Industry associations across settings took aim at the way the Centers for Medicare and Medicaid Services calculated the market basket used to set their Medicare payments for fiscal 2024.

In comments on the proposed rules to update reimbursements for nursing homes, inpatient rehabilitation facilities and inpatient psychiatric hospitals, providers and trade groups urged CMS to recognize macroeconomic trends such as inflation and other challenges facing the healthcare sector. These include workforce shortages and the lingering effects of the COVID-19 pandemic. These comments align with pleas from the hospital industry about the draft regulation to set inpatient reimbursements.

"We remain concerned that CMS’ market basket approach continues to show lags in recognizing inflationary trends and may not fully capture the rising costs of care," the American Hospital Association wrote in a comment letter regarding the skilled nursing facility prospective payment system proposed rule.

CMS' proposal to maintain a 5% maximum for wage index decreases does not reflect labor market conditions, commenters wrote. "We encourage CMS to modify the wage index tables in the final rule to include the actual value for those providers subject to the cap,” the National Association for Behavioral Healthcare wrote.

Industry representatives also asked CMS to pump the brakes on changes to quality reporting and value-based payment programs and not make adoption mandatory. For example, they described a requirement to track staff and patient COVID-19 vaccination status as overly burdensome.

The AHA warned that CMS' proposed health equity adjustment to Medicare reimbursements would disadvantage rural providers and those operating in states that haven't expanded Medicaid under the Affordable Care Act. Under the inpatient psychiatric facility prospective payment system proposed rule, providers will partly be assessed on how many Medicare-Medicaid dually eligible beneficiaries they treat.

CMS should withdraw a proposal to include nursing staff turnover as a quality metric while nursing homes are struggling to find staff, the long-term care association LeadingAge wrote. The American Nurses Association, a labor union, urged CMS to delay this policy.