CMS: Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities

Federal Register

Jul 22, 2024

Notice of proposed rule from the Centers for Medicare & Medicaid Services (CMS) revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2025. This proposed rule would also update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, Rural Emergency Hospital Quality Reporting (REHQR) Program, ASC Quality Reporting (ASCQR) Program, and Hospital Inpatient Quality Reporting Program and proposes Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services. Among other things, this rule would request information on options being considered for future changes to the Overall Hospital Quality Star Rating methodology and further information related to a Tribal Technical Advisory Group request to apply the Indian Health Service encounter rate to all outpatient tribal clinics. This proposed rule would also provide exceptions to the Medicaid clinic services benefit four walls requirement for Indian Health Service and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas. Comments are due by September 9, 2024.

American Indian or Alaska Native · Behavioral health · Clinics · Healthcare quality · Hospitals · Inpatient care · Legislation and regulations · Medicaid · Medicare · Outpatient care · Reimbursement and payment models