The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) effective Jan. 1, 2024.
The rule:
- Provides a net 2.1% to the outpatient conversion factor for hospitals that report quality measure data. This will increase the factor from the current $85.58 to $87.38, after the 3.3% market basket is reduced for the required productivity cut, budget neutrality and other adjustments.
- Continues paying average sales price plus 6% for drugs and biologicals acquired under the 340B drug discount program.
- Consolidates the use of modifiers, “JG” and “TB”, for 340B drugs effective Jan. 1, 2024, with hospitals having the option to continue reporting the “JG” modifier or transition to solely using the “TB” modifier during 2024.
- Implements several provisions of the Consolidated Appropriations Act that will expand access to behavioral health services including:
- Adopting an additional, untimed code for virtual 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 virtual mental health service and within 12 months after virtual 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 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 (nine) 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.
- Expands 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 allows 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 extends this policy to these non-physician practitioners, who are eligible to supervise these services in CY 2024.
- Adds 10 services to the inpatient only list.
- Updates the outpatient quality reporting program.
- Adds 26 dental surgical procedures and 11 additional procedures to the ambulatory surgical center covered procedure list for CY 2024.
- Adopts 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 Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy.
- Risk-Standardized Hospitals Visits Within Seven Day After Hospital Outpatient Surgery.
- Requires hospitals to utilize a standard template for hospital transparency files, including additional required data elements and establishes additional CMS enforcement mechanisms for reporting requirements. While hospitals need to utilize the new format by July 1, 2024, several of the new data elements will not be required until Jan. 1, 2025.
The MHA will provide hospitals with an updated estimated impact analysis within the next several weeks.
Members with questions should contact Vickie Kunz at the MHA.