Following a lawsuit brought by hospital groups against the agency, the Department of Health and Human Services (HHS) issued a notice stating that it intends to implement a manufacturer 340B final rule previously scheduled to take effect in July 2019 on January 1, 2019.
CMS’ 2019 OPPS proposed rule, released in late July, continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments.
Continuing with numerous specific requests for comment in last year’s OPPS proposed rule, CMS is once again asking stakeholders for feedback on a variety of issues for the 2019 OPPS proposed rule for future potential rulemaking. You may submit comments to the agency until September 24, 2018.
Along with quality measure removals in the 2018 OPPS and MPFS final rules, CMS has continued to propose additional removals in the 2019 proposed rules. In addition, the agency is proposing to add to its ability to remove quality measures in the future.
In the 2019 OPPS proposed rule, CMS does not introduce a new skin substitute payment policy but is seeking comment on potential changes for future rulemaking.
CMS did not propose any new comprehensive APCs (C-APC) last year, taking a rare year off, but it did introduced three new C-APCs in the 2019 OPPS proposed rule, released in late July.
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.
CMS released the Notice of Benefit and Payment Parameters for 2019 final rule April 9 to give states additional flexibility when choosing benefits in essential health benefit benchmark plans offered under health insurance marketplaces.
CMS recently released its annual report of Health Insurance Exchange open enrollment, which revealed that open enrollment is down from 12.2 million in 2017 to 11.8 million for 2018.
An audit of Medicare Part B payments from 2014 through 2016 revealed that CMS improperly paid providers more than $66.3 million for specimen validity tests billed in combination with urine drug tests, according to a report by the OIG.
