CMS Issues Final Rule to Increase Price Transparency, Access to Care, Safety & Health Equity; Comments Due January 1
Published November 03, 2023
The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period on the 2024 Medicare hospital outpatient prospective payment system (OPPS)/Medicare ambulatory surgery center (ASC) payment system, which expands access to behavioral health services for people with Medicare through coverage of intensive outpatient services and makes it easier for the public to learn what a hospital charges for items and services through improved hospital price transparency requirements.
The policies in the final rule will further advance the agency’s commitment to increasing price transparency and enforcing compliance and would apply to each hospital operating in the United States.
The final rule:
- Implements the Consolidated Appropriations Act, 2023 provisions that created a new benefit category for intensive outpatient program services for individuals with acute behavioral health needs. This establishes payment and program requirements for the benefit across various settings, including hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers, and Rural Health Clinics, effective January 1, 2024. Across all of these settings, intensive outpatient program services are available for both individuals with mental health conditions and individuals with substance use disorders. Coverage is extended for intensive outpatient services in Opioid Treatment Programs for the treatment of opioid use disorder.
- Strengthens hospital price transparency regulations to require hospitals to make standard charges publicly available in a more standardized manner. This will make it 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 the following improvements: 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.
- Advances health equity by ensuring CMS’ programs support health for all people we serve, particularly those who are underserved. The rule allows Indian Health Service (IHS) 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.
The provisions of this rule are effective January 1, 2024. Comments are due January 1, 2024.