As a result of AHA’s successful litigation to stop the Centers for Medicare & Medicaid Services’ unlawful 340B payment policy in calendar year 2022, Medicare Administrative Contractors will pay 340B hospitals Average Sales Price plus 6%, rather than ASP minus 22.5%, for all CY 2022 drug claims with modifier “JG,” the Center for Medicare and Medicaid Services confirmed for AHA yesterday. Judge Rudolph Contreras of the U.S. District Court for the District of Columbia on Sept. 18 ordered CMS to immediately halt its unlawful outpatient payment reimbursement for certain 340B hospitals.
Affected 340B hospitals should reach out to their MAC if the contractor has not notified them about the adjustment to ensure eligible 2022 claims for drugs provided before Sept. 28 are adjusted. CMS will auto-process any claims after Sept. 28, as previously announced on its website.
AHA called the clarification a significant victory for 340B hospitals subject to the outpatient prospective payment system cuts in CY 2022, which will help them to continue to serve their communities.