its word." <br> <br>The AHA, Federation, AEH and AAMC urged the D.C. Circuit to consider the vast potential consequences of the government’s shift for American hospitals both in the DSH context and beyond it. "At minimum, its approach compounds the complexity of an already-byzantine administrative apparatus and needlessly increases uncertainty," the brief notes. "Congress did not intend any of this. It enacted a simple provision that broadly allows hospitals to seek immediate review of any final CMS determination that reduces the payment amounts they will receive — including the DSH adjustment. This Court should give effect to Congress’s judgment and affirm."</p> Tue, 30 Jul 2024 15:11:53 -0500 Prospective Payment Systems (PPS) /news/headline/2024-07-10-cms-proposes-increasing-payment-rates-26-cy-2025 <p>The Centers for Medicare & Medicaid Services July 10 issued a <a href="https://public-inspection.federalregister.gov/2024-15087.pdf">proposed rule</a> that would increase Medicare hospital outpatient prospective payment system rates by a net 2.6% in calendar year 2025 compared to 2024. This includes a proposed 3.0% market basket update, offset by a 0.4 percentage point cut for productivity. <br><br>In a <a href="/press-releases/2024-07-10-aha-statement-cy-2025-opps-proposed-rule">statement</a> shared with the media, Ashley Thompson, AHA senior vice president of public policy analysis and development, said, "CMS has yet again proposed an inadequate update to hospital payments. This proposed increase for outpatient hospital services of only 2.6% comes despite the fact that many hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging. Hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be in jeopardy, and we urge CMS to provide additional support in the final rule.  <br><br>In addition, CMS proposes to adopt three measures related to health equity for the outpatient, ambulatory surgical center and rural emergency hospital quality reporting programs and to extend voluntary reporting of data for two hybrid measures in the Inpatient Quality Reporting Program.</p><p>CMS also proposes several changes to payment for drugs. Among these are proposals that would provide separate payment for diagnostic radiopharmaceuticals with per-day costs above a threshold of $630, exclude certain qualifying cell and gene therapies from packaging under the comprehensive ambulatory payment classification policy, and pay for HIV pre-exposure prophylaxis in hospital outpatient departments.</p><p>The agency also proposes new conditions of participation for hospitals and critical access hospitals focused on obstetrical services and maternal care. Among other policies, CMS would require hospitals and CAHs with obstetrical care units to adopt certain processes for the organization, staffing and delivery of obstetrical care services and to incorporate maternal and obstetrical care into their quality assessment and performance improvement programs. CMS also proposes to require hospital emergency services to have protocols for addressing obstetrical emergencies, complications and immediate post-delivery care. Lastly, the agency proposes to require hospitals to have written policies and procedures for transferring patients under their care, including transfers both within and outside of the hospital.</p><p>“The AHA fully shares CMS’ goals of improving maternal health outcomes and reducing inequities in maternal care,” Thompson said, “However, we are deeply concerned by CMS’ continued and excessive use of Conditions of Participation to drive its policy agenda. We believe a less punitive and more collaborative and flexible approach is far superior. We will carefully review CMS’ proposals to determine whether they are feasible, sufficiently flexible for the wide variety of hospitals to which they would apply and do not inadvertently exacerbate maternal care access challenges.”</p><p>CMS will accept comments on the proposed rule through Sept. 9</p> Wed, 10 Jul 2024 15:38:55 -0500 Prospective Payment Systems (PPS) /news/headline/2024-06-10-aha-says-cms-proposed-fy-2025-ltch-payment-updates-not-enough <p>The AHA submitted a <a href="/lettercomment/2024-06-07-aha-comment-cmss-fiscal-year-2025-ltch-prospective-payment-system-proposed-rule">lette</a>r to the Centers for Medicare & Medicaid Services June 7, commenting on the fiscal year 2025 proposed rule for the long-term care hospital prospective payment system. The AHA expressed concerns about CMS’ payment updates, which includes an inadequate proposed market basket update as well as a harmful proposed update to high-cost outlier payments. AHA argued that these updates risk jeopardizing care access to some Medicare beneficiaries and lag inflation. <br>  <br>“These escalating costs for essential clinicians, personnel, drugs, supplies, and other items and services have put a strain on the entire health care continuum,” AHA wrote. “In all, Kaufman Hall found that total expenses have risen by 18% for hospitals compared to 2021. This is felt keenly by LTCHs, who care for the highest acuity patients with unique needs.”  <br><br>The AHA submitted separate comments on the rule’s <a href="/lettercomment/2024-06-05-aha-comments-cms-inpatient-payment-proposal-fy-2025">inpatient PPS</a> and <a href="/lettercomment/2024-06-10-aha-comments-cms-proposed-transforming-episode-accountability-model-team">Transforming Episode Accountability Model</a> proposals. </p> Mon, 10 Jun 2024 15:37:04 -0500 Prospective Payment Systems (PPS) /news/headline/2024-03-28-cms-proposes-41-payment-update-snfs-and-revise-nursing-home-enforcement-authority-fy-2025 <p>The Centers for Medicare & Medicaid Services March 28 issued a <a href="https://public-inspection.federalregister.gov/2024-06812.pdf">proposed rule</a> for fiscal year 2025 for the skilled nursing facility prospective payment system, which would increase aggregate Medicare spending by 4.1% or $1.3 billion compared with FY 2024. This reflects a proposed 2.8% market basket update, a 1.7 percentage-point increase to counter the agency’s market basket error in FY 2023, and a 0.4 percentage-point productivity decrease. <br><br>CMS proposes to revise regulations regarding its nursing home enforcement authority to allow the agency to impose additional financial penalties on facilities where health and safety deficiencies are identified.<br><br>While CMS does not propose to adopt or remove any quality measures from the SNF Quality Reporting Program, the agency proposes to adopt and modify certain patient assessment items related to health-related social needs; SNFs would be required to collect and report specific data elements related to living situation, food and utilities beginning with the FY 2027 SNF QRP. CMS also proposes to adopt a data validation process for the SNF QRP beginning the same year.<br><br>CMS proposes a number of operational updates to the SNF Value-based Purchasing program, including policies regarding measure removal and review and corrections. The agency also proposes an update to the case mix methodology used to calculate the Total Nurse Staffing measure.</p><p>CMS will accept public comments on the proposed rule through May 28.</p> Thu, 28 Mar 2024 15:54:58 -0500 Prospective Payment Systems (PPS) /news/headline/2024-03-20-aha-recommends-changes-ltch-pps-high-cost-outlier-policy <p>AHA March 19 urged the Centers for Medicare & Medicaid Services to modernize its high-cost outlier policy for the long-term care hospital prospective payment system to reflect a shrinking patient population and more acute patient mix under the new dual-rate LTCH PPS payment structure. <br><br>“These trends, along with the increasing fixed-loss amount, have led to the current HCO policy becoming inadequate in meeting its goal of reasonably reducing the financial losses that would otherwise be incurred by hospitals when treating beneficiaries in need of the costliest care,” AHA <a href="/lettercomment/2024-03-20-protecting-critically-ill-medicare-beneficiaries-through-reforms-long-term-care-hospital-pps-high-cost">wrote</a>. “Further, this inadequacy is being exacerbated by other market dynamics, including inadequate payment updates, growth in Medicare Advantage, and a workforce crisis, resulting in payments that fall short of the cost of care and an uncertain future for the LTCH field.” </p> Wed, 20 Mar 2024 14:59:33 -0500 Prospective Payment Systems (PPS) <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Centers for Medicare & Medicaid Services (CMS) on July 27 issued its final rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS) for fiscal year (FY) 2024.</p> <div class="panel module-typeC"> <div class="panel-heading"> <h3>Key Highlights</h3> <p>The final rule:</p> <ul> <li>Increases payments by a net 4%, or $355 million, relative to FY 2023 payments. This includes a market basket update of 3.6%, reduced by 0.2 percentage points for productivity and increased by 0.6 percentage points due to a change in the outlier threshold.</li> <li>Rebases the IRF market basket using 2021 claims data and increase the labor-related share by 1.2%, from 72.9% to 74.1%.</li> <li>Eliminates the requirement that IRF units only begin operating at the beginning of hospital cost-report periods.</li> <li>Finalized its IRF QRP proposals to adopt two new measures as well as a modified version of an existing measure while removing three measures. CMS also finalized proposals to begin public reporting of four measures.</li> </ul> </div> </div> <h2>AHA Take</h2> <p>Consistent with the proposed rule, the final rule does not include any changes to the structure and mechanics of the IRF PPS. While the finalized market basket is 0.4 percentage points higher than the proposed, we are disappointed that the agency acknowledged, but declined to address, the missed forecasts in recent years that underestimated the inflation IRFs faced.</p> <p>Highlights from the rule follow.