- The Centers for Medicare and Medicaid Services is adding a new element to controversial price transparency regulations, suggesting it will continue to collect data on hospitals' median payer-specific negotiated rates and consider how that information could be used to set relative Medicare payment rates.
- In the draft of the Medicare Hospital Inpatient Prospective Payment system for fiscal 2021, posted Monday, the agency also proposed raising the rate for inpatient hospital services by about 1.6%, which would amount to nearly $2.1 billion.
- The IPPS draft rule would create a new diagnosis-related group, or billing code, for CAR-T cell therapies for cancer to help reimburse hospitals for what is typically a loss-making endeavor and to provide "payment flexibility" as more therapies become available.
The American Hospital Association, which is suing HHS for earlier price transparency efforts, did not mince words when responding to the draft Monday.
"We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms," the group said in a statement. "The disclosure of privately negotiated rates will not further CMS's goal of paying market rates that reflect the cost of delivering care."
In arguments last week in the U.S. District Court for the District of Columbia, AHA argued the mandates to disclose secret negotiated prices violate the First Amendment, claiming the data are protected proprietary information.
CMS had said it would update its proposal for the hospital star ratings methodology in the draft rule, but the agency will now hold off until future rulemaking because of pressures from regulatory adaptions to the COVID-19 pandemic. Hospitals have said the ratings are flawed and don't provide accurate and useful information on care quality.
CMS hinted at the CAR-T reimbursement change previously. Currently, payment is made under a category for stem cell and bone marrow transplants with a new technology add-on payment and often results in hospitals taking a loss.
The new DRG code would set payment for CAR-T therapy at roughly $240,000, which will help standardize reimbursement but still leave some hospitals short, wrote analysts at the Cowen Washington Research Group in a note to clients.
Under the proposed change, CMS would end for fiscal year 2021 a New Technology Add-on Payment that's currently used for CAR-T.
In the draft payment rule, the agency also proposes 24 new applications for add-on payments and expanding the pathway for antimicrobial products that the Food and Drug Administration has designated as a Qualified Infectious Disease Product.
CMS Administrator Seema Verma said on Twitter the change will create a more streamlined process for certain antimicrobial products, "speeding up beneficiary access to critical therapies they need."
Comments on the proposed rule are due July 10.