On July 25, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. Among other provisions, the proposal would extend 2018 reimbursement cuts to the 340B Drug Pricing Program to include currently excepted, off-site hospital-affiliated outpatient clinics.
In 2018, 340B reimbursement under HOPPS was cut from Average Sales Price (ASP) +6 percent to ASP -22.5 percent. For 2019, CMS is proposing to extend that cut to 340B drug reimbursement even further by applying it to most off-site hospital outpatient clinics except rural sole community hospitals, children’s hospitals, and Medicare Prospective Payment System (PPS)-exempt cancer hospitals.
CMS is also proposing to apply Medicare Physician Fee Schedule (MPFS) payment rates for certain visits to off-campus hospital-affiliated providers paid under HOPPS. If implemented, this proposal would pay hospital-affiliated clinics at the lower MPFS rate at which non-hospital affiliated clinics are reimbursed.
Furthermore, CMS is soliciting stakeholder feedback on a potential Competitive Acquisition Program (CAP) model. They are seeking input as to the scope of such a program, including who should be included or excluded, what drugs should be included, the potential distribution model and any additional payments that should be considered for specialties like oncology.
ASCO is currently assessing the full potential impact of the proposal on the oncology community, but the society has serious concerns about these cuts and will outline them for CMS in comments to the agency before the proposal’s open comment period closes on September 24, 2018.
CMS released “Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Requests for Information on Promoting Interoperability and Electronic Health Care Information, Price Transparency, and Leveraging Authority for the Competitive Acquisition Program for Part B Drugs and Biologicals for a Potential CMS Innovation Center Model” online ahead of publication. It will be published in the Federal Register on July 31.
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