</p> <h2>IRF PPS Payment Changes</h2> <h3>FY 2024 Payment Updates</h3> <p>CMS estimates that its finalized updates will increase net payments to IRFs in FY 2024 by 4% overall ($355 million) relative to FY 2023. This includes a 3.6% market basket update offset by a statutorily mandated productivity cut of 0.2 percentage points. In addition, the finalized change to the outlier threshold is expected to increase FY 2024 IRF payments by an estimated 0.6 percentage points relative to FY 2023.</p> <p>The 3.6% market basket update is based on the latest available data and is higher than the proposed rule’s 3.2% forecast. Applying this update, as well as small budget neutrality factors for changes in case mix group (CMG) weights and wage adjustments, CMS finalized a standard payment conversion factor of $18,541 for FY 2024.</p> <p>CMS also finalized its annual update to the CMG weights and tiers. These updated weights are available in Table 2 of the final rule. CMS estimates that 99.4% of IRF discharges will be in CMGs and tiers that will experience a less-than-5% change in weight, relative to FY 2023, which is consistent with its estimate in the proposed rule.</p> <h3>Rebasing of Market Basket</h3> <p>Approximately every four years, CMS rebases the IRF market basket, which involves evaluating the relative weight of typical cost categories for IRFs, as well as examining the appropriate proxies to use for those cost categories. CMS finalized its proposal to rebase the market basket using FY 2021 data. In Table 11 of the rule, it provides its finalized changes to the weights and price proxies for each cost category. In addition, Table 12 of the final rule shows that the updated market basket would, overall, produce similar updates for both historical and prospective fiscal years compared to the current market basket.</p> <h3>Labor-Related Share</h3> <p>As a result of the market basket rebasing, CMS proposed and now finalizes a notable change to the labor-related share, increasing it to 74.1%, from the current level of 72.9%. CMS stated that a large portion of this increase is the result of data reflecting hospitals’ increased use of contract labor, and the larger portion of costs allocated to this expense in the new market basket.</p> <h3>New Unit Classification</h3> <p>CMS finalized its proposal to modify the rules surrounding opening of IRF units in hospitals. The agency’s longstanding policy was to only permit the opening of new IRF units at the beginning of hospitals’ cost reporting periods. However, CMS will now permit the opening of a new IRF unit at any time, provided that the hospital notifies its fiscal intermediary and the CMS Regional Office in writing of the change at least 30 days before the date of the change.</p> <h2>IRF Quality Reporting Program (QRP)</h2> <p>CMS finalizes its proposals to adopt two new measures as well as a modified version of an existing measure while removing three measures. CMS also finalizes proposals to begin public reporting of four measures.</p> <h3>Modified COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) Measure</h3> <p>Beginning with the FY 2025 IRF QRP, CMS will modify the current HCP COVID-19 Vaccination measure used in the IRF QRP. The current measure assesses the number of HCP who have received a complete vaccination course against COVID-19; CMS will replace the definition of “complete vaccination course” with a definition of “up to date” with CDC-recommended COVID-19 vaccines. The agency makes this modification to incorporate new CDC guidance related to booster doses and their associated timeframes.</p> <p>CMS did not propose any changes to the data submission or reporting processes for this measure. Compliance with the FY 2025 IRF QRP will be based on reporting of individuals who are up to date beginning in quarter four of CY 2023. Public reporting of the modified version of the measure will begin with the September 2024 Care Compare refresh, or as soon as technically feasible.</p> <h3>Adoption of Discharge Function Score Measure</h3> <p>Beginning with the FY 2025 IRF QRP, CMS will adopt this outcome measure that estimates the percentage of IRF patients who meet or exceed an expected discharge score during the reporting period. The score is calculated by summing individual function item values at discharge, while the expected score is computed by risk-adjusting the observed discharge function score for each IRF stay. The measure is not endorsed by a consensus-based entity.</p> <h3>Removal of Overlapping Discharge Function Measures</h3> <p>CMS believes the newly adopted Discharge Function Score measure better measures functional outcomes through the removal of the following three measures from the IRF QRP, beginning in FY 2025:</p> <ul> <li>Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function</li> <li>Change in Self-Care Score for Medical Rehabilitation Patients</li> <li>Change in Mobility Score for Medical Rehabilitation Patients</li> </ul> <h3>Adoption of Percent of Patients/Residents Who are Up to Date with COVID-19 Vaccination Measure</h3> <p>Beginning with the FY 2026 IRF QRP, CMS will adopt this assessment-based process measure that reports the percent of stays in which patients in an IRF are, per the CDC’s latest guidance, up to date on their COVID-19 vaccinations. The measure has no exclusions, including those for patients who were offered a vaccine and refused, or for patients who have medical contraindications to the COVID-19 vaccine. CMS will publicly report measure performance on Care Compare.