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Association Comments on CY 2023 OPPS Proposed Rule

In a Sept. 13 letter to the Centers for Medicare & Medicaid Services (CMS), America’s Essential Hospitals commented on the calendar year (CY) 2023 Outpatient Prospective Payment System (OPPS) proposed rule.

Several provisions of the proposed rule would have a disproportionately negative effect on essential hospitals and impede the ability of essential hospitals to remain financially solvent and continue care in underserved communities.

The association called on CMS to swiftly restore full Medicare Part B drug payment rates for hospitals in the 340B Drug Pricing Program and to institute a remedy making 340B hospitals whole for five years of payment cuts.

America’s Essential Hospitals also urged the agency to:

  • define the select group of hospitals with a safety net mission that provide a substantial share of uncompensated care and identify new policies that will ensure stable funding to these hospitals;
  • increase its proposed annual hospital payment update to account for the effects of inflation and rising workforce costs on hospitals;
  • preserve adequate reimbursement rates for essential hospitals’ excepted and non-excepted provider-based departments;
  • implement Section 603 of the Bipartisan Budget Act of 2015 consistent with the legislative text to minimize adverse effects on patient access;
  • finalize permanent OPPS payment for remote mental health services, work to expand the list of reimbursable services, and provide additional flexibility to encourage provision of mental health services;
  • withdraw its policy requiring prior authorization for Medicare services;
  • withdraw its proposal to change the calculation of reimbursable organ acquisition costs at transplant centers;
  • continue to refine the Outpatient Quality Reporting (OQR) Program to include measures that provide valid, accurate, and meaningful information to consumers about care quality, and ensure essential hospitals are provided flexibility;
  • examine the effect of COVID-19 on underlying quality measure data and, if merited, suppress the Overall Hospital Quality Star Ratings to ensure consumers receive fair, accurate, and meaningful information; and
  • remove services from the inpatient-only list based on established criteria for determining removal.

Additionally, the association urged CMS to address health equity in the Hospital OQR Program, including stratifying measure performance by social risk factors beyond dual eligibility for Medicaid and Medicare; refraining from publicly reporting disparities results; and considering additional hospital characteristics in disparities reporting.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Andrea Lugo is a communications associate at America's Essential Hospitals.

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