额外的细节
付款更新
- OPPS付款更新: CMS提议将OPPS下的支付增加2%.6%. 这是根据预计的医院市场篮子增长3.建议的生产率调整为0,减少了0%.4%. CMS estimates that total payments to OPPS providers for CY 2025 will increase by approximately $5.与2024年相比,OPPS支付了20亿美元.
- CMS will also continue to implement the statutory two percentage point reduction in payment for hospitals that fail to meet quality reporting requirements.
- ASC付款更新: 从2019年到2023年, CMS adopted a policy to update the ASC payment system using the hospital market basket update. 在2019冠状病毒病突发公共卫生事件之后, CMS将这一政策延长了两年,至2024年和2025年. As such, CMS is using the hospital market basket methodology to propose an update of 2.到2025年,ASCs的增长率为6%. CMS estimates that total payments to ASCs will increase by approximately $202 million compared to the CY 2024 ASC payment.
编码和覆盖变化
- ASC涵盖程序和辅助云顶集团清单的变更: 2025年CY, CMS is proposing to add 20 medical and dental procedures to the ASC covered procedures and 辅助 services lists.
- 仅限住院病人名单的更改: 针对2025年CY, CMS拟在IPO名单中增加3个CPT代码. These are codes are newly created by the AMA CPT Editorial Panel and will be effective January 1, 2025. 它们包括:
- CPT 0894T (cannulation of the liver allograft in preparation for connection to the normothermic perfusion).
CPT 0895T (connection of liver allograft to normothermic machine—initial four hours of monitoring).
CPT 0896T (connection of liver allograft to normothermic machine perfusion device, hemostasis control; each additional hour).
- 医疗补助和CHIP的持续资格: CMS is proposing to codify the requirement of the Consolidated Appropriations Act (CAA) of 2023, which requires states to provide 12 months of continuous eligibility to children under the age of 19 in Medicaid and CHIP.
- 然而, CMS is proposing to remove the previous option of applying continuous eligibility to a subgroup of enrollees or limiting continuing eligibility to a time period of less than 12 months. 对芯片, CMS is proposing to remove failure-to-pay premiums as an optional exception to continuous eligibility.
- 获得非阿片类药物治疗缓解疼痛: CMS正建议实施《官方网站》的另一项规定, which provides temporary additional payments for certain non-opioid treatments for pain relief in the hospital outpatient and ASC settings through 2027. CMS is proposing that seven drugs and one device qualify as non-opioid treatments for pain relief starting in CY 2025.
- 专门诊断放射性药物的付款: 目前, the costs associated with radiopharmaceuticals are packaged into the payment for nuclear medicine tests with which they are used. CMS is proposing to refine this packaging policy by paying separately for any diagnostic radiopharmaceutical with a per-day cost greater than $630 and removing their costs from the payment amount for the nuclear medicine tests. Diagnostic radiopharmaceuticals with a lower per-day cost would continue to be policy-packaged.
- Exclusion of Cell and Gene Therapies from Comprehensive Ambulatory Payment Classification (C-APC) Packaging: CMS is proposing to exclude nine qualifying cell and gene therapies from C-APC packaging. These therapies are generally used for the treatment of certain rare ocular or spinal conditions, 当进行管理时, are the primary treatment being provided to a patient and thus are not integral, 辅助, 支持, 依赖, 或辅助任何主要的C-APC云顶集团. 出于这个原因, CMS proposes not to package payment for these therapies into the payment for the primary C-APC service. CMS is seeking comment on whether any other changes to the C-APC packaging policy should be considered.
质量计划
- 医院门诊质量报告(OQR)计划: 2025年CY, CMS is proposing several additions to the OQR program as well as the removal of two measures. 医院 that do not meet quality reporting requirements will receive a reduction of two percentage points in their annual payment update.
- CMS建议采取以下措施:
- 医院承诺健康公平(HCHE)措施,从2025年开始
- 筛查健康的社会驱动因素(SDOH)措施, 2025年自愿报告,2026年强制报告
- SDOH测量筛检阳性率, 2025年自愿报告,2026年强制报告
- Patient Understanding of Key Information Related to Recovery After a Facility-Based Outpatient Procedure or Surgery, 患者报告的结果测量, with voluntary reporting in the CY 2025 followed by mandatory reporting in CY 2026
- CMS建议从2025年开始取消以下措施:
- 腰椎MRI对腰痛的测量
- Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery measure
- CMS建议采取以下措施:
- 流动外科中心质量报告(ASCQR)计划:
- CMS建议采取以下措施.
- 基金承诺卫生公平措施,从2025年开始
- SDOH措施筛查, 2025年自愿报告,2026年强制报告
- SDOH测量筛检阳性率, 2025年自愿报告,2026年强制报告
- CMS is also seeking comment on a request for information (RFI) regarding development of a Specialty-Focused Reporting and Minimum Case Number for Required Reporting framework. This framework would revise reporting requirements by only requiring ASCs to report on quality measures that are applicable to conditions they treat and/or procedures they perform through use of factors such as case minimums.
- CMS建议采取以下措施.
其他的更新
- 设备直通应用: CMS received 14 applications for device pass-through payments on which they are soliciting public comment. CMS will make final determinations on these applications in the CY 2025 OPPS/ASC final rule.
- Review Time Frame for Hospital Outpatient Department (OPD) Prior Authorization Process: CMS is proposing a change to the current review time frame for prior authorization requests from 10 business days to 7 calendar days for standard review.
- 产科云顶集团参与条件(CoP): CMS is proposing revisions to the current CoP for OB services in an effort to combat the maternal health crisis and improve health and safety. 这些修订包括组织结构和人员编制等因素, 云顶集团提供标准, 员工培训, 质量评估, 急救室准备就绪, 以及传输协议.
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编辑: 马特杂粮面包
出版于2024年7月16日