2023 Outpatient Prospective Payment System/Ambulatory Surgical Center Proposed Rule Released

On July 15, 2022, the CMS released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule, which includes proposals to update payment rates, policies, and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2023.

For CY 2023, CMS proposes to increase payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System by 2.7%. In continuation of an existing policy, hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0 percentage point reduction in the CY 2023 fee schedule increase. Consistent with these increases, CMS proposes a CY 2023 OPPS conversion factor of $85.093 and a CY 2023 ASC conversion factor of $51.315. CMS estimates, based on the proposed policies, that total payments to OPPS and ASC providers (including beneficiary cost-sharing and estimated changes in enrollment, utilization, and case-mix) for CY 2023 will be approximately $86.2 billion and $5.4 billion, respectively. This represents increases of approximately $6.2 billion and $130 million, respectively, from CY 2022 payment amounts.

Key takeaways from the CY 2023 OPPS and ASC Payment System Proposed Rule include:

• Proposal to include facet joint interventions as a service subject to prior authorization.
• Proposals to ensure continued access to mental health services via telehealth following the conclusion of the COVID-19 public health emergency (PHE).
• Proposal to maintain its site neutrality process but also, for the first time, to exempt rural sole community hospitals from the existing policy.
• Payment policies for rural emergency hospitals (the new hospital type authorized by legislation enacted in 2020).
• Further cementing of recent flexibilities allowing certain nonphysician practitioners to supervise select diagnostic services.
• Compensation to hospitals for the increased cost of acquiring certain personal protective equipment during the COVID-19 pandemic.The agency did not disclose how it will change payments to hospitals for drugs purchased and furnished under the 340B program in light of a recent U.S. Supreme Court decision invalidating steep payment reductions first implemented in 2018, although it is expected that CMS will formalize a revised policy in the final rule, effective for CY 2023.

  Comments on the proposed rule are due September 13, 2023.

  Read proposed rule here: https://public-inspection.federalregister.gov/2022-15372.pdf

  The press release is available here: https://www.cms.gov/newsroom/press-releases/cms-proposes-rule-advance-health-equity-improve-access-care-and-promote-competition-and-transparency

  The fact sheet is available here: https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center