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14 July 2023

Daily Newsletter

14 July 2023

CMS in US proposes rules to improve hospital price transparency

The proposed policies aim to expand coverage of intensive outpatient services for behavioural health care.

July 14 2023

The US Centers for Medicare & Medicaid Services (CMS) have proposed several policies to improve access to behavioural health services and increase hospital price transparency.

These proposed policies aim to address the gap between individual outpatient therapy and partial hospitalisation programmes by expanding coverage of intensive outpatient services for behavioural healthcare.

The CMS is seeking public comment on potential payment adjustments to hospitals for establishing and maintaining a buffer stock of essential medicines to address shortages.

They are also taking steps to improve hospital compliance with price transparency requirements, enhance automated access to standard charge information and improve public understanding of hospital charges.

CMS administrator Chiquita Brooks-LaSure said: “CMS is taking action to help shape a resilient, equitable, and high-value healthcare system.

“This proposed rule expands access to behavioural 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 proposed rules include actions to promote health equity for tribal communities and updates to payment rates for hospital outpatient services and ambulatory surgical centres.

The CMS is seeking feedback on how to pay for high-cost drugs and services provided by Indian Health Service (IHS) and tribal facilities.

These proposed policies are part of the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rule for the calendar year 2024.

CMS deputy administrator and director Dr Meena Seshamani said: “This proposed rule reflects CMS’ commitment to ensuring Medicare is comprehensive in its ability to address patient needs, filling gaps in the health care system, including behavioural health.

“Through these proposals, we will ensure people get timely access to quality care in their communities, leading to improved outcomes and better health.”

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