(April 7, 2023) – CMS Issues Final Rule for 2024 Medicare Advantage, Prescription Drug Plans
This week, the Centers for Medicare & Medicaid Services released a final rule that would increase oversight of Medicare Advantage plans and better align them with Traditional Medicare, address access gaps in behavioral health services and further streamline prior authorization processes. The rule also establishes additional health plan utilization management oversight processes to include required annual reviews of MA plans' policies and coverage denial reviews by health care professionals with relevant expertise. In addition, the rule would tighten MA marketing rules to protect beneficiaries from misleading advertisements and pressure tactics; expand requirements for MA plans to provide culturally and linguistically appropriate services; make changes to MA star ratings to address social determinants of health; and implement Inflation Reduction Act provisions to make prescription drugs more affordable for eligible low-income individuals. Notably, it appears the proposal to change the legal standard for identifying an overpayment, which was of concern to hospitals and health systems, was not codified in the final regulation.
AHA will continue to carefully review the final rule and urges the agency to conduct rigorous oversight and enforcement to ensure meaningful compliance. For more details, see the CMS fact sheet on the final rule. AHA members will receive a Special Bulletin soon with more on the rule's provisions.
CMS Releases FY 2024 IRF, IPF and SNF Payment and Policy Updates
The Centers for Medicare & Medicaid Services released the fiscal year 2024 Medicare payment and policy updates for the inpatient rehabilitation facility, inpatient psychiatric facility and skilled nursing facility prospective payment systems.
IRF PPS Updates:
- Market basket increase of 3.0 percent (3.2 percent less 0.2 percent productivity adjustment)
- After outlier payment adjustments are accounted for, the estimated net increase in payments will be 3.7 percent, or $335 million
- Quality reporting program revisions
- Comments are due by 4 p.m. Friday, June 2
IPF PPS Updates:
- Market basket increase of 3.0 percent (3.2 percent less 0.2 percent productivity adjustment)
- After applying other payment and policy proposed changes, the estimated net increase in payments will be 1.9 percent, or $55 million
- Quality reporting program revisions
- Comments are due by Monday, June 5
SNF PPS Updates:
- The net increase in payments is estimated to be 3.7 percent, or $1.2 billion
- Quality reporting program revisions
- Continuation of a review of minimum staffing requirements
- Comments are due by Monday, June 5
Medicare Trustees Release 2023 Annual Report to Congress
The Medicare Trustees released the 2023 Annual Report to Congress about the financial and actuarial status of the hospital insurance and supplementary medical insurance trust funds. According to the report, Medicare covered 65 million people in 2022, with about 46 percent enrolled in a Medicare Advantage product. Total expenditures were $905.1 billion, with income of $988.6 billion. The total assets held in special issue U.S. Treasury securities increased by $83.4 billion due to lower-than-expected expenditures. Of the $905.1 billion in total expenditures, hospitals received $205.5 billion, while private health plans (MA) received $403.3 billion. MHA published an issue brief with additional information.
CDC Issues End of PHE Talking Points
The Centers for Disease Control and Prevention issued talking points on the ending of the COVID-19 public health emergency, which occurs Thursday, May 11. The agency has not released any formal changes; however, the talking points highlight identified priority items.
CMS Clarifies Ending of Waivers
The Centers for Medicare & Medicaid Services issued guidance on the passage of HJR 7, clarifying the effect it would have on waivers and flexibilities afforded to health care providers during the pandemic response. HJR 7 ends the COVID-19 national emergency and is awaiting the president's signature. CMS notes that even if the national emergency would end, it will not impact the planned Thursday, May 11, expiration of the federal public health emergency for COVID-19 and any associated unwinding plans. Additionally, the flexibilities extended through the passage of the Consolidated Appropriations Act for fiscal year 2023 are not impacted.
HHS Updates 2024 MA Program and Part D Payment Policies
The Centers for Medicare & Medicaid Services released the Medicare Advantage and Part D rate announcement for calendar year 2024. CMS estimates MA plans will receive an increase of 3.32 percent from 2023 to 2024, amounting to approximately $13.8 billion.
CMS Releases FY 2024 Hospice Payment and Policy Updates
The Centers for Medicare & Medicaid Services released the Medicare hospice payment and policy updates for fiscal year 2024. The following are major updates.
- Estimated payment increase of $720 million, or 2.8 percent — this is a result of a 3.0 percent market basket increase reduced by a productivity adjustment of 0.2 percent
- Proposal to codify the Hospice Quality Reporting Program data submission threshold
- Proposes that physicians who order or certify hospice services for Medicare beneficiaries must be enrolled in Medicare or validly opted-out as a prerequisite for payment
CMS Reminds Hospitals of Q4 2022 Submission Deadlines
Hospitals participating in the Inpatient Quality Reporting and/or Outpatient Quality Reporting programs are reminded of the following submission deadlines for Q4 2022 data, which includes Oct. 1 to Dec. 31, 2022, dates of service.
- Wednesday, April 5
- Hospital Consumer Assessment of Healthcare Providers and Systems patient perspective on care survey data
- Monday, May 1
- Inpatient population and sampling counts
- Outpatient clinical data, and population and sampling counts
- Monday, May 15
- Inpatient clinical sepsis data and PC-01 data
- Outpatient web-based measures (Jan. 1 to Dec. 31, 2022, dates of service)
- Maternal morbidity structural measure attestation (Jan. 1 to Dec. 31, 2022, dates of service)
- Submission of the calendar year 2022 Data Accuracy and Completeness Acknowledgement
- HCP influenza vaccination measure (Oct. 1, 2022, to March 31, 2023, dates of service)
- HCP COVID-19 vaccination measure data into the NHSN
CMS Provides Claims Detail Reports for OIE Measures
Claims detail reports for the following outpatient imaging measures for the calendar year 2025 payment determination are available for hospitals participating in the Outpatient Quality Reporting program.
- Magnetic Resonance Imaging Lumbar Spine for Low Back Pain (OP-8)
- Abdomen Computed Tomography - Use of Contrast Material (OP-10)
- Cardiac Imaging for Pre-Operative Risk Assessment for Non-Cardiac, Low-Risk, Surgery (OP-13)
- Breast Cancer Screening Recall Rates (OP-39)
The clinical data repositories include preliminary claims data collected from July 1 through Nov. 30, 2022. Facilities can download the reports from the Hospital Quality Reporting portal.
CART Outpatient Version 1.22.0 Available
The Centers for Medicare & Medicaid Services released CMS Abstraction and Reporting Tool Outpatient 1.22.0. The release supports the Oupatient Quality Report master code list diagnosis updates, as well as the removal of OP-2 and OP-3 data collection. Version 1.22.0 must be used for April 1 to Dec. 31, 2023, encounter dates. Installation instructions and other resources are available on QualityNet.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews: