Hospital Outpatient Prospective Payment System (OPPS) 

Proposed Rule released in Federal Register with provisions around Conditions of Participation (CoPs) for Critical Access Hospitals (CAH’s) and quality reporting programs for Rural Emergency Hospitals (REHs)

On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the proposed Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services. The comment period will close on September 9, 2024. 

Review the CMS Fact Sheet for major provisions of the proposed rule on payment rates and addressing health disparities.  Expanding access to behavioral health care, improving transparency in the health system while promoting safe, effective, and patient-centered care.

• CMS is further proposing revisions to the emergency services CoP related to emergency readiness for hospitals and CAH’s that provide emergency services. 
• CMS is proposing revisions to the Discharge Planning CoP for all hospitals and CAH’s related to transfer protocols.
• Updates to OPPS and ASC payment rates
• Intensive Outpatient Programs
• Partial Hospitalization Program
• Access to Non-Opioid Treatments for Pain Relief
• Overall Hospital Quality Star Rating & Hospital Quality Reporting Programs (Inpatient & Outpatient)
• Rural Emergency Hospital Quality Reporting. (REHQR) Program