Archive for 340b

 

Federal Health Policy Update for Wednesday, July 20

The following is the latest health policy news from the federal government as of 2:30 p.m. on Wednesday, July 20.  Some of the language used below is taken directly from government documents.

White House

The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19.  Find a transcript of that teleconference briefing here.

COVID-19 Public Health Emergency

HHS Secretary Xavier Becerra has renewed the COVID-19 public health emergency effective July 15.

Centers for Medicare & Medicaid Services

  • CMS has released its proposed Medicare outpatient prospective payment system regulation for calendar year 2023.  Highlights include:
    • A proposed rate increase of 2.7 percent for Medicare-covered outpatient services.
    • A proposed rate increase of 2.7 percent for ambulatory surgical center services.
    • A proposal to pay rural sole-community hospitals the full outpatient prospective payment system rate, rather than the site-neutral, physician fee schedule equivalent rate, for clinic visits in excepted off-campus provider-based departments.
    • An incomplete proposal for 340B payments in which CMS is formally proposing a payment rate of average sale price minus 22.5 percent for drugs and biologicals acquired through the 340B program, as it has been in recent years, but the proposed

Federal Health Policy Update for Tuesday, June 21

The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, June 21.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • The Supreme Court has ruled that CMS acted inappropriately when it reduced 340B payments to hospitals.  In a unanimous decision, the court found that the law creating the program gives the federal government two ways to set 340B payments for outpatient drugs for qualified providers and that the manner in which CMS cut those payments in 2018 followed neither.  Learn more from the Supreme Court opinion.
  • CMS has approved requests from Maine, Minnesota, New Mexico, and Washington, D.C. to expand from 60 days to 12 months postpartum Medicaid and CHIP coverage, as authorized temporarily by the American Rescue Plan.  This brings to 14 the number of states that have taken advantage of this option.  Learn more from this HHS news release.
  • The latest edition of MLN Connects, CMS’s online newsletter about Medicare reimbursement issues, includes items about FY 2023 ICD-10 diagnosis codes, the July update of the ambulatory surgical center payment system, revised requirements for mental health visits via

Supreme Court Rejects 340B Payment Cuts

The federal government had no business cutting section 340B payments to hospitals in the manner it did, the Supreme Court has ruled.

In an unanimous decision, the court found that the law creating the program gives the federal government two ways to set 340B payments for outpatient drugs for qualified providers and that the manner in which the Department of Health and Human Services cut those payments in 2018 followed neither.

Hospital groups estimate that the 340B payment cut amounted to about $1.6 billion annually.

Learn more about the high court ruling in the Healthcare Dive article “Hospitals win SCOTUS case against 340B rate cuts” and the Supreme Court decision.…

Federal Health Policy Update for Tuesday, March 22

The following is the latest health policy news from the federal government as of 2:30 p.m. on Tuesday, March 22.  Some of the language used below is taken directly from government documents.

Provider Relief Fund

  • As of March 22 at 11:59 p.m. (eastern) the HRSA (Health Resources and Services Administration) COVID-19 Uninsured Program will stop accepting claims for testing and treatment due to lack of funds and on April 5 at 11:59 p.m. (eastern) the HRSA COVID-19 Uninsured Program and COVID-19 Coverage Assistance Fund will stop accepting vaccination claims due to a lack of funds.  HRSA has released additional information about this significant change in federal COVID policy with the publication of two new documents:

o   HRSA COVID-19 Uninsured Program Shutdown FAQs

o   HRSA COVID-19 Coverage Assistance Fund Shutdown FAQs

Separately, HRSA advises that “Submitted claims will be paid subject to the availability of funds.”  This means that when the money is gone HRSA will no longer be able to pay claims.  The administration continues to encourage Congress to provide additional funding to support COVID-related activities and replenish this fund but it is not clear at this point if it will succeed in doing so.

  • Providers that received Provider Relief

Federal Health Policy Update for Thursday, November 4

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, November 4.  Some of the language used below is taken directly from government documents.

New Federal Vaccination Requirements

CMS has unveiled its new COVID-19 vaccine requirements for health care providers that receive reimbursement from the federal government.  The highlights include:

  • CMS is requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs.
  • The staff vaccination requirement applies to the following Medicare and Medicaid-certified provider and supplier types:  ambulatory surgery centers, community mental health centers, comprehensive outpatient rehabilitation facilities, critical access hospitals, end-stage renal disease facilities, home health agencies, home infusion therapy suppliers, hospices, hospitals, intermediate-care facilities for individuals with intellectual disabilities, clinics, rehabilitation agencies, public health agencies as providers of outpatient physical therapy and speech-language pathology services, psychiatric residential treatment facilities, Programs for All-Inclusive Care for the Elderly Organizations (PACE), rural health clinics/federally qualified health centers, and long-term care facilities.
  • Facilities covered by this regulation must establish a policy ensuring that all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care,