Staff Contact: Andrew Wheeler
CMS released the CY 2023 Medicare OPPS payment and policy updates, which also include additional proposed regulations for Rural Emergency Hospitals. CMS is proposing to increase the OPPS market basket by 2.7% and estimates that OPPS payments to all providers would increase by 2.9%. Highlights of the proposed changes include the following.
- use of June 2020 cost report data and CY 2021 claims data for CY 2023 OPPS and ASC payment system rate setting due to the COVID-19 PHE
- pay ASP minus 22.5% for drugs purchased under the 340B drug discount program; due to the recent SCOTUS decision, CMS anticipates increasing these payments to ASP plus 6% in the final CY 2023 OPPS rule
- allow behavioral health services to be furnished remotely by clinical staff of hospital outpatient departments through the use of telecommunications technology to beneficiaries in their home
- update the inpatient only list
- adjust payment for additional costs associated with domestic NIOSH-approved surgical N95 respirators
- implement the REH program
- payment rate of OPPS rate plus 5%
- copays will be based on the OPPS rate and exclude the additional 5%
- monthly fixed payments will be based on the difference in payments to all CAHs and the estimated total amount that would have been paid under the respective fee schedules and divided by the number of CAHs enrolled in the Medicare program; future updates will be based on the market basket update
- REH enrollment process
- physician self-referral law updates
- quality of care CoPs
MHA published an issue brief with additional details. Comments are due on Tuesday, Sept. 13.
