AHA: Proposals in outpatient payment rule 'run afoul of the law'

The American Hospital Association is "deeply disappointed" in certain proposals in CMS' Outpatient Prospective Payment System proposed rule for 2019, the group said in a comment on the proposed rule submitted Sept. 24.

The AHA said some of the proposals in the proposed rule "run afoul of the law and rely on the most cursory of analyses and policy rationales." Specifically, the group said it opposes CMS' proposals to make payments for clinic visits site-neutral, to reduce payment for services from expanded clinical families provided in off-campus provider-based departments, and to continue the current policy that pays hospitals 22.5 percent less than the average sales price for drugs purchased through the 340B drug discount program and extend that payment rate to 340B drugs provided at nonexcepted off-campus provider-based departments.

CMS proposed making clinic visits site-neutral by reducing the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments to 40 percent of the OPPS rate. The AHA said CMS lacks the statutory authority to make the payment reduction.

"The proposed payment reduction is unlawful because Congress expressly chose not to confer on CMS the authority to reimburse excepted off-campus PBDs at the reduced rates paid to nonexcepted off-campus PBDs," the AHA said.

The AHA also encouraged CMS to withdraw its proposal to reduce the payment rate for 340B drugs provided at nonexcepted off-campus provider-based departments, arguing CMS lacks the legal authority to make that change.

Taken together, the proposals "would have a chilling effect on beneficiary access to care and new technologies, while also dramatically increasing regulatory burden," the AHA said.

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