CMS Issues Final Rule on Outpatient and ASC Payment Policies

On November 2, 2023, CMS released the calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems Final Rule, which includes proposals to update payment rates, policies, and regulations affecting Medicare services furnished in outpatient and ASC settings.

For CY 2024, there will be an update to OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.8%. This update is based on the projected hospital market basket percentage increase of 3%, reduced by 0.2 percentage points for the productivity adjustment. Using the proposed hospital market basket update, CMS also updated the ASC rates for CY 2024 by 2.8% for ASCs that meet relevant quality reporting requirements.

Key takeaways from the CY 2024 OPPS and ASC Payment System Final Rule include the following:

• Strengthened hospital price transparency regulations, which require each hospital operating in the United States to make its standard charges public. To make it easier for the public to learn what a hospital charges for items and services and to further enhance the hospital price transparency enforcement process, CMS proposed new requirements to standardize the hospital’s display of standard charge information in their machine-readable file and new requirements governing how hospitals must publicly post those files on their websites.
• For CY 2024, CMS will continue to pay the statutory default rate for drugs and biologics furnished in outpatient or ASC settings, which is generally ASP plus 6% for 340B acquired drugs and biologicals. The payment for these drugs and biologicals will not differ from the payment rate for those not acquired through the 340B program.

Read the full text of the final rule here.