On August 4, 2021, the Centers for Medicare & Medicaid Services (CMS) published proposed changes to enforcement of the hospital price transparency rules that went into effect earlier this year. The proposed changes, part of...more
On July 2, 2021, the U.S. Supreme Court granted petitions to hear two cases related to Medicare payments for health care providers. The Court will consider a hospital appeal of a Ninth Circuit decision that vacated part of a...more
As part of the FY 2022 Inpatient Prospective Payment System (IPPS) proposed rule issued on April 27, 2021, CMS intends to repeal a requirement that hospitals report their median payer-specific negotiated charges with Medicare...more
On April 13, 2021, four key lawmakers in the U.S. House of Representatives wrote to the U.S. Department of Health and Human Services (HHS) expressing concern over reports of non-compliance with hospital price transparency...more
On November 20, 2020, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment period (IFC) to implement a payment model that will significantly reduce Medicare reimbursement rates for...more
12/1/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Drug Pricing ,
Health Care Providers ,
Hospitals ,
Interim Final Rules (IFR) ,
Manufacturers ,
Medicare ,
Payment Methods ,
Prescription Drugs ,
Reimbursements
In an effort to provide beneficiaries with an increased choice of care and in another nod toward CMS' policy of increasing choice and its site neutrality initiative, CMS has proposed the elimination of the Inpatient Only...more
On July 31, 2020, the D.C. Circuit Court of Appeals issued a decision reversing a lower court decision and upholding Medicare payment cuts to certain hospitals participating in the 340B drug pricing program that have been in...more
8/20/2020
/ Administrative Authority ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Hospitals ,
Medicare Part B ,
Medicare Payment Reform ,
Outpatient Prospective Payment System (OPPS) ,
Payment Rates ,
Reversal ,
Section 340B
On August 4, 2020, CMS issued a proposed rule to further reduce outpatient drug payment rates under Medicare to certain hospitals participating in the 340B drug pricing program. As part of the 2021 OPPS Proposed Rule, CMS...more
On June 23, 2020, a federal district court upheld a Centers for Medicare and Medicaid Services (CMS) regulation that requires hospitals to publicly report information regarding their standard charges, including privately...more
7/20/2020
/ Administrative Procedure Act ,
Appeals ,
Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Free Speech ,
Hospitals ,
Lack of Authority ,
Penalties ,
Price Transparency ,
Reaffirmation ,
Regulatory Oversight ,
Reporting Requirements
The Health Resources and Services Administration (HRSA) has issued guidance eliminating a longstanding enforcement position that delayed the ability of hospitals participating in the 340B drug pricing program to use...more
On June 9, 2020, the Department of Health and Human Services (HHS) announced additional payments under the COVID-19 Provider Relief Fund to reimburse providers for health care related expenses and revenue losses attributable...more
On May 1, 2020, the Department of Health and Human Services (HHS) announced additional payments under the COVID-19 Provider Relief Fund to reimburse providers for health care related expenses and revenue losses attributable...more
5/15/2020
/ Attestation Requirements ,
CARES Act ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Funding Portal ,
Guidance Update ,
Health Care Providers ,
Hospitals ,
Long Term Care Facilities ,
MACPAC ,
Overpayment ,
Provider Relief Fund ,
Reporting Requirements ,
Rural Health Care Providers
Both the U.S. Senate and House of Representatives have now passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and the President is expected to sign the bill into law shortly. The CARES Act appropriates...more
3/27/2020
/ CARES Act ,
Centers for Disease Control and Prevention (CDC) ,
Coronavirus/COVID-19 ,
Federal Funding ,
Health Care Providers ,
Hospitals ,
Medical Research ,
National Institute of Health (NIH) ,
Rural Health Care Providers ,
SAMHSA ,
Substance Abuse
Four separate government releases coming over a three-week period have once again highlighted the intense interest in the 340B drug pricing program, with a federal agency and two government watchdog groups issuing guidance...more
1/30/2020
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Discounts ,
Drug Pricing ,
GAO ,
Health Care Providers ,
Hospitals ,
HRSA ,
Information Reports ,
Medicaid ,
Medicare ,
Medicare Part B ,
MedPAC ,
New Guidance ,
Non-Profit Hospitals ,
Pay Reductions ,
