CMS Releases Proposed Rule: Remedy for the 340B-Acquired Drug Payment Policy for Calendar years 2018-2022.
- CMS proposes to pay hospitals that received a reduced rated a lump sum to gross up payments as if the payments were not reduced.
- The proposed methodology to calculate the lump sum for each hospital is in the Proposed Rule.
- The proposed timing of the payment is 60 days after CMS issues a Change Request (CR) #hospital or Technical Direction Letter (TDL) to MACs regarding the final methodology to calculate the lump sum payments.
- CMS proposes to pay those same hospitals a lump sum to compensate them for the co-payments they would have received from beneficiaries had the invalid, lower payment amount not been in effect.
- In order to make the remedy budget neutral, CMS proposes to reduce future non-drug item and service payments by adjusting the OPPS conversion factor by minus 0.5% starting in CY 2025 and for the next sixteen (16) years.
- CMS proposes that this reduction to the conversion factor will not apply to providers that enrolled in Medicare on or after January 1, 2018.
This Proposed Rule, CMS 1793-P, will be published on 7/11/2023. There will be a 60-day comment period. CMS states that the Final Rule regarding this proposed remedy is to be released before the CY 2024 OPPS Final Rule in the Fall of 2023. The Proposed Rule is 60 pages.
