While America’s hospitals and health systems are dedicated to ensuring patients have the information they need to make informed health care decisions, including knowing what their expected out-of-pocket costs will be, the Centers for Medicare & Medicaid Services’ proposal mandating the disclosure of negotiated charges between health plans and hospitals is the wrong approach, exceeds the Administration's legal authority and should be abandoned, AHA told the agency today in comments on the outpatient prospective payment system rule for calendar year 2020.
AHA said it also opposes several other proposals in the rule that exceed the agency’s legal authority, would reduce beneficiary access to care and increase regulatory burden. Specifically, it recommended that CMS restore the higher payment rates for clinic visits in grandfathered off-campus outpatient departments, repay hospitals the difference and abandon its 2020 proposal to complete the phase-in of the policy, citing a recent court decision that CMS exceeded its statutory authority when it cut payments for these visits. In addition, AHA urged CMS to recalculate the payments due to every 340B-participating hospital that was subject to “unlawful” cuts, restore their full Average Sales Price plus 6% payment with interest and hold non-340B hospitals harmless. AHA also opposed the proposal to continue the 340B payment cuts in 2020. In addition, AHA urged CMS to withdraw its proposal to implement prior authorization requirements for certain services, which it said are contrary to law, arbitrary and capricious, and contrary to the agency’s goal of reducing regulatory burden.
Among other comments, AHA urged CMS not to finalize proposals to remove total hip arthroplasty from the inpatient-only list and add total knee arthroplasty and coronary intervention procedures to the list of ASC-covered procedures as these policies are clinically inappropriate and would pose a significant safety risk to Medicare beneficiaries. It also voiced strong support for a proposal to change the minimum required level of supervision from direct supervision to general supervision for hospital outpatient therapeutic services provided by all hospitals and critical access hospitals, noting that it has “repeatedly urged CMS for such a solution to this critical issue for rural hospitals.”

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