CMS Settles Lawsuit, Will Allow States to Exempt Hospitals From Including National Drug Codes on Medicaid Claims

The Centers for Medicare & Medicaid Services has settled a lawsuit by Safety Net Hospitals for Pharmaceutical Access and University Medical Center of Southern Nevada challenging a CMS requirement that all hospitals must include national drug codes on Medicaid claims for physician-administered outpatient drugs, according to a report by AHANews.

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As part of the settlement, CMS will allow states to exempt hospitals from the reporting requirement if the drugs are billed at no more than the purchasing cost. SNHPA filed the suit alleging that the reporting requirement would cost safety net hospitals that participate in the Section 340B federal drug discount program millions of dollars to implement. CMS will issue a clarification to Medicaid agencies within 30 days, according to the report.

Read the AHANews’ report on the CMS reversal on reporting drug codes.

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