CMS Releases IPPS Proposed Rule

On April 23, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year (FY) 2020.

In the IPPS proposed rule, the agency proposes to:

• increase the wage index of low wage index hospitals
• support broad access to "transformative technologies" by proposing several payment policy changes, including increasing the new technology add-on payment
• modernize payment policies for medical devices that meet FDA Breakthrough Devices designation

The agency fact sheet specifically addresses CAR-T therapy in the context of applications for new technology add-on payments for FY 2020. In the proposed rule, CMS presents 17 new applications for new technology add-on payment for FY 2020, and proposes to continue the new technology add-on payments for 10 of the 13 technologies currently receiving the add-on payment (3 technologies will no longer be in their newness period in FY 2020). Two of the technologies CMS is proposing to continue payments for are types of chimeric antigen receptor (CAR) T‑cell therapy.

The ACCC policy team is analyzing the proposed rule and will provide a more in-depth analysis to members shortly.

Read the agency fact sheet.
Access the proposed rule.

Posted 4/23/2019