</p> <h3>Public Reporting</h3> <p>Beginning with the September 2024 Care Compare refresh, CMS will publicly display data for the previously adopted Transfer of Health information to the Patient and Transfer of Health Information to the Provider measures.</p> <h2>Further Questions</h2> <p>Please contact Jonathan Gold, AHA’s senior associate director of policy, at <a href="mailto:jgold@aha.org?subject=Special Bulletin: CMS Releases FY 2024 Inpatient Rehabilitation Facility PPS Final Rule Queston on Payment">jgold@aha.org</a> with any questions related to payment, and Caitlin Gillooley, AHA’s director of policy, at <a href="mailto:cgillooley@aha.org?subject=Special Bulletin: CMS Releases FY 2024 Inpatient Rehabilitation Facility PPS Final Rule Queston on Quality">cgillooley@aha.org</a>, regarding any quality-related questions.</p> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2023/07/Special-Bulletin-CMS-Releases-FY-2024-Inpatient-Rehabilitation-Facility-PPS-Final-Rule.pdf" target="_blank" title="Click here to download the Special Bulletin: CMS Releases FY 2024 Inpatient Rehabilitation Facility PPS Final Rule PDF."><img alt="Special Bulletin: CMS Releases FY 2024 Inpatient Rehabilitation Facility PPS Final Rule page 1." data-entity-type="file" data-entity-uuid="cfe94cc8-4926-4b0f-9410-a96ecba4d2c3" src="/sites/default/files/inline-images/Page-1-Special-Bulletin-CMS-Releases-FY-2024-Inpatient-Rehabilitation-Facility-PPS-Final-Rule.png" width="695" height="900"></a></p> </div> </div> </div> Fri, 28 Jul 2023 13:27:36 -0500 Prospective Payment Systems (PPS) <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Centers for Medicare & Medicaid Services (CMS) July 13 released its calendar year (CY) 2024 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) <a href="https://public-inspection.federalregister.gov/2023-14768.pdf" target="_blank">proposed rule</a> that would increase OPPS rates by a net 2.8% in CY 2024 compared to CY 2023. The rule also includes proposals related to hospital price transparency requirements, behavioral health services and Rural Emergency Hospitals (REHs). The final rule will be published on or around Nov. 1 and take effect Jan. 1, 2024. CMS will accept comments on the proposed rule through Sept. 11.</p> <div class="panel module-typeC"> <div class="panel-heading"> <h3>Key Highlights</h3> <p>CMS’ proposed rule would:</p> <ul> <li>Increase Medicare hospital OPPS rates by a net 2.8% in CY 2024 compared to CY 2023.</li> <li>Create standardized formats for hospital price transparency files, including new required data elements such as contracting type for negotiated rates, and establish additional CMS monitoring and enforcement mechanisms.</li> <li>Expand access to behavioral health services, including new coverage for intensive outpatient programs for behavioral health conditions.</li> <li>Pay for 340B acquired drugs and biologicals at the average sales price (ASP) plus 6% and, effective Jan. 1, 2025, require that all 340B hospitals only report the “TB” modifier.</li> <li>Add 10 services to the inpatient-only list.</li> <li>Adopt new measures for the Outpatient, ASC and REH Quality Reporting Programs and modify several others.</li> <li>Seek comments on a potential payment mechanism for hospitals to establish and maintain access to a buffer supply of essential medicines.</li> </ul> </div> </div> <h2>AHA Take</h2> <p>The AHA is deeply concerned that CMS is proposing a CY 2024 outpatient hospital payment update of only 2.8% despite persistent financial headwinds facing the hospital field. Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day. Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized.</p> <p>Separately, hospitals remain committed to helping patients access the information they need when planning for their care, including meaningful information about the cost of that care. The AHA will be carefully reviewing the proposed changes to the Hospital Price Transparency Rule to ensure they continue to advance our shared objective with CMS of making it easier for patients to access pricing and cost information while reducing unnecessary administrative burden and costs on hospitals and health systems.</p> <h2>What You Can Do</h2> <ul> <li><strong>Participate in an AHA members-only webinar on Friday, Aug. 18 at 2 p.m. ET</strong> to share your questions and feedback on this regulation for AHA’s comment letter to CMS. <a href="https://aha.adobeconnect.com/oppsasc2024/event/registration.html" target="_blank">Register for this 90-minute webinar.