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  • Washington Highlights

    AAMC Submits Comment Letter on CY 2023 OPPS Proposed Rule


    Mary Mullaney, Director, Hospital Payment Policies
    Phoebe Ramsey, Director, Physician Payment & Quality
    For Media Inquiries

    The AAMC submitted comments in response to the calendar year (CY) 2023 Outpatient Prospective Payment System (OPPS) proposed rule. The comments addressed proposals to modify the 340B Drug Pricing Program, hospital payment updates, and the Hospital Outpatient Quality Reporting (OQR) Program. Highlights of the AAMC’s comments are below.

    Payment Proposals

    The letter discussed the AAMC’s concerns related to reimbursement for 340B-acquired drugs. In light of the June 15 U.S. Supreme Court’s ruling, the letter noted that the AAMC believes that the Centers for Medicare & Medicaid Services (CMS) has no choice but to finalize reimbursement for 340B-acquired drugs at average sales price (ASP) plus 6% beginning Jan. 1, 2023 [refer to Washington Highlights, June 17]. Further, the AAMC asked the agency to calculate the budget neutrality adjustment for CY 2023 to ensure proper OPPS payments to hospitals. As proposed, hospitals would see a permanent reduction in OPPS payments if the CMS finalizes a -4.04% budget neutrality adjustment. The AAMC strongly urged the agency to only apply a -3.19% budget neutrality adjustment to the CY 2023 OPPS conversion factor to restore the original adjustment the agency applied when it first implemented the policy. The letter also asked the CMS to promptly repay hospitals for 340B-acquired drugs the difference between the ASP plus 6% and the amount actually paid to hospitals for 340B drugs (plus applicable interest) for all the years the agency reduced payments to 340B hospitals. Finally, the letter noted that the CMS should not ask hospitals to return monies they received as a result of the implementation of the policy in a budget-neutral manner. 

    The letter asked the CMS to calculate the final OPPS payment update based upon the final Inpatient Prospective Payment System update to be consistent with the CMS’ past practices. Additionally, because of concerns that the proposed outlier threshold is significantly higher than last year due to the impact of COVID-19 cases, the AAMC asked the agency to consider using a lower charge inflation factor to decrease the dramatic increase in the outlier threshold for CY 2023.

    The AAMC supported the proposal to designate certain services to diagnose, evaluate, or treat a mental health disorder furnished via telecommunications as covered outpatient services and payable under the OPPS. The letter urged the CMS to reimburse the full OPPS rate for behavioral health services furnished via telehealth by hospital outpatient clinic staff. Additionally, the association noted that in-person visits should not be a requirement for coverage of mental health services furnished via telehealth.

    In response to the proposals related to organ acquisition, the AAMC suggested that proposals should not negatively impact access and equity, stating that changing the calculation of Medicare’s share may have unanticipated “cascading impacts on organ access and equity in organ distribution.” The letter asked the CMS not to finalize the proposals and instead continue to work with all participants to further understand the potential impacts of changes to Medicare organ acquisition payments.

    The AAMC did not support the proposal to add a new prior authorization category, Facet Joint Intervention. Facet joint interventions are a beneficial non-drug option to treat chronic pain, and the association stated that instituting prior authorization could limit beneficiaries’ access to these minimally invasive procedures. If finalized, prior authorization for these services would begin March 1, 2023.

    The association supported the proposal for an OPPS payment adjustment for domestically made, NIOSH-approved surgical N95 masks beginning Jan. 1, 2023. The letter stressed the importance of the need to strengthen current supply chains to ensure adequate product supply and that the agency should not apply this proposal under the OPPS in a budget-neutral manner. Rather, the letter states, it should find an alternative authority for subsidizing the purchase of these masks that does not require an offsetting reduction in the OPPS payments.

    Hospital OQR Program

    The AAMC also responded to changes to the OQR Program, including support for returning the cataracts visual function patient experience measure to voluntary reporting in recognition of changes caused by the pandemic and aligning patient encounter quarters to the calendar year for reporting chart-abstracted measures. In response to the potential future adoption of a volume indicator, the association recommended the CMS reevaluate and focus on developing outcome measures that are meaningful and comprehensible for patients.

    Overall Hospital Quality Star Ratings

    The letter urged the CMS to add a filter to allow patients to choose to include Veterans Health Administration hospitals in the ratings rather than default to their inclusion beginning in CY 2023. Additionally, the association asked the agency to further clarify the data used for annual updates to the ratings and to provide transparency regarding impacts of the COVID-19 public health emergency on the ratings.