CMS Releases 2024 Medicare Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) Proposed Rule

On July 13, 2023, CMS released the calendar year (CY) 2024 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 prospective payment system (OPPS) and ambulatory surgical center (ASC) settings beginning in CY 2023.

For CY 2024, CMS is proposing to update OPPS payment rates for CY 2024 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 is also proposing to update the ASC rates for CY 2024 by 2.8% for ASCs that meet relevant quality reporting requirements.

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

• CMS proposes to strengthen the hospital price transparency regulations, which require each hospital operating in the United States to make its standard charges public. CMS proposes 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, building on actions taken to streamline enforcement earlier this year. These proposals include 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.
• CMS proposes to compensate hospitals for the increased cost of acquiring certain personal protective equipment during the COVID-19 pandemic.
• For CY 2024, CMS received six complete applications for device pass-through payments by March 1, 2023, which was the last quarterly deadline for applications to be included in the CY 2024 OPPS/ASC proposed rule.

For CY 2024, CMS proposed to 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 340B acquired drugs and biologicals would not differ from the payment rate for those not acquired through the 340B program. CMS issued a proposed rule on July 7, 2023, discussing the proposed remedy for payment for 340B acquired drugs for CYs 2018 to 2022 — including how those payments would impact OPPS payment policy in future calendar years.

Comments on the proposed rule are due September 11, 2024.

Read the proposed rule here