CMS Releases CY 2024 Hospital Outpatient Payment Final Rule

The Centers for Medicare and Medicaid Services (CMS) released an unpublished final rule on Thursday that updates Medicare payment policies for hospitals under the Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center Payment System and Quality Reporting Program for calendar year (CY) 2024. The final rule is scheduled for publication in the Federal Register on Nov. 22. CMS released an accompanying fact sheet Nov. 2. 

In the final rule, CMS will increase all payment rates under the OPPS hospital outpatient department fee schedule by 3.1% based on the most recent updated cost reports and claims data available. The final rule includes several provisions of interest to the blood and biotherapies community. AABB has summarized these sections below.

Payment Rates

In the final rule, CMS adopted its proposal to increase payment rates for most transfusion and laboratory services, as well as for chimeric antigen receptor (CAR) T-cell therapy. However, the agency will decrease payment rates for most blood products in 2024.

In response to a request from the blood community to ensure that reimbursement rates for blood products are sufficient, CMS stated that the agency will continue to establish payment rates using the agency’s blood-specific cost-to-charge (CCR) methodology, which uses actual or simulated CCRs from the most recently available hospital cost reports to convert hospital charges for blood and blood products to costs.  

AABB is preparing a summary of final payment rates for member reference.  

Supplies of Essential Medicines

This year, CMS sought comments on a proposal to provide a separate payment to hospitals under the Inpatient Prospective Payment System (IPPS) to establish and maintain access to a buffer stock of 86 essential medicines, as defined by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response.

Notably, the list did not include blood and blood products due to supply chain differences. In response to this omission, AABB, America’s Blood Centers and the American Red Cross (ARC) strongly urged CMS to include blood and blood products within the scope of the proposed payment policy. The organizations also requested that CMS ensure that payment rates are sufficient to cover the costs of maintaining a buffer stock of blood and blood products. Other commenters addressed effective quality management practices and potential administrative burden.

In response to these comments, CMS expressed its appreciation for the “broad consensus regarding the need to curtail pharmaceutical shortages of essential medicines and promote resiliency.” The agency also agreed with many commenters that a multifaceted approach is likely necessary.

CMS intends to propose new Conditions of Participation in forthcoming notice and comment rulemaking to address hospital processes for pharmaceutical supply. However, the agency declined to adopt a policy regarding payment under the IPPS or OPPS for establishing and maintaining access to essential medicines in this final rule.

“In response to the comments received, we continue to seek feedback from interested parties on ways to address the additional costs hospitals face to address pharmaceutical shortages and prepare for future emergencies,” the agency said.