Articles and Blogs

OPPS

The Price May Not Be Right, But It Will Be Public: CMS Finalizes Price Transparency Rule Requiring Hospitals to Publish Payer-Specific Rates

[11/18/19]

Posted on November 18, 2019 in Health Law News

Published by: Hall Render

On November 15, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released the final rule on Price Transparency Requirements for Hospitals to Make Standard Charges Public (“Final Rule”) (available here). Despite broad opposition from the industry, CMS finalized the rule largely as proposed. CMS did delay the effective date until January 1, 2021,... READ MORE

Tags: , , , , , , , ,

Hall Render’s This Week in Washington – November 15, 2019

[11/15/19]

Posted on November 15, 2019 in Federal Advocacy

Published by: Hall Render

CMS Releases Price Transparency Rules On November 15, CMS issued a proposed and final rule, both intended to increase the transparency in pricing for health care providers. One of the rules is the Calendar Year (“CY “) 2020 Outpatient Prospective Payment System (“OPPS”) final rule. The second rule is the Transparency in Coverage proposed... READ MORE

Tags: , , , , ,

Proposed CMS Hospital Survey Could Support CMS’s Efforts to Reduce 340B Drug Reimbursement

[10/07/19]

Posted on October 7, 2019 in Health Law News

Published by: Hall Render

On September 30, 2019, the Centers for Medicare & Medicaid Services (“CMS”) published notice of a proposed survey (“Survey”) of drug acquisition costs for all hospitals participating in the 340B drug discount program (“340B Program”). The Survey would require reporting of acquisition cost data on 340B discounted drugs, referred to as specified covered outpatient... READ MORE

Tags: , , , , , ,

Hospitals Win Battle Over Site-Neutral Pay Cuts

[09/18/19]

Posted on September 18, 2019 in Health Law News

Published by: Hall Render

CMS was dealt a blow from the D.C. District Court on September 17, 2019 when the court determined the agency’s “site neutral” payment policy in the CY 2019 Outpatient Prospective Payment System (“OPPS”) Final Rule exceeded its statutory authority to adjust payments under the OPPS. Refusing to accept the government’s argument that the plaintiffs... READ MORE

Tags: , , , , , , ,

Here’s Price Transparency![1]

[09/13/19]

Posted on September 13, 2019 in Health Law News

Published by: Hall Render

On June 24, 2019, the Trump administration changed the game for the health care industry through the release of an executive order on price transparency. Entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” the executive order is aimed primarily at giving patients access to price and quality information about... READ MORE

Tags: , , , , , , , , , ,

CMS Continues 340B Payment Cuts in 2020 OPPS Proposed Rule Yet Acknowledges Potential for Future Reversal

[08/02/19]

Posted on August 2, 2019 in Health Law News

Published by: Hall Render

This week, CMS released the 2020 Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center Payment System Proposed Rule (“Proposed Rule”). Among a host of other items, CMS announced its intent to continue paying Average Sales Price (“ASP”) minus 22.5 percent for most drugs acquired under the 340B drug discount program (“340B... READ MORE

Tags: , , , , , ,

Wage Index Fix? CMS Proposes Changes for Low Wage Hospitals and Rural Floor

[04/30/19]

Posted on April 30, 2019 in Health Law News

Published by: Hall Render

On April 23, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released the Federal Fiscal Year (“FFY”) 2020 Medicare Inpatient Prospective Payment System (“IPPS”) proposed rule (“IPPS Proposed Rule”). Among many other changes, CMS proposed several changes to address disparities between high and low wage index areas and fixing the so-called “rural floor.”... READ MORE

Tags: , , , , , ,

The 340B Crystal Ball: New Clarity on 340B Prices and the Program’s Future

[04/05/19]

Posted on April 5, 2019 in Health Law News

Published by: Hall Render

It’s no April Fools’ joke. On April 1, 2019, the Health Resources & Services Administration Office of Pharmacy Affairs (“HRSA”) unveiled a long-awaited website that gives providers participating in the 340B drug pricing program (“340B Program”) direct access to information about the maximum amounts that pharmaceutical companies may charge for certain drugs. This moves... READ MORE

Tags: , , , , , , , , , , , , ,

Impact Analysis: Federal Court Blocks 2018 Cuts to 340B Drug Discount Program Payments

[01/11/19]

Posted on January 11, 2019 in Health Law News

Published by: Hall Render

On December 27, 2018, a federal judge ruled in favor of hospital associations and hospitals challenging the reduction in reimbursement for drugs purchased at a discount under the 340B Program established in the 2018 Outpatient Prospective Payment System final rule (“2018 OPPS Rule”). Judge Rudolph Contreras of the United States District Court in Washington,... READ MORE

Tags: , , , , , ,

340B Program OPPS Payment Reductions and Legislative Limitation Proposals: What’s Smoke and What’s Fire?

[07/27/18]

Posted on July 27, 2018 in Health Law News

Published by: Hall Render

On July 25, the Centers for Medicare & Medicaid Services (“CMS”) issued its 2019 Outpatient Prospective Payment System (“OPPS”) Proposed Rule (“OPPS Proposed Rule”). As anticipated based on public comments made by Department of Health and Human Services (“HHS”) Secretary Alex Azar, CMS is proposing to expand application of reduced payment for discounted drugs... READ MORE

Tags: , , , ,