CMS Issues CY 2027 OPPS Proposed Rule, Includes Site-Neutral Payment Cuts
On July 2, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2027 Medicare Outpatient Prospective Payment System (OPPS)
proposed rule. CMS proposed a 2.4% rate update, including a 3.2% market basket update reduced by a 0.8 percentage point productivity adjustment.
CMS also proposed several harmful policy changes. Specifically, CMS proposed new site neutral payments that would apply Medicare Physician Fee Schedule equivalent payment rates to any Healthcare Common Procedure Coding System (HCPCS) codes assigned to imaging without contrast ambulatory payment classifications when provided at excepted off-campus provider-based departments.
Additionally, following the separately payable drug acquisition cost survey fielded earlier this year, CMS proposed lowering Medicare reimbursement for 340B-acquired drugs to the drug’s average sales price minus 33.4%. This policy would be budget neutral, increasing reimbursement for non-340B drug services. CMS estimates this proposal will reduce Medicare drug payments by $4.55 billion and beneficiary drug payments by $1.15 billion in the first year.
CMS also proposed increasing the clawback related to its 2018 policy reducing Medicare reimbursement for 340B-acquired drugs. While CMS has been lowering the OPPS conversion factor by 0.5% each year, it proposed increasing the clawback to 3% effective CY 2027 and moving forward until the budget neutral offset provided to OPPS hospitals between 2018 and 2022 is repaid.
Several other policy changes were included in the proposed rule. A CMS fact sheet summarizing the major proposals in the rule is available
here. IHA will make facility-specific estimated financial impact reports available via the IHA C-Suite in the coming weeks. CMS will accept comments on the CY 2027 OPPS proposed rule for 60 days following the publication of the proposed rule in the
Federal Register. IHA will submit comments on behalf of IHA members, but we encourage all OPPS hospitals to review the rule and its impact on your facility and consider submitting your own comments as well.
CMS Releases CY 2027 HH PPS Proposed Rule
Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2027 home health prospective payment system (HH PPS)
proposed rule. CMS proposed a CY 2027 HH payment update of 2.4%, which includes a 3.1% market basket update, 1 percentage point productivity cut, and 0.3% increase for outlier payments.
CMS has made several permanent negative base rate adjustments to the HH PPS base rate since transitioning to the patient-driven grouping model (PDGM) in 2020. For CY 2027, CMS does not propose an additional permanent adjustment. However, to fulfill the statutory requirement that permanent adjustments are implemented in a budget-neutral manner, CMS is proposing to implement at temporary adjustment of -3.0% to the CY 2027 national, standardized payment rate. CMS states this temporary adjustment will allow for continued recoupment of retrospective overpayments made for CYs 2020-2025.
CMS is also proposing several provider enrollment provisions, including retroactive revocations (currently revocations are prospective), and adding or expanding rationales for revocation or denial of enrollment for hospices, HHAs, and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Additional proposed payment, quality, and policy changes are outlined in a CMS fact sheet, available
here. IHA will make facility-specific estimated financial impact reports available via the IHA C-Suite in the coming weeks. Comments are due 60 days after the proposed rule is published in the
Federal Register.
Illinois Dept. of Early Childhood Officially Launched July 1
Yesterday, the Illinois Dept. of Early Childhood (IDEC) officially began operations as Illinois’ first agency focused entirely on early childhood programs and services. The agency joins together programs previously administered by the Illinois Dept. of Children and Family Services, Illinois Dept. of Human Services, Illinois State Board of Education, and Governor’s Office of Early Childhood Development. It was established as part of a broader effort to streamline services, improve coordination, and strengthen early learning systems statewide.
Programs now under IDEC’S purview include Child Care; Head Start State Collaboration Office; Migrant Seasonal Head Start; Early Intervention; Maternal, Infant, and Early Childhood Home Visiting; Maternal Child Home Visiting; Early Childhood Block Grant including Preschool for All, Preschool for All Expansion, and Prevention Initiative; Child Care Licensing; and Infant and Early Childhood Mental Health.
Click here for more information.
Early Seasonal West Nile Virus Activity, High Case Numbers
The Centers for Disease Control and Prevention (CDC) issued a
notice yesterday that it is seeing the earliest start to the West Nile virus (WNV) season in the United States, with the highest number of human disease cases reported by this time of year since 2004. At least 48 cases have been reported as of June 30, with 38 reported as severe. Since 2004, an average of 10 human disease cases has been reported to CDC by the end of June. CDC said the surge is driven by early circulation of the virus, with 23 states reporting West Nile virus activity, which is also the highest number recorded over the last 10 years.
CDC Reports Spike of Parasitic Illness Cyclosporiasis
The Centers for Disease Control and Prevention (CDC) is
reporting at least 145 cases of cyclosporiasis have been reported across 17 states, including Illinois. Cyclosporiasis is a type of food poisoning caused by a parasite, according to the CDC. People typically are infected by eating contaminated food or water. While cyclosporiasis symptoms can vary, CDC says watery diarrhea is the most common symptom.
Illinois joins New York and Texas in reporting some of the highest numbers of cases in the U.S. Nationally 20 people have been hospitalized after suffering severe symptoms; to date no related deaths have been reported. There is currently no evidence of a single, multistate Cyclospora outbreak linking all cases, according to the CDC. However, public health teams are investigating several clusters of reported cases.
Joint Commission International Launches Center of Excellence Certification
Joint Commission International (JCI) this week
launched a Center of Excellence (COE) Certification, which is designed to give international healthcare organizations an independently validated framework to define and recognize clinical service line excellence. JCI said the certification is available for five clinical service lines, including: pediatrics, oncology, trauma, orthopedics, and maternal-perinatal care. JCI will continue to expand the COE certification portfolio to include additional clinical specialties.
Illinois Respiratory Disease Surveillance Data
The Infectious Respiratory Disease Surveillance Dashboard from the Illinois Dept. of Public Health (IDPH) provides the latest data on hospital visits, seasonal trends, lab test positivity and demographic data. IDPH also tracks COVID-19, influenza and respiratory syncytial virus information through the Illinois Wastewater Surveillance System dashboard.
Briefly Noted
Amgen
recalled select lots of its heart medication Corlanor and kidney disease treatment Sensipar due to concerns of the presence of foreign material and deviations from current good manufacturing practices. The recall affects multiple lots of Corlanor (ivabradine) 5 milligram and 7.5 milligram tablets.
The Food and Drug Administration yesterday
issued supplemental approval for the gene therapy Casgevy to be used for patients aged 2 years and older with sickle cell disease (SCD). This is the first gene therapy approved for patients aged 2 years and older with SCD, providing them with a new treatment option for this debilitating, life-threatening blood disorder. Casgevy has been previously approved for the treatment of patients aged 12 years and older with SCD.
Leading the News
Illinois Speaker Welch calls on Rep. Harry Benton to resign after investigation of his conduct
Chicago Tribune
Illinois House Speaker Emanuel “Chris” Welch on Wednesday called on a Democratic lawmaker from Plainfield accused of improper conduct to resign from the General Assembly after an internal investigation revealed what Welch said were “clear patterns” of behavior that are “outrageous, unethical, and unbecoming of a member of the Illinois House of Representatives.”
‘The time for balance is now’: HSHS CEO urges medical liability reform
Becker’s Hospital Review
Dave Smith, MD did not set out to become a rural physician initially. He had planned to pursue an academic career in chemistry on the East Coast from an elite school, but life pulled him back to the Midwest, closer to family and closer to his hometown. He found his way into medicine and, over the next 40 years, built the kind of practice many communities still want to see preserved.
‘Explosive’ diarrhea illness detected in multiple states. See where most cases are being reported
WIFR
Health officials say they are seeing a spike in cases when it comes to a parasitic illness that can cause “explosive” diarrhea, among other symptoms. The Centers for Disease Control and Prevention reports that at least 145 cases of cyclosporiasis have been reported across 17 states, with 20 people having been hospitalized after suffering severe symptoms.
