AHA Comments on the OPPS and ASC Payment System Proposed Rule for CY 2023

September 13, 2022

The Honorable Chiquita Brooks-LaSure
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W., Room 445-G
Washington, DC 20201

Re: CMS–1772–P: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating Proposed Rule (Vol. 87, No. 142), July 26, 2022.

Dear Administrator Brooks-LaSure:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2023.

We support a number of the OPPS proposed rule’s provisions, including CMS’ decision to end its policy to significantly cut reimbursements to 340B hospitals following the Supreme Court’s unanimous ruling in American Hospital Association v. Becerra. In restoring the payments for CY 2023, we urge the agency to apply the same budget neutrality adjustment it implemented when the policy was first put into place; doing so would ensure that CMS does not introduce permanent payment shortfalls related to this policy. In addition, we urge the agency to support a remedy that promptly reimburses those hospitals affected by these cuts for all years that it was in place (CYs 2018-2022). At the same time, no hospital should be penalized for the agency’s implementation of an unlawful policy, including through unlawful attempts at achieving retrospective budget neutrality. The end of this harmful policy and prompt repayment of funds without any retrospective claw backs will help ensure that both 340B and non-340B hospitals can continue to care for the patients and communities they serve.

In addition, we appreciate the opportunity to further comment and provide feedback on the establishment of the new Medicare provider type, the Rural Emergency Hospital (REH). We thank the agency for its work on this program, as hospitals are eager to evaluate the feasibility of conversion. We support a number of proposals issued by CMS, including the use of Medicare claims data to calculate the monthly facility payment. We ask that the agency continues to consider reimbursements and regulatory requirements that ensure the sustainability of REHs and look forward to working with the agency in implementing those guidelines.

However, we are very concerned that the proposed market basket update of 3.1% is woefully inadequate and does not capture the unprecedented inflationary environment hospitals and health systems are experiencing. Therefore, we urge CMS to take action to increase the market basket in the final rule to better account for these extraordinary circumstances in order to ensure that beneficiaries continue to have access to quality outpatient care. We also are concerned about the proposed reduction for productivity, and ask CMS to elaborate in the final rule on the specific productivity gains that are the basis for the proposed 0.4 productivity offset. Such a cut does not align with hospital and health systems’ public health emergency (PHE) experiences related to actual losses in productivity during the COVID-19 pandemic.

Finally, we oppose CMS’ proposal to add a service category, facet joint interventions, to its prior authorization process. The increased utilization of these services have other appropriate justifications, the current data reveals that utilization levels of these services have already recessed, and there are other oversight mechanisms available to CMS that do not inappropriately delay care that should be used, rather than prior authorization, to address improper Medicare payments.

We appreciate your consideration of these issues. Our detailed comments are attached.

Please contact me if you have questions or feel free to have a member of your team contact Roslyne Schulman, director for policy, at rschulman@aha.org.



Stacey Hughes
Executive Vice President