CMS Releases Proposed Rules for 2024 PFS, OPPS and ASC

The Centers for Medicare and Medicaid Services (CMS) CY 2024 Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) proposed rules released this week have caught major criticism from the industry for cuts to physician pay and inadequate raises for hospitals. But the OPPS proposal also contains a number of initiatives to build on the agency’s health equity strategy, including significant expansions in behavioral healthcare.

CMS proposed it would allow family therapists, mental health counselors and substance use disorder counselors to enroll in Medicare and bill for services. Behavioral Health Business says that the agency wants to allow certain providers to bill for integrated behavioral health services within primary care.

From Meena Seshamani, MD, Center for Medicare director and CMS deputy director:

If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs — physical health, behavioral health, oral health, social determinants of health, and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.

In the 2024 proposed OPPS rule, the agency is also boldly proposing to establish an intensive outpatient program (IOP), in order to promote behavioral healthcare services that are more intensive than outpatient therapy visits but not as dire as partial hospitalization for psychiatric concerns. Inside Health Policy reports that opioid treatment would be included in the new Medicare program by revising the definition of opioid use disorder treatment services to include IOPs.

According to a CMS release, the agency proposes establishing payment and program requirements for the benefit category for hospital outpatient departments, community mental health clinics, federally qualified health centers and rural health clinics beginning January 1, 2024.

CMS also announced it would update hospital price transparency guidelines to include requirements for hospitals to describe available behavioral health services through coverage of intensive outpatient services.

From CMS Administrator Chiquita Brooks-LaSure, in a CMS press release:

This proposed rule expands access to behavioral health care and supports the Biden-Harris Administration’s priority to remove barriers that limit price transparency with a goal of increasing competition to bring down health care costs.

The Medicare Shared Savings Program will also receive some changes to accountable care organizations (ACOs). Inside Health Policy explains that the OPPS includes a new Clinical Quality Measure collection type and changes for financial benchmarking in ACOs regional service areas.

The changes, explained in a CMS Fact Sheet, were met with support by the National Association of ACOs.

From NAACOs president and CEO Clif Gaus:

[The rule] addresses several issues that NAACOS has been advocating for, including improvements in quality reporting, more fair benchmarking policies, a smooth transition to a new risk adjustment model, keeping advanced payments for new ACOs who transition to risk, helping ACOs who serve high-cost beneficiaries and others.