CMS发布cy2024 OPPS和ASC支付系统建议规则

7.17.23

额外的细节

付款更新

• 哦: CMS is proposing to update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.8%，这是基于预计的医院市场篮子更新3.0和0.生产率调整下调2个百分点. CMS还建议维持法定的2.0 percentage point reduction in payment for hospitals that fail to meet the hospital outpatient quality reporting requirements.
• ASC率: 2019年CY, CMS finalized its proposal to apply the productivity-adjusted hospital market basket update to the ASC payment system in 添加ition to the OPPS system for an interim period of five years (CY 2019 to CY 2023). 在这个规则中, CMS is proposing to continue applying this market basket to ASC payment rates for an 添加itional two years. 因此，CMS提议对ASC费率2的2024年CY支付进行更新.8%.
• Rural Emergency 医院 (REHs), Indian Health Service (IHS) Facilities, and Tribal Facilities: 部落医院和IHS医院转换成REH, CMS is proposing to pay providers under the same all-included-rate (AIR) methodology that would apply to IHS and tribal facilities that are not an REH. CMS also is proposing that IHS and tribal facilities that convert to REHs would receive the REH monthly facility payment. CMS打算提出这些改变, 如果最终确定, would help stabilize IHS facilities that convert to REHs and promote access to tribal and IHS hospitals.
• 340 b的药物: CMS is proposing to continue to pay 340B-eligible hospitals at the statutory default rate, 一般是ASP加6%, 用于340b收购的药物和生物制品.
  • 值得注意的, CMS于7月7日发布了一项相关的拟议规则, 2023, discussing the proposed remedy for underpayment to 340B-eligible hospitals for 340B-acquired drugs from CY 2018 to CY 2022. 这一补救措施将包括估计为90亿美元的一次性付款，约为1亿美元,600家医院, which would be funded by future reductions to OPPS payments to all hospitals spread over a 15-year period. 参见心电图的发布摘要 在这里.

行为健康方案的改变和建议

• PHP的变化: The PHP is an intensive outpatient program designed to serve as an alternative to psychiatric hospitalization and is paid on a per diem basis under the OPPS. CMS is proposing to expand the PHP’s existing rate structure by 添加ing two Ambulatory Payment Classifications (APCs) for each provider type. This would include one rate for days with three services per day and one rate for days with four or more services per day. CMS is also proposing to calculate these rates using OPPS data, including PHP and non-PHP days. 当前的方法只使用PHP数据. 这种支付结构也适用于下面概述的新提议的国际收支.
• 提出了IOP: CMS提议在医疗保险下建立IOP. This proposal is intended to 添加ress gaps in behavioral health coverage within Medicare and promote access. An IOP is a distinct outpatient program of psychiatric services provided for individuals who have an acute mental illness or substance use disorder.
  • CMS建议在医院门诊部提供IOP云顶集团, 社区精神健康中心(CMHCs), 联邦合格医疗中心(FQHCs), 农村卫生诊所(RHCs).
  • CMS is proposing to base the per diem payment for these behavioral health services either as part of the PHP benefit or under the OPPS more generally. 正如上面建议的PHP更改所反映的那样, CMS建议建立两个apc(一价三天三云顶集团, and one for days with four or more services) and to base payment rates on cost per day using a broader set of OPPS data that includes both PHP days and non-PHP days.
  • 2024年世锦赛, CMS is also proposing to extend IOP coverage to include opioid treatment programs (OTPs). 为了支持这一点, CMS proposes the establishment of a weekly payment adjustment via an 添加-on code for IOP services furnished by OTPs.
• CMHC参与条件(CoP)的更改: To implement provisions established by the Consolidated Appropriations Act (CAA) of 2023, CMS提议修改 requirements for CMHCs to include IOP services throughout the CoP. 最后, CMS提议修改 personnel qualifications to include a revised definition of a mental health counselor and 添加 marriage and family therapists.

质量计划

• CMS提议修改, 添加, and remove several measures within the Hospital Outpatient Quality Reporting (OQR) and the Ambulatory Surgical Center Quality Reporting (ASCQR) Programs, 如下:
  • 拟议的收养措施:
    • Risk-Standardized Patient-Reported Outcomes Following Elective Primary Total Hip and/or Total Knee Arthroplasty measure to provide specific insight into the quality of care of a common procedure
    • Hospital Outpatient/ASC Facility Volume Data on Selected Outpatient Surgical Procedures measures with modifications from the previously adopted version of the measures that were removed from the programs to increase measure granularity
    • [建议只在医院OQR内采用] Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults electronic clinical quality measure (eCQM) to promote patient safety
  • 建议取消的措施:
    • 离开而不被看见的量度, as it does not provide actionable information in sufficient detail to improve quality or patient outcomes
  • 建议修改措施:
    • COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure to align with the updated Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network measure specifications
    • Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery to further standardize the survey instrument, 改进数据收集, 减少设备负担
    • Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure to align with updated clinical guidelines
• 在农村急诊医院质量报告(REHQR)计划范围内, CMS建议采取四项初步措施, 包括以下三个基于权利要求的度量和一个图表抽象度量:
  • 腹部CT:造影剂的使用
  • Median Time from Emergency Department (ED) Arrival to ED Departure for Discharged ED Patients
  • 设施7天风险-门诊结肠镜检查后标准化的医院就诊率
  • 医院门诊手术后7天内风险标准化就诊

其他的更新

• 加强对医院价格透明数据使用的合规, CMS建议修改45 CFR 180的标准电荷显示要求.50. 此外，CMS建议更新45 CFR 180的执行条款.70 .精简执法程序并提高透明度.

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