RECOVERINGFEES IN THE340B DRUGPROGRAM

In October, 2022, the United States District Court for the District of Columbia ruled in favor of the American Hospital Association who brought suit against the Department of Health and Human Services The court ruled that HHSmust immediately halt the departments?unlawful cuts to outpatient reimbursement rates for the remainder of 2022 for certain hospitals that participate in the 340B Drug Pricing Program. ?The prospective portion of the 2022 reimbursement rate shall be vacated because it is defective and because vacating this portion of the 2022 OPPSRule will not cause substantial disruption,?wrote Judge Rudolph Contreras. ?HHSshould not be allowed to continue its unlawful 340B reimbursements for the remainder of the year just because it promises to fix the problem later.? The AHA in August urged the court to halt the 2022 cuts, explaining that ?each and every passing day? HHScontinues to "underpay for 340B drugs pursuant to this unlawful" policy Judge Contreras has not yet ruled on AHA?s motion to include 2020-2022 reimbursement cuts in AHA?s case, as well as AHA?s motion to repay hospitals for the unlawful cuts since 2018 without penalizing other hospitals AHA?s August brief noted that nothing in the 340B law authorizes HHSto retrospectively take back these funds, and in similar circumstances HHShas never recouped funds already spent without explicit congressional authorization, which does not exist here. As a result of the court order the Centers For Medicare and Medicaid Services (CMS) must revise its methodology for paying 340B hospitals for outpatient drugs and reprocessing claims paid on or before the September 28, 2022 ruling

CMSceased reimbursing 340B hospitals the default ate after it released the 2018 Outpatient Prospective Payment System (OPPS) final rule. That final rule reduced reimbursement rates by 28 5 percent and saved the government about $1 6 billion But the judge was unimpressed and now HHSmust restore full payment to 340B hospitals.

Recoveringfees In The340b Drugprogram

The Ruling At A Glance... And Your Opportunity

- Medicare is under a court order to stop applying the unlawfully discounted rate for 340B drugs on claims processed on and after September 28, 2022

- One MAC,Novitas, has issued instructions to providers to request corrected reimbursement for the claims processed between January 1,2022and September 28,2022by resubmitting claims which billed separately payable drugs with modifier JG

- Other Medicare Administrative Contractors are beginning to issue instructions on claims for dates of service within 2022. Palmetto GBA, as an example, has limited providers resubmission of corrected claims to 1 (one) year from discharge