4/19/2023 0 Comments Final oplc payment rate![]() ![]() The policy applies to cost reporting periods beginning on or after Jan. The agency finalized the policy to provide payment adjustments under the inpatient prospective payment system (IPPS) and the OPPS for domestically made, NIOSH-approved surgical N95 masks. Certain hospital costs typically incurred when donors die from cardiac death will be covered as organ acquisition costs to promote organ procurement and enhance equity. The CMS finalized the policy to exclude research organs from the calculation of Medicare’s share of organ acquisition costs and require a cost offset. The six-month in-person visit will not apply to beneficiaries who began receiving mental health telehealth services during the PHE or during the 151-day period at the end of the PHE. The finalized policy will require beneficiaries to have an in-person service within six months prior to the first telehealth visit and an in-person visit within 12 months thereafter. Under this policy, for CY 2023, the agency finalized a separate payment in the ASC setting for five non-opioid pain management drugs that function as surgical supplies, including certain local anesthetics and ocular drugs, that meet the criteria in 42 CFR 416.174.īehavioral health services using telecommunications technology furnished to beneficiaries in their homes by clinical staff of hospital outpatient departments (HOPDs), including staff of critical access hospitals, will be considered by the agency as covered outpatient services and paid under the OPPS. The CMS will continue the current policy to separately pay for non-opioid pain management drugs and biologics that function as supplies in the ASC setting. These finalized proposals are modifications from the proposed rule. The agency will remove eleven services from the Inpatient Only List and will add four procedures to the ASC Covered Procedures List. To account for the impacts of the COVID-19 public health emergency (PHE), the agency will use cost report data from the June 2020 extract from Healthcare Cost Report Information System, which includes cost report data through CY 2019. Hospitals that successfully meet the hospital Outpatient Quality Reporting program requirements would be eligible for the full update.Ĭlaims data from CY 2021 will be used to set CY 2023 OPPS and ASC rates. The increase is based on a hospital market basket percentage increase of 4.1% reduced by a productivity adjustment of a 0.3 percentage point. ![]() ![]() The agency finalized an increase in payment rates by 3.8% under the OPPS for CY 2023. The CMS stated in the final rule it will address the remedy for 340B-acquired drug payments for years 2018 through 2022 in future rulemaking prior to the CY 2024 OPPS/ASC proposed rule. As required by statute, the CMS will implement a -3.09% reduction in payment rates for non-drug services to achieve budget neutrality for the 340B rate change for CY 2023. The agency acknowledged this change is being made in light of the Supreme Court decision in June rejecting cuts to 340B hospitals. The CMS finalized a general payment rate of average sales price plus 6% for drugs and biologics acquired through the 340B Drug Pricing Program. Listed below are summaries of the finalized CY 2023 provisions of importance to health care delivery at academic medical centers. The AAMC previously submitted comments to the CY 2023 OPPS proposed rule. ![]() 1 released the calendar year (CY) 2023 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, and provided additional details in a fact sheet and press release. Centers for Medicare & Medicaid Services (CMS) on Nov. ![]()
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