In addition to finalizing payment rates, the rule aims to strengthen Medicare and focuses on changes to help address health inequities.
The Centers for Medicare & Medicaid Services (CMS) on Thursday updated Medicare payment rates by 3.1 percent for hospital outpatient and ambulatory surgical center (ASC) services for calendar year (CY) 2024.
Like the Medicare Physician Fee Schedule (PFS) final rule, which was also released on Thursday, the 2024 OPPS and ASC Payment System Final Rule includes policies that align with goals of the Biden-Harris Administration, including promoting health equity, expanding access to behavioral health care, improving transparency in the health system, and promoting safe, effective, and patient-centered care.
CMS said the final rule fills gaps in behavioral health services for people with Medicare through coverage of intensive outpatient services. In addition, the agency said it is making it easier for the public to learn what a hospital charges for items and services through improved hospital price transparency requirements.
“CMS is committed to expanding access to behavioral health care and is finalizing coverage of intensive outpatient services for both mental health conditions and substance use disorders,” said CMS Administrator Chiquita Brooks-LaSure in an announcement. “Additionally, the final rule strengthens hospital price transparency by improving the standardization of hospital standard charges and enhancing CMS’ enforcement capabilities, thereby better enabling the American people to understand and meaningfully use hospital standard charges for items and services.”
The final rule:
- Implements a new benefit category for intensive outpatient program services for individuals with acute behavioral health needs. CMS is establishing payment and program requirements for the benefit across various settings, including hospital outpatient departments, community mental health centers, federally qualified health centers, rural health clinics, and opioid treatment programs for those with substance use disorders effective January 1.
- Extends coverage for intensive outpatient services in programs for the treatment of opioid use disorder.
- Requires hospitals to make standard charges publicly available in a consistent way to it will be easier for the public to learn what a hospital charges for a particular service, for third parties to develop consumer-friendly materials, for hospitals to comply, and for CMS to enforce the regulations.
- Streamlines hospital price transparency enforcement capabilities, including certification by hospital officials as to the accuracy and completeness of the machine-readable file data; requiring hospital acknowledgment of warning notices; reserving the right for CMS to communicate directly with health system leadership when a hospital with a compliance issue is found to be part of a health system; and publishing other enforcement activities, in addition to civil monetary penalties, on a CMS website.
- Promotes health equity for Tribal communities by allowing Indian Health Service and Tribal facilities that convert to the new Rural Emergency Hospital (REH) provider type to be paid for hospital outpatient services under an all-inclusive rate in addition to receiving the monthly facility payment that applies to all REHs.