DHPA provided a comment letter to the Centers for Medicare and Medicaid Services (CMS) on the Medicare Program Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule for Calendar Year 2023 (OPPS/ASC Proposed Rule).
In its comment letter, DHPA focused on three main points regarding Medicare payments to 340B hospitals arising from the Supreme Court’s June 2022 decision that the U.S. Department of Health and Human Services (HHS) and, by extension, CMS acted unlawfully in implementing a lower payment formula of Average Sales Price (ASP) minus 22.5% for reimbursement of drugs to 340B hospitals because the Agency had failed to undertake a survey of acquisition costs to support the reimbursement level it had set for that group of hospitals.
The three points included in the letter are of profound consequence to the sustainability of high quality, cost-efficient and convenient care delivery furnish in the independent ASC setting:
- As was the case in 2018, when CMS implemented the more appropriate payment level of ASP minus 22.5% for 340B hospitals, the ASC payment system should be insulated from any change CMS makes to OPPS payments in light of the Supreme Court’s decision in AHA v. Becerra that reduce the OPPS conversion factor for CY 2023;
- ASC payments for CYs 2018-2022 (when CMS paid 340B hospitals at ASP minus 22.5%) should not be subject to any retroactive recoupment; and
- CMS should undertake, without delay, the survey of acquisition costs required by the Medicare statute and base Medicare payments to 340B hospitals on that survey starting with CY 2023. As CMS recognized through the payment policy it had in effect for 2018 through 2022, a cost survey is necessary to ensure that 340B hospitals not be reimbursed by Medicare for Part B drugs far in excess of their acquisition costs. To pay 340B hospitals at ASP + 6% would exacerbate the unleveled playing field that independent gastroenterology (and other specialty) practices confront and fuel further anti-competitive behavior and physician acquisitions by hospitals.
Click here to read the full letter >>