CMS Must Protect Access to Care for Medicare Beneficiaries in Final Hospital Outpatient Payment Rule

October 1, 2019

In a comment letter to the Centers for Medicare & Medicaid Services (CMS) ASCO expressed significant concerns that provisions in the 2020 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule have the potential to undermine patient access to cancer care for Medicare beneficiaries.

ASCO does support CMS’ proposal to loosen physician supervision requirements for outpatient therapeutic services and urges caution around efforts to require price transparency. However, the society opposes provisions that would expand prior authorization, continue limiting reimbursement for certain prescription drugs, and potentially limit access to precision diagnostic testing under Medicare. 

Specific recommendations and concerns in ASCO’s comment letter include:

  • CMS should not finalize its proposed policy implementing prior authorization for certain services paid for under HOPPS.
  • ASCO continues to object to CMS’ policy that sets Medicare payment for separately covered outpatient drugs purchased under the 340B program at Average Sales Price minus 22.5%.
  • ASCO continues to object to CMS’ policy that sets payment for certain separately payable drugs and biologicals at 103% of the drug or biological’s Wholesale Acquisition Cost.
  • CMS should proceed cautiously with its efforts to require price transparency, particularly with its proposal to require hospitals to disclose charges for HOPPS services.
  • ASCO supports the proposal to loosen the physician supervision requirements for outpatient therapeutic services.
  • ASCO opposes the CMS proposed revisions to the laboratory date of service policy.

Read the full comment letter.   

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