Prescription Drugs ,
Provider Payments ,
Regulatory Agenda ,
Regulatory Oversight ,
Section 340B ,
State and Local Government
A federal district court has ruled, for a second time, in favor of hospitals challenging the legality of Medicare payment cuts targeting certain hospitals in the 340B drug pricing program. In a May 6, 2019 decision, the U.S....more
6/5/2019
/ Appeals ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Hospitals ,
Injunctive Relief ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Pay Reductions ,
Payment Rates ,
Prescription Drugs ,
Provider Payments ,
Remand ,
Remedies ,
Section 340B ,
Stays ,
Unlawful Policies
On May 3, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a draft of long-awaited guidance for hospitals on how they can share space, services and staff with other co-located hospitals and health care...more
The U.S. government has appealed a federal district court decision issued in December 2018 that found the Department of Health & Human Services (HHS) exceeded its authority by reducing Part B drug reimbursement to certain...more
3/19/2019
/ Abeyance ,
Appeals ,
Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Hospitals ,
Lack of Authority ,
Medicare ,
Medicare Part B ,
Outpatient Prospective Payment System (OPPS) ,
Prescription Drug Coverage ,
Prescription Drugs ,
Remedies ,
Section 340B
In an opinion issued December 27, 2018, a Federal District Court ruled that the Department of Health & Human Services (HHS) exceeded its authority by reducing Part B drug reimbursement to certain hospitals in the 340B drug...more
1/11/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
Drug Pricing ,
DSH ,
Government Shutdown ,
Hospitals ,
Lack of Authority ,
Medicare ,
Motion To Stay ,
Outpatient Prospective Payment System (OPPS) ,
Permanent Injunctions ,
Remedies ,
Ripeness ,
Rural Health Care Providers ,
Section 340B ,
Subsequent Litigation ,
Trial Court Orders
Two recent announcements by the Health Resources and Services Administration (HRSA) highlight the agency's plans for increased oversight in the next year of drug manufacturers under the 340B drug pricing program and...more
12/13/2018
/ Affordable Care Act ,
Civil Monetary Penalty ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Enforcement Actions ,
Health Care Providers ,
Hospitals ,
HRSA ,
Manufacturer Liability ,
Office of Pharmacy Affairs Information System (OPAIS) ,
OIG ,
Pharmaceutical Industry ,
Pharmacies ,
Prescription Drugs ,
Section 340B
As the Trump Administration moves forward with proposed policy changes to address high drug prices, a common theme is emerging: a number of the proposals have the potential to reduce Medicare reimbursement to hospitals and...more
8/10/2018
/ Add-ons ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Hospitals ,
MCOs ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part B ,
Medicare Part D ,
MedPAC ,
Outpatient Prospective Payment System (OPPS) ,
Pay Reductions ,
Physician Fee Schedule ,
Physicians ,
Prescription Drug Coverage ,
Prescription Drugs ,
Provider Payments ,
Request For Information ,
Section 340B ,
Trump Administration
On July 31, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule outlining the proposed payment rates for 2019 under the Medicare Outpatient Prospective Payment System (OPPS), one of several payment...more
The Medicare program is once again looking to reduce payments to 340B hospitals for Part B drugs and biologicals. As part of its proposed payment regulation for hospitals under the Outpatient Prospective Payment System (OPPS)...more
8/7/2018
/ Biologics ,
Biosimilars ,
Centers for Medicare & Medicaid Services (CMS) ,
Dismissals ,
Disproportionate Share Adjustments ,
Hospitals ,
Injunctive Relief ,
Medicare ,
Medicare Part B ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Pay Reductions ,
Prescription Drug Coverage ,
Provider Payments ,
Ripeness ,
Rural Health Care Providers ,
Section 340B ,
Trump Administration
On April 2, 2018, CMS issued updated guidance related to the dramatic Medicare payment reductions that went into effect this year for certain 340B hospitals. The guidance explains the planned application of the payment cuts...more
4/12/2018
/ Appeals ,
Bipartisan Agreement ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Dismissals ,
Disproportionate Share Adjustments ,
Exemptions ,
Hospitals ,
Medicare ,
Medicare Advantage ,
Medicare Part B ,
New Guidance ,
Out of Network Provider ,
Outpatient Prospective Payment System (OPPS) ,
Pay Reductions ,
Preliminary Injunctions ,
Prescription Drugs ,
Proposed Legislation ,
Reversal ,
Ripeness ,
Rural Health Care Providers ,
Section 340B ,
Statutory Authority