CMS will increase payments for home health and outpatient services in hospitals

The Medicare and Medicaid Service Centers are increasing payments for outpatient hospital and home health care services and cutting reimbursements to physicians next year, in line with three final rules released Tuesday.
Payment rates for outpatient hospitals and outpatient surgery centers will rise by 2% each. Medicare home health care reimbursement rates will rise 2.6%, which CMS predicts will increase benefits by $ 465 million.
The agency will reduce the talk rate on the doctors’ pay schedule by $ 1.30 to $ 33.59 as the temporary reimbursement under the Consolidated Appropriations Act expires.
But CMS is expanding reimbursement for telemedicine services that treat mental health problems.
“The COVID-19 pandemic has highlighted gaps in our current healthcare system and the need for new solutions to deliver treatment to patients wherever they are,” CMS administrator Chiquita Brooks-LaSour said in a press release. “This is especially true for people who need mental health services, and the improvements we are proposing will give people greater access to telehealth and other care options.”

Outpatient the rule
Hospitals will face stricter penalties next year if they do not publish contractual rates with insurers and comply with other transparency rule requirements as outlined in the outpatient prospective payment system rule.
Major hospitals will pay a maximum annual fine of more than $ 2 million unless they post machine-readable files on rates they agree with payers, gross fees and discounted cash prices. Small hospitals will pay up to $ 109,500 if they don’t follow the rules.
Patients’ Rights Advocate’s analysis from May to July showed that less than 6% of hospitals were fully compliant. Lawyers representing the hospitals said some large hospitals would prefer to pay the fine rather than publish the data.
“CMS is committed to promoting and delivering price transparency and we take seriously the concerns we have heard from consumers that hospitals are not providing clear and accessible pricing information online as they were required to do as of January 1, 2021,” – Brooks – says the message from LaSure.
Federal regulators have suspended plans to phase out a list of inpatient-only services, which includes services that can only be provided in hospitals. The goal of CMS was to reduce costs by providing more outpatient services as far as technology allowed.
But the agency suspended the IPO delisting until next year and added nearly all of the 298 services it delisted last year after hospitals said safety would suffer if treatment were moved to outpatient facilities.

“We are delighted that CMS has recognized the unique role that hospital outpatient departments play in patient care,” the American Hospital Association said in a written statement.

The final rule also continued to cut $ 340 billion in discounted drug payments, excluding rural hospitals, certain cancer hospitals and children’s hospitals. The U.S. Supreme Court is weighing whether CMS was mandated to cut it started in 2018.
“The four-year cut in Medicare affected 340B hospitals, some of which were forced to cut essential services or postpone expanding health care services that would benefit their communities. We remain concerned that these cuts will become necessary as the cuts continue, ”340B Health President and CEO Maureen Testoni said in a prepared statement.

Home health rule
The final home health rule will expand quality-based reimbursement to home health agencies.
The CMS formalized a nationwide expansion of the home health cost-based purchasing model starting in 2023. The initial pilot program showed an average 4.6% improvement in quality scores for participating agencies over a three-year period and an average annual savings of $ 141 million. – said the regulators. Starting in 2025, the agency will adjust payments for services to Medicare-certified home care agencies based on the quality of care provided to beneficiaries during calendar year 2023.
The final home health rule will strengthen data collection efforts to address health inequalities and access issues for the poor, CMS said.

Doctor’s rule
In the final rule for physicians’ payment schedule, CMS will remove geographic restrictions that restrict patients with mental health problems from accessing mental health care.
Medicare will only pay for audio consultations and therapy visits provided by federal-compliant rural clinics and health centers, which should mitigate access problems for people with limited Internet access, regulators said.

“(AHA) welcomes today’s final rule for the 2022 Physician Fee Chart to defer the Eligible Use Criteria program and expand access to telemedicine services, especially for mental health services,” the association said in a statement.

CMS also plans to expand outpatient pulmonary rehabilitation services, expand its Medicare Diabetes Prevention Program, raise rates for multiple vaccines, and expand access to nutritional therapy.
Meanwhile, regulators are slashing Medicare payments to physicians next year by nearly 9%, taking into account an expiring 3.75% increase they received in 2021 under the Consolidation of Appropriations Act.
“With the ongoing pandemic, it is more important than ever to protect patients by stopping these contractions and working on a long-term solution to stabilize the healthcare system,” said Dr. John Ratliff, American Association of Neurological Surgeons / Neurological Congress. The chairman of the Washington Committee of Surgeons spoke on behalf of the Surgical Care Coalition.
CMS is postponing its mandate for accountable healthcare organizations to electronically report quality metrics, which has been approved by the National Association of the ACO.

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