A new Medicare proposal would repeal a requirement that hospitals report specific negotiated charges for all its Medicare Advantage, which the CAP had previously advocated against as it may not capture the value of the professional component of clinical pathology services. The proposal, published by the Centers for Medicare & Medicaid Services (CMS) on April 27, would repeal a market-based Medicare Severity-Diagnosis Related Group (MS-DRG) relative weight data collection and change in methodology also opposed by the CAP.

The CMS released these changes in the proposed 2022 Medicare Hospital Inpatient Prospective Payment System and Long Term Care Hospital regulation. The payment system provides fixed reimbursements for diagnosis-related groups for hospital services. The CAP is carefully reviewing the proposals, which would go into effect in 2022, and will provide its input by a June 28 comment deadline.

1,000 New GME Positions

The CMS also proposed implementing policies for graduate medical education (GME) that were included in the 2021 Consolidated Appropriations Act. The act was signed into law in December 2020. The provisions impact direct and indirect payments for GME that provide 1,000 new GME positions to be distributed beginning in fiscal year 2023 and several changes to the full-time equivalent resident limits of urban and rural hospitals.

The proposed regulation also would create a new Medicare group for Chimeric Antigen Receptor (CAR) T-cell immunotherapy. The CMS proposed not to use clinical trial cases where the hospital does not have a cost for the therapy product. The CAP advocated for the appropriate pricing for these services.

Additionally, the agency requested information about adopting a digital measurement approach for its hospital quality and value-based purchasing programs and strategies to close the health equity gap in those programs. Specific changes are proposed for the quality reporting programs for acute inpatient hospital stays, Prospective Payment System-exempt cancer hospitals, and long-term care hospitals.