The Centers for Medicare & Medicaid Services (CMS) issued proposed policies to expand access to behavioral health services through the coverage of intensive outpatient services as well as increase hospitals’ transparency with the public regarding charges for services.
In a press release Thursday, CMS announced the calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule, in which the agency seeks to expand access to behavioral health services, increase efforts around hospital price transparency and the public’s understanding of charges, and promote health equity for vulnerable communities.
“CMS is taking action to help shape a resilient, equitable, and high-value health care system,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “This proposed rule expands access to behavioral health care and supports the Biden-Harris Administration’s priority to remove barriers that limit price transparency with a goal of increasing competition to bring down health care costs.”
CMS is proposing an update to the OPPS payment rate for CY 2024 for hospitals that meet applicable quality requirements by 2.8 percent. The agency said the proposed update is based on the projected hospital market basket percentage increase of 3.0 percent reduced by 0.2 percentage point for the productivity adjustment. CMS is also proposing to update ASC rates for CY 2024 by 2.8 percent for ASCs that meet relevant quality reporting requirements.
From a behavioral health perspective, the CY 2024 OPPS and ASC Payment System Proposed Rule aims to implement provisions of the Consolidated Appropriations Act, 2023 that created a new benefit category for Intensive Outpatient Program services, which the agency said would address an existing gap in coverage for people with Medicare in need of behavioral health services that fall between individual outpatient therapy visits and a partial hospitalization program. CMS proposes payment and program requirements for the benefit across multiple settings, including hospital outpatient departments, community mental health centers, federally qualified health centers, and rural health clinics. The proposal also includes payment for intensive outpatient program services offered by opioid treatment programs.
Among the proposals, CMS also seeks to increase hospital price transparency regulations, proposing that hospitals be required to make standard charges public in their machine-readable file and publicly post the information on their websites.
The rule also proposes:
- New policies to strengthen the agency’s enforcement capabilities with hospital officials regarding acknowledgement of warning notices, CMS’ direct communication capabilities with health system leadership, and the publishing of enforcement activities such as civil monetary penalties on the CMS website
- A request for comment on separate payment to hospitals for establishing and maintaining access to a back-up supply of essential medicines
- Indian Health Service (IHS) and tribal facilities that convert to the new Rural Emergency Hospital provider type continue to be paid a per visit rate and also receive the monthly facility payment provided to all REHs
- A request for comment on payment for high-cost drugs and services provided by IHS and tribal facilities outside of the per visit rate
CMS will accept comments on the FY 2024 OPPS and ASC Payment System Proposed Rule until September 11. For more information, see the CMS fact sheets for the CY 2024 OPPS/ASC Payment System proposed rule and the hospital price transparency proposals.