RISE summarizes recent regulatory news, primarily the release of several final rules.

CMS issues 2023 OPPS and ASC Payment System Final Rule

The Centers for Medicare & Medicaid Services (CMS) this week finalized Medicare payment rates for hospital outpatient and ambulatory surgery center services (ASC) as part of the 2023 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule.

In addition to payment rates, the rule includes policies that address the health equity gap, the COVID-19 public health emergency (PHE), transparency in the health system, and promotes safe, effective, and patient-centered care. The policies will affect approximately 3,500 hospitals and 6,000 ASCs under the rule.

Final Physician Payment Rule improves access to behavioral health services

The Department of Health and Human Service (HHS), through CMS, this week also released the 2023 Physician Fee Schedule Final Rule. The rule expands access to behavioral health care, cancer screening coverage, and dental care.

In an announcement, HHS said the rule directly supports President Biden’s Cancer Moonshot Goal to cut the death rate from cancer by at least 50 percent and also supports the administration’s commitment of strengthening behavioral health. HHS Secretary Xavier Becerra said that the administration is committed to expanding access to prevention and treatment services. The rule emphasizes that beneficiaries receive coordinated care services and have access to prevention and treatment services for substance use, mental health services, crisis intervention, and pain care. “Providing whole person support and services through Medicare will improve health and wellbeing for millions of Americans and even save lives,” Becerra said.

The final rule is scheduled to be published in the Federal Register on November 18.

CMS issues ESRD PPS Final Rule

CMS last week issued a final rule updating payment rates and policies under the end-state renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023. The rule also updates requirements for the ESRD Quality Incentive Program. In an announcement, CMS said that it appreciated responses for requests for information in the proposed rule. The information will help the agency identify ways to align resource use with payment and ensure that Medicare beneficiaries with ESRD have continued access to technologies that can improve health outcomes and quality of life. The final rule is scheduled to be published in the Federal Register on November 7.

CMS updates payment policies and rates for home health agencies

CMS has also issued the 2023 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates Medicare payment policies and rates for home health agencies. The agency estimates that Medicare payments to home health agencies in 2023 will increase in the aggregate by 0.7 percent or $125 million compared to 2022. The rule includes a discussion of the comments received on the future collection of data regarding the use of telecommunications technology during a 30-day home health period of care on home health claims, for which CMS will begin collecting data voluntarily January 1, 2023 and will then require on a mandatory basis July 1, 2023. The rule is currently available in the Federal Register. For more information, see the CMS announcement.

HHS renews PHE for monkeypox outbreak

HHS this week has renewed its determination that a public health emergency (PHE) still exists due to the outbreak of monkeypox in several states. HHS Secretary Xavier Becerra first declared a PHE for monkeypox in August. The extension of the PHE will free up resources to fight the virus including vaccines, treatments, and tracking. The Centers for Disease Control and Prevention reports that as of November 3, the United States has 28,619 confirmed cases of monkeypox.

KFF studies show few Medicare enrollees compare plan options or switch plans

Two new analyses from the Kaiser Family Foundation suggest that a relatively small share of the nation’s 65 million Medicare beneficiaries will shop around among the many coverage options for 2023 or switch plans. That decision could have a significant impact on enrollees’ coverage and costs.

In an announcement about the studies, KFF said that one of the studies reveals that only three in in 10 beneficiaries (29 percent) compared their current plan with other Medicare plans offered during the open enrollment period for 2020. The share of beneficiaries reviewing their coverage options was even lower among certain subgroups, including beneficiaries with lower incomes (15 percent); enrolled in both Medicare and Medicaid (16 percent); age 85 or older (18 percent); Hispanic (19 percent); or under age 65 with disabilities (22 percent).

The second analysis finds that few beneficiaries choose to switch plans during open enrollment, regardless of whether they are enrolled in Medicare Advantage (MA) or traditional Medicare. For instance, among people in MA plans with prescription drug coverage, only one in 10 beneficiaries enrolled in such plans voluntarily switched plans for 2020. Among beneficiaries in traditional Medicare with a stand-alone drug plan, only two in 10 opted for a different plan during open enrollment.

Despite year-to-year changes in MA plans, about half (54 percent) of all MA enrollees reviewed their current plan for potential changes in premiums or other out-of-pocket costs for coverage in 2020, while the other half did not, according to the study. The same share (54 percent) reported they reviewed their current plan for potential changes in the kinds of treatments, drugs, and services that would be covered in the following year.

The analysis also finds Medicare’s official information resources are not widely used, especially the 1-800-MEDICARE helpline. Just under half of beneficiaries (49 percent) reported that they had read all or part of the Medicare & You handbook, and 44 percent said that they (or someone on their behalf) had visited the Medicare.gov website. Only 29 percent said they had called the helpline.

The two new KFF analyses are based on Medicare beneficiary survey and claims data from CMS.