Articles and Blogs

On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued its CY 2022 Medicare Physician Fee Schedule (“MPFS”) Final Rule. Simultaneously, CMS released its CY 2022 Outpatient Prospective Payment System (“OPPS”) Final Rule with comment period. Below is a high-level summary of significant changes established by the MPFS Final Rule. For... READ MORE

The FFY 2022 IPPS Proposed Rule (“Proposed Rule”) was released on April 27, 2021, and CMS published the associated tables on its website. In addition, the Proposed Rule is expected to be published in the Federal Register on May 10. The release of the Proposed Rule and the accompanying tables triggers the start of... READ MORE

Last week, the D.C. Circuit Court of Appeals (the “Court”) reinstated a rule cutting reimbursement rates for drugs purchased at a substantial discount under Section 340B of the Public Health Service Act (the “340B Program”) that had previously been ruled unenforceable by the District Court. In American Hospital Association v. Azar,[1] the Court held... READ MORE

Recognizing that hospitals need additional flexibilities and financial stability to combat COVID‑19, CMS published in a second Interim Final Rule enabling hospitals to temporarily relocate excepted off-campus and on-campus provider-based hospital departments without losing the ability to receive payment for hospital outpatient services paid under the outpatient prospective payment system (“OPPS”). Despite this increased... READ MORE

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

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

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

On May 6, 2019, the United States District Court in Washington, D.C. issued its opinion on the appropriate remedy to address the invalidated payment cuts set forth in the 2018 and 2019 Outpatient Prospective Payment System final rules (“2018 and 2019 OPPS Rules”) for drugs purchased under the 340B drug discount program (“340B Program”).... READ MORE

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

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