</a></li> <li><strong>Share this advisory with your senior management team</strong> and ask your chief financial officer to examine the impact of the proposed payment changes on your Medicare revenue for CY 2024. Spreadsheets comparing the proposed changes in the APC payment rates and weights from 2023 to 2024 are available on the AHA’s <a href="/topics/outpatient-pps">OPPS webpage</a>. To access these, you must be logged on to the website.</li> <li><strong>Share this advisory with your billing, medical records, quality improvement and compliance departments, as well as your clinical leadership team</strong> to apprise them of the proposals around the ambulatory payment classifications (APCs), mental health services, hospital price transparency and quality measurement requirements.</li> <li><strong>Submit comments to CMS with your specific concerns by Sept. 11 at <a href="https://www.regulations.gov/" target="_blank">www.regulations.gov</a>.</strong></li> </ul> <p><strong><em><a href="/system/files/media/file/2023/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2024.pdf" target="_blank" title="Click here to download the Regulatory Advisory: Hospital Outpatient, Ambulatory Surgical Center Proposed Rule for CY 2024 PDF."><span>Download the complete Regulatory Advisory PDF.</span></a></em></strong></p> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2023/07/Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2024.pdf" target="_blank" title="Click here to download the Regulatory Advisory: Hospital Outpatient, Ambulatory Surgical Center Proposed Rule for CY 2024 PDF."><img alt="Regulatory Advisory: Hospital Outpatient, Ambulatory Surgical Center Proposed Rule for CY 2024 page 1." data-entity-type="file" data-entity-uuid="943f8cf9-0395-44c4-85dd-44c05960648e" src="/sites/default/files/inline-images/Page-1-Regulatory-Advisory-Hospital-Outpatient-Ambulatory-Surgical-Center-Proposed-Rule-for-CY-2024.png" width="695" height="900"></a></p> </div> </div> </div> Fri, 28 Jul 2023 08:05:57 -0500 Prospective Payment Systems (PPS) /news/headline/2023-07-13-opps-rule-cms-proposes-increasing-payment-rates-28-modifying-price-transparency-rules <p>The Centers for Medicare & Medicaid Services July 13 issued a <a href="https://public-inspection.federalregister.gov/2023-14768.pdf?mkt_tok=NzEwLVpMTC02NTEAAAGM8J6m1SsrwSdqSHuDdgVdGHss7Dt6Q5kasmuY8lQYPtPYF9dpeWUW0ElkEjQBK2_WlXqYuL8c24-dw01KCpE">proposed rule</a> that would increase Medicare hospital outpatient prospective payment system rates by a net 2.8% in calendar year 2024 compared to 2023. This includes a proposed 3.0% market basket update, offset by a 0.2% cut for productivity.<br /> <br /> In a <a href="/press-releases/2023-07-13-aha-statement-cy-2024-opps-proposed-rule">statement</a> shared with the media, AHA Executive Vice President Stacey Hughes said, “The AHA is concerned that CMS is proposing an outpatient hospital payment update of only 2.8% in spite of persistent financial headwinds facing the hospital field. Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day. Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized.” <br /> <br /> In addition, CMS proposes several changes to the hospital price transparency requirements. These proposals would require that hospitals use one of several standardized formats for the machine-readable files; revise the oversight and enforcement process, including by requiring hospital attestations of compliance; and establish new website requirements intended to ease navigation of hospital price transparency files, among other proposals. In addition, the agency seeks comments on ways it can better align the various hospital and insurer price transparency policies.<br /> <br /> “Hospitals remain committed to helping patients access the information they need when planning for their care, including meaningful information about the cost of that care,” Hughes said. “The AHA will be carefully reviewing the proposed changes to the Hospital Price Transparency Rule to ensure they continue to advance our shared objective with CMS of making it easier for patients to access pricing and cost information while reducing unnecessary administrative burden and costs on hospitals and health systems.”<br /> <br /> CMS also proposes multiple provisions that would improve access to behavioral health services, including implementation of a statutorily required Medicare benefit for Intensive Outpatient Programs and a new payment code for remote group psychotherapy. The agency also proposes to delay the in-person visit requirement for remote outpatient mental health services until the end of 2024; expand and revise the payment structure for Medicare Partial Hospitalization Program services; and update the Conditions of Participation for Community Mental Health Centers as directed by the Consolidated Appropriations Act of 2023, including coverage for treatment under IOPs and by mental health counselors and marriage and family therapists.<br /> <br /> CMS will accept comments on the proposed rule through Sept. 11. AHA members will receive a Special Bulletin with more details tomorrow.</p> Thu, 13 Jul 2023 18:26:26 -0500 Prospective Payment Systems (PPS)