Medicare reimbursement benchmark definition update#
As with other rules, CMS is publishing this proposed rule to meet the legal requirements to update Medicare payment policies for OPPS hospitals and ASCs annually. The hospital price transparency proposed policies impact over 7,000 institutions that are licensed as hospitals. These proposed payment policies will affect approximately 3,500 hospitals and approximately 6,000 ASCs. It also seeks comment on potential payment adjustments to hospitals for the additional costs of establishing and maintaining a buffer stock of essential medicines in order to help curtail shortages of these medicines in the future. The proposed rule advances the Agency’s commitment to strengthening Medicare and uses the lessons learned from the COVID-19 PHE to inform the approach to quality measurement, focusing on changes that will help address health inequities. In addition to proposing payment rates, this year’s rule includes proposed policies that align with several key goals of the Administration, including promoting health equity, expanding access to behavioral health care, improving transparency in the health system, promoting safe, effective, and patient-centered care, and addressing medical product shortages.
The final rule will be issued in early November. The Calendar Year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule is published annually and will have a 60-day comment period, which will end on September 11, 2023. On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) proposed Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services.
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