Medicare DSH payments ruling could boost hospital reimbursement under 1115 waivers
Hospitals obtained a victory in a case about Medicare disproportionate share hospital (DSH) payments, with potentially significant reimbursement implications. In a July 27 ruling in Covenant Medical Center v. Kennedy, a judge with the U.S. District Court for Northern Texas struck down an HHS rule that excluded certain patients from the DSH formula if they were…
SUSTAIN 340B Act proposes major changes for hospitals and pharmacies
A bipartisan working group in Congress released a preliminary legislative draft that attempts to resolve some of the most disputed aspects of the 340B Drug Pricing Program. One noteworthy provision in the legislation would curtail the 340B rebate model, which was finalized by the Health Resources and Services Administration on July 31 and is scheduled to begin Jan.…
HRSA sets 2027 launch for the 340B rebate model, announces requirements
The Health Resources and Services Administration (HRSA) followed through with plans to pilot a rebate model for the 340B Drug Pricing Program beginning Jan. 1, 2027. As described in a notice published July 31, HRSA previously scrapped plans for a 2026 pilot following litigation. In response to that legal challenge, the agency provided additional information…
What appeals court 340B rebate decision means for federal rebates
An appeals court barred 340B rebate programs by drug manufacturers, among recent legal developments. The case could have ramifications for federal 340B rebates. On July 21, the U.S. Court of Appeals for the D.C. Circuit upheld a lower court ruling that barred alternative 340B rebate models without explicit approval from HHS. “That’s certainly welcome news…
House bill would increase tax-exempt hospital reporting requirements
A bill that advanced out of a House committee Wednesday would add significant reporting requirements for tax-exempt hospitals. As passed by the Ways and Means Committee, the Tax-Exempt Hospital Transparency Act includes increased reporting obligations in areas such as community benefit, charity care, the 340B Drug Pricing Program and service-line spending. Requirements would be more…
Utilization review, HIPAA updates and more
Nick Hut talks with HFMA’s Kathy Stull about the Medicaid work requirement and 340B developments. Erika Grotto discusses utilization review with Kevin Coloton, CEO of HURC and HIPAA updates with Jon Bilotti, enterprise technology consultant at BCS365.
340B bill would levy various restrictions on participating hospitals
Legislative language overhauling the 340B Drug Pricing Program faces a long and uncertain path in Congress but would have significant implications if some of the provisions become law. A preliminary bill draft released by Sen. Bill Cassidy (R-La.) would tighten oversight of hospitals and contract pharmacies, increase transparency and require 340B discounts to be transferred…
Update: Litigation about the 340B program’s ‘patient’ definition could affect hospital savings
Note: This story is an update to prior coverage. Providers weighing in on potentially disruptive litigation involving the 340B Drug Pricing Program say a ruling in favor of the drug manufacturer would have substantial implications for the program. In a case brought by AbbVie Inc. against the federal government, the central question concerns the definition…
340B rebate model pilot advances as providers warn of added costs
The Health Resources and Services Administration (HRSA) continues to take steps toward implementing a rebate model for the 340B Drug Pricing Program. After soliciting comments on a planned model over a two-month period, HRSA sent an updated notice May 27 to the Office of Management and Budget (OMB) for a review that remains ongoing. That…
Hospitals, insurers clash on 340B rebate costs
Hospitals and insurers both urged federal regulators to ignore the cost projections of the other side in their comments on a coming redux of a 340B rebate model. The comments came in response to a request for information (RFI) from the Health Resources and Services Administration (HRSA) seeking input on whether and how to implement…