WSHA and the AHA strongly recommend hospitals impacted by the 340B cuts take steps to preserve their right to the prior payment level by appealing claims. The American Hospital Association (AHA), hospitals and their associations are currently engaged in litigation with the Centers for Medicare and Medicaid Services (CMS) to reverse the cut to Medicare payment for 340B drugs under the 2018 CMS rule. WSHA joined with other hospital associations to submit an Amicus Curiae brief in support of the hospitals. AHA is concerned that even if the lawsuit is successful, if hospitals have not taken steps to appeal CMS will claim hospitals have effectively accepted the lower payments.
To appeal, hospitals must submit requests for redetermination of the specific claims where the hospital received the reduced payment. An appeal must be submitted within 120 days of the initial payment. AHA has provided a set of instructions and forms for use by hospitals available on a the AHA website. Under the 2018 CMS rule, Medicare payment for separately billed 340B drugs by 340B hospitals other than critical access hospitals, children’s hospitals, critical access hospitals, and cancer hospitals are reduced by about 30 percent. (Andrew Busz, andrewb@wsha.org)
