On November 1, the Centers for Medicare & Medicaid Services (CMS) posted its calendar year (CY) 2023 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule. WSHA is preparing a comprehensive summary and hospital-specific analyses of the final rule which will be sent to each hospital’s CFO or designated finance person when completed within the next few weeks. Major provisions of the rule:
- Provides a net Medicare OPPS market basket increase rate of 3.8% in CY 2023 compared to 2022. While the increase is greater than what was the proposed rule, it is significantly less than inflation and increases to the cost of providing care.
- Finalizes payment for PPS 340B hospitals at the restored rate of average sales price (ASP) plus 6% for CY 2023. Medicare claims for 340B drugs paid under OPPS after September 28, 2022, will be paid at the restored rate. The rule defers the proposal for a remedy for the unlawful 340B reductions occurring in 2018-2022 until sometime before next year’s CY 2024 OPPS payment rule. The rule includes a 3% subject neutrality adjustment to the general OPPS rate, essentially reversing the budget neutrality adjustment put in place when the payment reductions to 340B hospitals were implemented.
- Exempts rural sole community hospitals (SCHs) from the site-neutral clinic visit cuts. Clinic visits furnished in grandfathered off-campus provider-based departments (PBDs) of these hospitals will be paid at the full OPPS rate rather than 40% of the OPPS rate. WSHA submitted comments in favor of the change and called for CMS to also reverse the cuts made to other hospital clinics.
- Establishes, beginning on Jan. 1, 2023, the Rural Emergency Hospital (REH) model for eligible critical access hospitals and small rural hospitals. The rule finalized proposals related to model payment, covered services, conditions of participation and quality measurement.
- Makes permanent payment for remote behavioral health services beyond the end of the public health emergency (PHE).
(Andrew Busz, Andrewb@wsha.org)
