Medicare payment policy updates
Key Questions
What payment changes are proposed for 340B drugs under the CY 2027 OPPS rule?
CMS proposes a $4.55 billion cut via ASP-33.4% survey-based pricing, with accelerated recoupment starting in 2029 instead of 2041, prompting pushback from the AHA.
What is the overall payment update in the CY 2027 OPPS/ASC proposed rule?
The rule includes a 2.4% payment update along with $260 million in savings from site-neutral policies applied to imaging without contrast.
How does the home health payment proposal for CY 2027 affect providers?
It provides a 2.4% aggregate increase offset by a -3% temporary adjustment to recoup prior overpayments, plus new fraud measures including retroactive revocations.
CMS CY 2027 OPPS/ASC proposed rule includes $4.55B cut to 340B drug payments via ASP-33.4% (survey-based), $260M savings from expanding off-campus volume control to imaging without contrast, and 2.4% payment update. New detail: accelerated recoupment timeline (2029 vs 2041); AHA pushes back calling it 'enormous cut'. CMS proposed rule for CY 2027 home health payments includes 2.4% aggregate increase but -3% temporary adjustment to recoup overpayments, plus fraud action items: retroactive revocations, ownership change requirements. Both are primary-source documents with direct Medicare payment and federal budget implications.