额外的细节
付款更新
- 哦: CMS is proposing to update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 3.1%,这是基于预计的医院市场篮子更新3.3%和0.生产率调整下调2个百分点. CMS也在最后确定其维持法定的建议.0 percentage point reduction in payment for hospitals that fail to meet the hospital outpatient quality reporting requirements.
- ASC率: 2019年CY, CMS finalized its proposal to apply the productivity-adjusted hospital market basket update that is applied to the OPPS system to the ASC payment system for an interim period of five years (CY 2019 to CY 2023). 在这个规则中, CMS正在最后确定将这一政策再延长两年的提案, 到2024年和2025年. 因此,CMS正在完成2024年CY的ASC费率更新.8%.
- Rural Emergency 医院 (REHs), Indian Health Service (IHS) Facilities, and Tribal Facilities: 部落医院和IHS医院转换成REH, CMS正在定稿 its proposal to pay providers under the same all-included rate (AIR) methodology that would apply to IHS and tribal facilities that are not an REH. CMS is also finalizing a policy that would provide REH monthly facility payments to IHS and tribal facilities that convert to REHs. CMS notes that the intent of these policies is to bring stability to IHS and tribal facilities that convert to REHs and to promote access to these hospitals.
- 340 b的药物: CMS正在定稿, 没有修改, 继续以法定违约率支付340b级合资格医院的建议, 一般是ASP加6%, 用于340b收购的药物和生物制品.
- 值得注意的, CMS于7月7日发布了一项相关的拟议规则, 2023, discussing the proposed remedy for underpayment to 340B-eligible hospitals for 340B-acquired drugs from CY 2018 to CY 2022. 这一补救措施将包括估计为90亿美元的一次性付款,约为1亿美元,600家医院, which would be funded by future reductions to OPPS payments to all hospitals spread over a 15-year period. 参见心电图的发布摘要 在这里.
行为健康方案的改变和建议
- PHP的变化: The PHP is an intensive outpatient program designed to serve as an alternative to psychiatric hospitalization and is paid on a per diem basis under the OPPS. CMS正在定稿 its proposal to expand the PHP’s existing rate structure by adding two Ambulatory Payment Classifications (APCs) to include one rate for days with three services per day and one rate for days with four or more services per day. CMS notes that this policy will appropriately increase payment rates for higher-intensity days in all settings. 这种支付结构也适用于下面概述的新提议的国际收支.
- 眼内压: CMS正在最终确定医疗保险下IOP的建立. An IOP is a distinct outpatient program of psychiatric services provided for individuals who have an acute mental illness or substance use disorder.
- CMS正在定稿 the policy that IOP services may be furnished in hospital outpatient departments, 社区精神健康中心(CMHCs), 联邦合格医疗中心(FQHCs), 农村卫生诊所(RHCs).
- CMS正在定稿 a consolidated list of service codes to be included in the IOP that were previously paid as part of the PHP benefit or more generally under the OPPS. CMS也正在最后确定设立两个运兵站(一天收费,三种云顶集团), and one for days with four or more services) and will base payment rates on cost per day using a broader set of OPPS data that includes both PHP days and non-PHP days.
- 2024年世锦赛, CMS is also finalizing its proposal to extend IOP coverage to include opioid treatment programs (OTPs). CMS is establishing a weekly payment adjustment via an add-on code for IOP services furnished by OTPs.
- CMHC参与条件(CoP)的更改: 执行《云顶集团》(CAA)的规定, CMS正在定稿 its proposal to modify requirements for CMHCs to include IOP services throughout the CoPs. CMS is also finalizing modifications to personnel qualifications to include a revised definition of a mental health counselor (MHC) and add marriage and family therapists (MFTs). 最后, CMS正在定稿 the addition of MFTs and MHCs to the list of practitioners who can lead interdisciplinary team meetings when deemed necessary.
质量计划
- CMS正在定稿 several changes to the Hospital Outpatient Quality Reporting (OQR) and the Ambulatory Surgical Center Quality Reporting (ASCQR) Programs, 如下:
- 最后确定的收养措施:
- Risk-Standardized Patient-Reported Outcomes Following Elective Primary Total Hip and/or Total Knee Arthroplasty measure to provide specific insight into the quality of care of a common procedure
- (Proposed for adoption in Hospital OQR only) Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in adults electronic clinical quality measure (eCQM) to promote patient safety
- 最终修改办法:
- COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure to align with the updated Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network measure specifications
- Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery measure survey instrument to further standardize data collection and reduce facility burden
- Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure to align with updated clinical guidelines
- 值得注意的, CMS is not finalizing the proposal to re-adopt Hospital Outpatient/ASC Facility Volume Data on Selected Outpatient Surgical Procedures following public feedback.
- CMS也没有最终确定取消“不被看到的离开”措施的提案.
- 在农村急诊医院质量报告(REHQR)计划范围内, CMS正在最后确定采取四项初步措施的建议, 包括以下三个基于权利要求的度量和一个图表抽象度量:
- 腹部CT:造影剂的使用
- Median Time from Emergency Department (ED) Arrival to ED Departure for Discharged ED Patients
- 设施7天风险-门诊结肠镜检查后标准化的医院就诊率
- 医院门诊手术后7天内风险标准化就诊
其他的更新
- 加强对医院价格透明数据使用的合规, CMS正在定稿 its proposal to modify the standard charge display requirements at 45 CFR 180.第50条和《官方网站》第180条拟议的执法条文.70 .提高执法程序的透明度.
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出版于2023年11月2日