MHA Today | November 6, 2023

Staff Contact: Andrew Wheeler

CMS released the CY 2024 final payment and policy updates for the Medicare Ambulatory Surgical Center and Outpatient PPS. The 2024 payment update is 3.1%, which includes a 3.3% market basket increase reduced by a 0.2% productivity adjustment. The following are major components of the rule.

• CMS estimates CY 2024 OPPS payments to increase $6 billion compared to CY 2023.
• CMS estimates CY 2024 ASC payments to increase $207 million compared to CY 2023.
• Hospitals that fail to meet outpatient quality payment reporting will receive a 2% reduction to the OPPS payments through a 0.9806 adjustment factor.
• CMS applies changes to Community Mental Health Centers CoPs.
• Medicare payment rates are being finalized for 240 dental codes.
• Hospital price transparency policies are being revised.
• Policies are changing to expand access to behavioral health care.

MHA soon will publish an issue brief with additional information.

Staff Contact: Andrew Wheeler

Based on a 2022 Supreme Court Decision, CMS issued a final rule that includes a remedy for the Medicare OPPS 340B-acquired drug payment policy for CYs 2018–2022. The remedy includes lump sum payments totaling $9 billion to affected 340B providers for claims covering CY 2018 through Sept. 27, 2022. CMS announced that approximately 1,700 affected 340B-covered entities would receive the payment. CMS will implement the remedy through a budget neutrality adjustment that will reduce the OPPS conversion factor by 0.5% beginning in CY 2026. MHA published an issue brief with additional information.

Staff Contact: Andrew Wheeler

CMS released the CY 2024 final payment and policy updates for Medicare payments under the Physician Fee Schedule. The payment rates will be reduced by 1.25% in CY 2024, as compared to CY 2023 while including significant increases in payments for primary care services. The rule also finalizes payments paid to practitioners who train caregivers to support patients with certain medical needs; finalizes coding and payment changes to better account for resources involved in furnishing patient-centered care; includes policy to pay separately for Community Health Integration, Social Determinants of Health Risk Assessment and Principal Illness Navigation services; temporarily adds health and well-being coaching services to the Medicare telehealth service lists; and includes payments for preventive vaccine administration services.

Staff Contact: Brian Kinkade

Beginning April 21, 2024, the MO HealthNet Division will require NDCs on all drug lines in crossover claims when Medicare pays a portion of the claim and Medicaid is billed for any remaining deductible or coinsurance. In addition, billed NDCs must be accompanied by correct HCPCS code descriptors for the units of the drug administered and billed.

Staff Contact: Stephen Njenga, Andrew Wheeler or Bryant McNally

The Flex Monitoring Team added new data to the CAH Measurement and Performance Assessment System tool. This data tool allows CAHs to assess their performance on financial, quality and community benefit measures. The CAHMPAS financial data have been updated with the 2022 data available to date (using June 2023 hospital cost report data).