New CMS rule to target opioid usage in ASCs

As part of its 2022 end-of-the-year spending package, Congress passed the NOPAIN Act, set to take effect in 2025, that will set up a separate Medicare payment for certain non-opioid pain management approaches in outpatient and ASC settings, according to a Sept. 11 report from the Baltimore Sun.

The law will incentivize ASCs to use pain relief methods like nerve blocks and long-acting numbing medications, instead of more addictive opioids. As enacted, the legislation would expire at the end of 2027, so long-term action is still needed. 

An estimated 5 million Americans over the age of 12 are currently addicted to opioids, according to the National Institute on Drug Abuse. One-third of people who take opioids for chronic pain misuse them. 

Opioids are currently reimbursed under Medicare Part D, so the price does not cut into what hospitals earn for procedures. The NOPAIN Act aims to create parity in how methods of pain relief are covered by also removing non-opioid options from the payment. 

In 2019, CMS made non-opioid options a separate payment for Medicare patients treated at ASCs. That year, there was a 120 percent increase in anesthetic used at facilities. 

Some advocates are now pushing for the NOPAIN Act to go into effect in 2024 instead of 2025 to accelerate the incentives. 

However, CMS denied the acceleration in July when the agency released its proposed Outpatient Prospective Payment System rule, which recommends Medicare payment rates and policies for outpatient and ASCs for the coming year.

A CMS spokesperson told the Baltimore Sun that the agency is required to implement the rule Jan. 1, 2025. To prepare for the change, the spokesperson said, CMS asked for comments on the devices and drugs that people believe would meet the definition of non-opioid treatments for pain relief.

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