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
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
The D.C. Circuit Court of Appeals has scheduled oral arguments for November 8, 2019 in the ongoing lawsuit challenging Medicare payment cuts to hospitals in the 340B drug pricing program. The court is considering an appeal by...more
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
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
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