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Public Policy Newsletter Article

Opportunity to Provide Feedback on CMS IPPS 2021 Proposed Rule

  • 2020-06-18T15:00:00.000+0000
  • California
  • Author: Brittany Blocker

On May 11, the Centers for Medicare and Medicaid released FY 2021 Inpatient Prospective Payment System (IPPS) proposed rule which includes an increase to hospital payment rates, the creation of a new Medicare-Severity Diagnosis-Related Group (MS-DRG) for chimeric antigen receptor T-cell (CAR-T) therapy, and new technology add-on payment pathway for certain antimicrobial products.

New MS-DRG for CAR-T. CMS is proposing the creation of a new MS-DRG specifically for cases involving CAR-T therapies. The new payment group would help to predictably compensate hospitals for their costs in delivering necessary care to Medicare beneficiaries and provide payment flexibility for the future as new CAR-T therapies become available.

Updated Payment Rates. Starting Oct. 1, 2020, under the proposed rule, acute care hospitals that report quality data and are meaningful users of EHRs will receive a 3.1 percent increase in Medicare rates in the FY 2021, compared to 2020. Overall payments for inpatient services would increase by about 1.6 percent, or $2.07 billion, in FY 2021.¬

Add-on Payments. CMS proposed new technology add-on payments for certain antimicrobials approved under the FDA's Limited Population Pathway for Antibacterial and Antifungal Drugs. The LPAD pathway encourages the development of safe and effective drug products that address the unmet needs of patients with serious bacterial and fungal infections.

Price Transparency. CMS is proposing to collect a summary of certain data already required to be disclosed by CMS’ 2019 price transparency rule, specifically hospitals’ median payer-specific negotiated inpatient services charges for Medicare Advantage organizations and third-party payers.

The deadline to submit comments is July 10. Biocom is requesting member feedback on the proposed rule. Please submit comments to Biocom's Manager of Regulatory Affairs, Brittany Blocker, at [email protected], by June 24.