July 14, 2023
CMS Releases Payment Rule for 2024
Mostly Bad News – Some Good News
CMS released its CY 2024 Proposed Rules for the Medicare Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center and Physician Fee Schedule. Attached are our initial high-level summaries of each rule. Here are highlights on key proposals that may be of interest. Not included are the potential 2% sequester cut and the 4% American Rescue Plan Act of 2021 cut for physicians and ASCs.
PFS
The rule proposes to:
- decrease the conversion factor for 2024 by 3.34 percent from the conversion factor for 2023, meaning that physician service will be paid less in 2024 than in 2023, and marking the second year in a row CMS has proposed a decrease in physician reimbursement,
- increase payments for telehealth payment rates,
- update the Quality Payment Program, including changes to the Merit-based Incentive Payment System Value Pathways (MVPs) including the Advancing Cancer Care MVP,
- add polices to implement required manufacturer refunds for discarded drugs, and
- codify previously finalized covered dental services, including dental exams and necessary treatments prior to the treatment for head and neck cancers.
This proposed rule is scheduled to be published in the Federal Register on August 7, 2023, and comments are due by September 11, 2023. CMS released a rule overview fact sheet and official press release.
OPPS/ASC
This rule proposes to:
- apply a payment update of 2.8 percent and also continue the cancer hospital payment adjustment for CY 2024,
- continue the rural sole community hospital site-neutral payment exemption, which exempts excepted off-campus provider-based departments of rural sole community hospitals from site neutral clinic visit payment reductions,
- continue pass-through payment for certain drugs, biologicals, and pharmaceuticals,
- continue non-opioid pain management drug and biological payment policies,
- continue 340B payment at average sales price plus 6 percent, and
- solicit comment on a potential payment adjustment to mitigate future drug shortages and maintain access to essential medicines needed for acute patient care.
This proposed rule is scheduled to be published in the Federal Register on July 31, 2023, and comments are due by September 11, 2023. See the press release here. CMS has provided a rule overview fact sheet and a hospital price transparency and behavioral health fact sheet relating to proposals in this proposed rule.
We are reviewing the proposed rules in depth and will follow up with additional detail. Let us know if you have any questions.
