The Centers for Medicare and Medicaid Services (CMS) released the proposed payment rates and rule changes for hospital outpatient and Ambulatory Surgical Center (ASC) services. CMS is proposing to update payments rates by a net 2.8%, amend hospital price transparency requirements to better encourage standardization and improve reimbursement for mental and behavioral health services. The Agency also wants to continue applying the productivity-adjusted market basket update to ASCs for two more years beyond its five-year trial period, which CMS hopes will provide more robust data to inform future outpatient payments. Comments are due September 11th and the final rule will be issued in November. AHPA’s full summary of the proposed rule will be released in the coming weeks. Click here for a preliminary summary.

Price Transparency

CMS proposes to amend several hospital price transparency requirements previously established. Below are some of the key proposals. Click here for CMS’ Fact Sheet.

  • Requiring that hospitals utilize a standard template to display standard charge information in machine-readable files and encode all applicable standard charge information in a manner CMS specifies.
  • Creating additional requirements on the display and format of hyperlinks to price transparency information from the hospital’s public facing website to improve accessibility via automated searches.
  • Launching new requirements designed to improve CMS’s enforcement of hospital price transparency:
    • Require hospitals to attest to the completeness and accuracy of their machine-readable file.
    • Require hospitals to submit an acknowledgment of any of the Agency’s warning notices for hospital noncompliance with the regulations.
    • Enable CMS to publicize their assessment of hospital noncompliance, any actions taken against the hospital, and the outcome of such action, while also allowing CMS to publish notifications sent to leadership.

Behavioral Health

  • Establishing a new program under Medicare: the Intensive Outpatient Program (IOP); this program will also extend coverage to include services provided in opioid treatment program settings.
  • Creating a new payment code for remote group psychotherapy.
  • Delaying the in-person visit requirement for remote outpatient mental health services until the end of 2024.
  • Expanding and revising the payment structure for Medicare Partial Hospitalization Program services.
  • Updating the Conditions of Participation for Community Mental Health Centers, including coverage for treatment under IOPs and by mental health counselors and marriage and family therapists.

To read more, click here for the CMS Fact Sheet for the Hospital OPPS/ASC Proposed Rule.