Medicare Outpatient Prospective Payment System Archives

340B Remedy Rule and Medicare Advantage Rates: Navigating Shifting Payments

by Emily J. Cook and Emily Curran | May 7, 2024 | Employee Benefits, Health and Welfare Plans

On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, otherwise known as the rate announcement. The rate announcement is released annually and includes updates to the methodologies used to calculate MA plan payments, as well as other payment policies that impact Part D. The CY 2025 rate announcement finalizes the policies proposed in CMS’s January 2024 advance notice.

Hospitals Shouldn’t Expect Quick Pay Despite 340B Win

by Emily J. Cook | Aug 2, 2022 | Benefit Controversies, Employee Benefits, Health and Welfare Plans

340B hospitals should not expect to receive withheld program funds anytime soon despite a recent US Supreme Court ruling. According to this Becker’s Hospital Review article, the Court reversed a 2020 federal appeals court ruling that found that the US Department of Health and Human Services (HHS) had the authority to make a $1.6 billion annual reimbursement cut to the program under its Medicare Outpatient Prospective Payment System (OPPS). McDermott Partner Emily J. Cook said that the ruling will not result in any immediate changes to Medicare payments for 340B drugs nor require that HHS restore the full payment rates for the drugs.

Access the article.

Supreme Court Agrees to Review Medicare Payment Cuts to 340B Drugs

by Drew Elizabeth McCormick and Emily J. Cook | Oct 19, 2021 | Employee Benefits, Health and Welfare Plans

The US Supreme Court announced in July that it will take up review of the decision by the US Court of Appeals for the District of Columbia Circuit upholding Medicare’s 2018 payment cuts to 340B drugs. The case will be closely watched, given its potentially far-reaching impacts on reimbursements to most hospitals that participate in the Medicare program, not just those that participate in the 340B Program.