本周早些时候, the United States Supreme Court ruled in favor of the American Hospital Association and other hospital groups. The court unanimously agreed that the Department of Health & 人类云顶集团部(HHS)没有进行调查 hospital costs as required by law before adjusting payments based on a hospital’s participation in the 340B outpatient drug discount program. These HHS payment policies reduced impacted hospital reimbursement for outpatient 药物 by approximately 30% and are valued at $1.60亿年 这段时间内的总和.
裁定摘要
这被认为是一个非常狭窄的 最高法院的裁决 and should be viewed in specific context.
The court found that Congress wrote into law that most hospital outpatient drug reimbursement rates must be set universally at 106% of the average sales price (ASP), which is a reflection of the average price paid by all Medicare hospitals (with modest markup). Only if HHS issues a drug acquisition cost survey to a hospital group for use in setting that hospital group’s outpatient drug reimbursement rates can it deviate from the ASP-based methodology.
HHS did not issue or use a hospital group-based survey for the 2018 and 2019 reimbursement years; therefore, the Supreme Court ruled that HHS’s drug payments at levels below 106% of ASP was unlawful for those years.
实际上, the Supreme Court ruled that payments that meet the following parameters were reduced unlawfully by HHS:
- 医院门诊用药: All HHS payments for outpatient hospital pharmaceutical products ordinarily priced using the Medicare Outpatient Prospective Payment System (OPPS) ASP methodology
- 2018及2019年度: OPPS drug reimbursements made for reimbursement years 2018 and 2019 when the appropriate surveys were not issued
- 受影响的340B医院: 340B hospitals that qualified as a disproportionate share hospital (DSH), 农村转诊中心, or urban sole community hospital (notably, 340B entities that qualified as children’s hospitals, 危重医院, and a few others were excluded from HHS’s original targeted payment reductions)
No direct 最高法院的裁决 was made addressing HHS payments from the 2020 reimbursement year and beyond. HHS issued the court-referenced hospital group surveys in 2020, but it is unclear how 该机构 will use this survey data in future and retrospective reimbursement rate calculations.
接下来是什么
The Supreme Court’s decision reversed a federal appeals court’s 2020 ruling that HHS had authority to make the reimbursement cuts in 问题. The four-year-old case has now been remanded to the District of Columbia Circuit Court of Appeals to determine the appropriate remedies 受影响的医院. At this point, the timeline and methodology for impacted hospital repayments remains unclear.
It is presently unknown how HHS’s OPPS drug payments for the 2020, 2021, and 2022 reimbursement years will be retroactively impacted by the lower court’s remedy and/or 该机构’s ongoing interpretation and application of the Supreme Court decision and 340B program outlook. The agency’s annual payment rule is typically released in July, which should provide some insight in the coming weeks.
340B计划展望
While this is a narrow ruling on a technical reimbursement calculation, and there are several other 340B program-related cases working through the legal system, hospitals have generally viewed this ruling as favorable news for the future of the often-contentious program.
The unanimous court opinion acknowledged that “340B hospitals perform valuable services for low-income and rural communities but have to rely on limited federal funding for support,” which indicates a positive outlook on the current court’s attitude toward the program.
Further, as one of its arguments before the court, HHS said that Congress would not have intended for 该机构 to “overpay” hospitals for 340B-discounted 药物. However, the justices unanimously agreed that Congress would have been “well aware” of the workings and impacts of the 340B program when setting 报销政策.
At the recommendation of MedPAC, HHS has exhausted significant efforts in recent years to reduce drug reimbursement to 340B entities in order to reflect the discounted acquisition pricing those hospitals can access through the 340B program. While it is unclear how 该机构 will apply the Supreme Court’s decision to future reimbursement decisions, the court has signaled its thoughts on HHS corrections for congressional intent regarding 340B provider payment neutrality, which could potentially result in less aggressive or targeted payment cuts by 该机构.
心电图 will continue to review the Supreme Court’s ruling, 美国卫生和公众云顶集团部行动, 以及对340B项目的整体影响. 如果您是340B实体, or are interested in learning more about the drug discount program’s benefits and considerations, contact our Performance Transformation or 策略 Business Advisory divisions to discuss how this ruling could affect your organization.
云顶集团出版于2022年6月17日