2023 Medicare Hospital Inpatient Payment Proposal Addresses CAR-T Reimbursement, Quality Disparities, Social Determinants of Health

April 19, 2022

On April 18, 2022, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule. In addition to updating Medicare payment rates and policies for inpatient hospitals in FY 2023, the proposed rule aims to measure health care quality disparities, improve the quality of maternity care, and obtain stakeholder feedback to advance health equity.

Proposed Payment Rate
CMS is proposing a projected 3.2% increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users. This reflects a FY 2023 projected hospital market basket update of 3.1% reduced by a projected 0.4 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by statute.

CAR-T Reimbursement
In 2021, CMS established a Medicare Severity Diagnosis Related Group (MS-DRG) 018 for Chimeric Antigen Receptor T-cell (CAR-T) services. In the FY 2022 IPPS final rule, CMS finalized its proposal and added procedure codes describing CAR-T services, non-CAR-T services, and other immunotherapies to MS-DRG 018 and updated the title for MS-DRG 018 to “Chimeric Antigen Receptor (CAR) T-cell and Other Immunotherapies” to reflect the additions. In its 2023 proposal, CMS continues to assess the appropriateness of the therapies assigned to MS-DRG 018 to address stakeholder concerns and improve the predictability and stability of hospital payments for these complex, novel cell therapies.

Improving Maternal Health Outcomes
CMS is proposing the creation of a new hospital designation to identify “birthing friendly hospitals” and additional quality measure reporting to drive improvements in maternal health outcomes and maternal health equity. The “Birthing-Friendly” hospital designation is meant to assist consumers in choosing hospitals that have demonstrated a commitment to maternal health through the implementation of best practices that advance health care quality, safety, and equity for pregnant and postpartum patients. 

Measuring Health Care Quality Disparities
To address health disparities in inpatient hospital care, CMS is proposing three health equity-focused measures for adoption in the Hospital Inpatient Quality Reporting (IQR) Program to assess a hospital’s commitment to establishing a culture of equity and delivering more equitable care, in addition to evaluating the hospital’s screening and identification of patient-level, health-related social needs practices. CMS is asking for public input on how to best measure health care quality disparities, including what to prioritize in data collection and reporting and considerations for provider accountability.

Social Determinants of Health
CMS is also soliciting public comments on how the reporting of social determinants of health diagnosis codes may improve the ability to recognize severity of illness, complexity of service, and/or utilization of resources.

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