CMS updates Stark Law, payment models: 4 notes

CMS' 2024 Inpatient Prospective Payment System would require physician-owned hospitals to satisfy all Stark Law hospital exceptions or rural provider exceptions to qualify for services referred by the physician owner or investor, Lexology reported May 23. 

Here are four more things to know:

1. The rule further specifies that physician-owned hospitals cannot increase the number of operating rooms, procedures rooms and beds above the level it was licensed for as of March 23, 2010, unless granted an exception by CMS. 

2. Additionally, the CMS Innovation Center found that between Oct. 1, 2020, and Sept. 30, 2022, more than 41.5 million Medicare and Medicaid patients with private insurance in multipayer model tests received care from, or will soon receive care from, plans participating in the CMS Innovation Center payment models.

3. The CMS Innovation Center was "established to test innovative payment and service delivery models to reduce program costs while preserving or enhancing quality of care to individuals who receive benefits from Medicare, Medicaid or Children’s Health Insurance Programs," according to Lexology

4. CMS issued a price cap on insulin copays for Medicare enrollees on Jan. 1. The price of insulin copays has been capped at $35 a month for each insulin prescription covered by a Medicare Part D plan. 

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