CMS Issues Medicare Hospital Outpatient Payment Proposal for 2013

by admin | August 1, 2012 3:03 pm

August 1, 2012—The Centers for Medicare and Medicaid Services (CMS) has proposed to budget $48.1 billion for Medicare reimbursement to hospital outpatient facilities in 2013, an increase of 2.1 percent above this year’s level. In addition, it will increase the payment rate for separately payable drugs and biologicals by 2 percent and drop a problematic payment methodology that hospitals enrolled in the 340B drug discount program have long opposed. [ms-protect-content id=”2799″]

In a July 30 proposed rule[1] for the hospital Outpatient Prospective Payment System (OPPS), CMS said that in calendar year 2013 it will pay average sales price (ASP) plus 6 percent for drug acquisition and pharmacy overhead costs for separately payable drugs and biologicals. The payment rate this year is ASP plus 4 percent.

For the past six years, CMS has used ASP as a proxy for the acquisition cost of separately payable drugs and biologicals. In tandem, it has used hospital claims data to estimate an add-on payment for overhead costs. Safety Net Hospitals for Pharmaceutical Access (SNHPA), which represents 340B hospitals, and other pharmacy stakeholders have argued that CMS’s formula underestimated overhead costs and that the inclusion of 340B data in the calculation exacerbated the problem.

In its proposal for 2013, CMS said it will begin using its authority under the Medicare statute to pay hospitals for separately paid drugs and biologicals at the same, fixed ASP plus 6 percent rate that Medicare pays physician offices. The law lets CMS use the other payment formula if hospital acquisition cost data are unavailable. CMS indicated that it will switch the payment methodology again if a better one is ever developed.

CMS noted that the shift to ASP plus 6 percent means that 340B hospital data no longer affect the drug payment rate.

The proposed reimbursement rates would apply to services furnished on or after Jan. 1, 2013. CMS is accepting comments on the proposed rule until Sept. 4 and will issue a final rule by Nov. 1.[/ms-protect-content]

 

Source URL: https://340bemployed.org/cms-issues-medicare-hospital-outpatient-payment-proposal-for-2013/

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