October 31, 2013—Final regulations setting next year’s Medicare reimbursement rates for hospital outpatient services and specified high-cost drugs will be held up for about a month due to the recent partial government shutdown.[ms-protect-content id=”2799″]
The Centers for Medicare and Medicaid Services (CMS) announced the delay in an Oct. 23 memo to providers. CMS originally planned to issue the rule around Nov. 1.
CMS published its outpatient prospective payment system (OPPS) proposed rule for calendar year 2014 in July. In it, the agency proposed for the second year in a row to pay for so-called “separately paid drugs and biologicals that do not have pass-through status” at the statutory default rate of average sales price (ASP) plus a 6 percent add-on payment for overhead. This category of drugs includes relatively high-cost physician-administered injectable and infusion medicines, many of which are used to treat cancer and related anemia and nausea.
Federal budget sequestration, however, has reduced reimbursement for these drugs in 2013 from ASP plus 6 percent to ASP plus 4.3 percent. Congress is debating whether to continue sequestration in 2014 and beyond.
Last year, CMS stopped including 340B drug sales in its methodology for calculating the add-on payment for overhead. Hospital, pharmacy, and drug industry groups all agreed that including these sales resulted in inadequate reimbursement for non-340B entities.
The final rule also is expected address how CMS plans to collect information on the frequency, type, and payment for services furnished in hospital off-campus outpatient facilities. In the proposed rule, CMS
Invited public comment on how it might gather data to help it “better understand the growing trend toward hospital acquisition of physician offices and subsequent treatment of those locations as off-campus provider-based outpatient departments.”[/ms-protect-content]