CMS Unveils 2024 Medicare PFS, OPPS Proposed Rules

The OPPS proposal did not feature reference to several high-profile issues industry leaders have been awaiting reform on.

Federal officials yesterday unveiled a pair of proposed rules, featuring potential adjustments to the Medicare Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) for the 2024 calendar year.

The Centers for Medicare & Medicaid Services (CMS) announcement highlighted rate updates, the promotion of health equity, and the expansion of access to critical medical services such as behavioral healthcare and certain oral health services, while also serving to advance the Biden-Harris Administration’s “Cancer Moonshot” mission to accelerate the fight against cancer – all in the PFS proposed rule alone.

“At CMS, our mission is to expand access to healthcare and ensure that health coverage is meaningful to the people we serve,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “CMS’s proposals in the proposed physician payment rule would help people with Medicare navigate cancer treatment and have access to more types of behavioral health providers, strengthen primary care, and for the first time, allow Medicare payment for services performed by community health workers.”

“CMS continues to demonstrate commitment to advancing health equity and building a stronger Medicare program,” added Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs – physical health, behavioral health, oral health, social determinants of health – and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.”

Officials said that overall, proposed payment amounts under the PFS would be reduced by 1.25 percent compared to 2023, in accordance “with factors specified by law.” CMS proposed increases in payments for many visit services, such as primary care, necessitating offsetting and budget-neutrality adjustments to all other services paid under the PFS. The proposed 2024 PFS conversion factor is $32.75, a decrease of $1.14, or 3.34 percent, from 2023.


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This article originally published on July 14, 2023 by RACmonitor.

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