- The American Hospital Association is suing HHS again for cutting payments to outpatient hospital departments.
- In one Lawsuit filed on Monday The AHA, the Association of American Medical Colleges, and three individual hospitals have made the same argument to the District of Columbia for the United States District Court that the court found compelling budget-neutral requirements four months ago.
- The hospitals are asking the court to abolish the final rule of the outpatient prospective payment system for 2020, to prevent CMS from being enforced, and to ask the agency to immediately pay amounts withheld.
Monday’s filing is the last in an ongoing struggle as hospitals are fighting hard against CMS ‘intent to bring outpatient payments into line with those that are not operated by the hospitals.
Judge Rosemary Collyer agreed with the hospitals in September that the location-neutral guideline implemented in the 2019 outpatient payment rule went beyond the responsibility of CMS, but the agency nevertheless included the provision in its payment proposal for 2020.
Following this decision, CMS has agreed to reprocess some of the reduced rate claims paid to hospitals, but it is not clear how much will be paid as a result. The agency has also appealed the September decision.
Last month, Collyer determined that it could not delete the 2020 provisions because its decision was limited to the 2019 rule, but said that CMS had “clearly ignored” the substance of the court’s earlier finding.
The hospitals agreed to this and took the necessary formal steps on Monday to try to also reject the site-neutral 2020 payment rule. “The final regulation for 2020 is no less inadmissible than the final regulation for 2019 and should have the same fate,” the plaintiffs argued in the application.
AHA also argues that the site-neutral policy is illegal because it ignores a distinction between exempted hospital outpatients previously set out in the Medicare statute.
Hospitals believe that the proposal could force institutions to “make difficult decisions about reducing services in response to the drop in payment rates” and warn that this would restrict access to care for the most vulnerable.
CMS said the policy would save $ 800 million by 2020 and allow patients to “receive care that is safe and clinically appropriate.”
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