The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) effective Jan. 1, 2024. The rule proposes to:
- Increase the outpatient conversion factor by a net 2.2% from the current $85.585 to $87.488, after the proposed 2.8% market basket is reduced for budget neutrality and other adjustments.
- Pay average sales price plus 6% for drugs and biologicals acquired under the 340B drug discount program and require use of a single modifier, “TB”, for 340B drugs, effective Jan. 1, 2025. Hospitals would have the option to continue reporting the “JG” modifier or transition to solely using the “TB” modifier during 2024.
- Implement several provisions of the Consolidated Appropriations Act that will expand access to behavioral health services including:
- Adopting an additional, untimed code for remote group psychotherapy and making technical refinements to how these codes are recorded that would allow billing for multiple units on the same day.
- Delaying the requirement for an in-person visit within six months prior to the first remote mental heath service and within 12 months after each remote mental health service until Jan. 1, 2025.
- Establishing an intensive outpatient program (IOP) benefit beginning Jan. 1, 2024, with regulatory changes to ensure consistency in requirements among rural health clinics, federally qualified health centers and hospitals. The proposed requirements govern:
- The scope of benefits and definition of IOP services paid on a per-diem basis.
- Minimum number of hours of IOP services per week (9) and frequency (at least every other month) for IOP coverage eligibility.
- Payment rates, established as two ambulatory payment classifications for each provider type and number of services per day.
- Expand the practitioners who may supervise cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services to include nurse practitioners, physician assistants and clinical nurse specialists. The CMS also proposed to allow for the direct supervision of these services to include virtual presence through audio-video, real-time communications technology (excluding audio-only) through Dec. 31, 2024, and to extend this policy to these nonphysician practitioners, who are eligible to supervise these services in calendar year (CY) 2024.
- Update the outpatient quality reporting program.
- Seek comments regarding whether gastric restrictive procedures (CPT codes 43775, 43644, 43645 and 44204) are appropriate for removal from the inpatient only list. Specifically, the CMS requests information on whether these services can be performed safely on the Medicare population in the outpatient setting. The CMS also proposes to add nine services for which codes were newly created.
- Add 26 dental surgical procedures to the ambulatory surgical center covered procedure list for CY 2024.
- Adopt four quality measures for required reporting beginning in CY 2024 for rural emergency hospitals:
- Abdomen CT – Use of Contrast Material.
- Median Time from ED Arrival to ED Department for Discharged ED Patients.
- Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy.
- Risk-Standardized Hospitals Visits Within 7 Day After Hospital Outpatient Surgery.
- Require hospitals to utilize a standard template to display their standard charge information.
The MHA will provide hospitals with an estimated impact analysis within the next several weeks and encourages hospitals to review the rule and submit comments to the CMS by Sept. 11.
Members with questions should contact Vickie Kunz at the MHA.