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CMS proposes 1.6% inpatient increase and new CAR-T cell therapy payment

Proposed changes to the inpatient prospective payment system would speed approval of new technology add-on payments for antimicrobials.

Susan Morse, Managing Editor

Hospitals in 2021 get a 1.6% increase for inpatient care paid by Medicare under a proposed rule released by the Centers for Medicare and Medicaid Services.

CMS is also proposing in the inpatient prospective payment system rule to have a separate new hospital payment category for Chimeric Antigen Receptor (CAR) T-cell therapy.

CAR-T is a gene therapy that uses a patient's own genetically modified immune cells to treat people with certain types of cancer, instead of additional chemotherapy or other types of treatment paid for under the inpatient prospective payment system.

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Currently, CAR-T hospital cases are paid at the same rate as bone marrow transplants and qualify for additional payments through the temporary new technology add-on payment for high-cost cases that's set to expire this year.

In addition, CMS is moving forward with its price transparency rule requiring hospitals to post their negotiated payment rates with insurers. CMS is proposing to collect a summary of certain data already required to be disclosed by CMS's 2019 price transparency rule, specifically hospitals' median payer-specific negotiated inpatient services charges for Medicare Advantage organizations and third party payers.

The agency is also requesting information regarding the potential use of this data to set relative Medicare payment rates for hospital procedures.

The American Hospital Association and other provider groups and health systems have sued the Department of Health and Human Services over the transparency rule. Oral arguments were heard in U.S. District Court last week.

The AHA said in a statement after the release of the proposed rule that it was "disappointed that CMS continues down the unlawful path." 

WHY THIS MATTERS

The rule would update Medicare payment policies for hospitals paid under the IPPS and the long-term care hospital prospective payment system for fiscal year 2021.

The new inpatient hospital payment category, or the Medicare Severity Diagnostic Related Group for CAR-T, would provide a predictable payment rate for hospitals administering the therapy, CMS said.

The rule includes proposals to remove barriers to new antimicrobials, which are antibiotics to treat drug-resistant infections. Medicare beneficiaries account for the majority of new diagnoses and resulting deaths due to drug-resistant infections, a situation that also remains a public health concern.

To support access to these antibiotics for Medicare beneficiaries, CMS is proposing changes for the new technology add-on payment, which is an additional payment to hospitals for cases using eligible high-cost technologies.

THE LARGER TREND

The proposals for acute care and long-term care hospitals furthers the agency's priority to transform the healthcare delivery system through competition while providing patients with better value and results, CMS said.

ON THE RECORD

"Today's payment rate announcement focuses on what matters most to help hospitals conduct their business and receive stable and consistent payment," CMS Administrator Seema Verma said.

"We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms. The disclosure of privately negotiated rates will not further CMS's goal of paying market rates that reflect the cost of delivering care. These rates take into account any number of unique circumstances between a private payer and a hospital and simply are not relevant for fixing Fee-for-Service Medicare reimbursement," the AHA said in a released statement.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com