CMS announced an increase in inpatient rates, new hospital payment category for CAR T

CMS | May 12, 2020

  • CMS announced the payment adjustment, which could also include potential penalties for excess readmissions.

  • The proposed changes also include creating a new hospital payment category for chimeric antigen receptor (CAR) T-cell therapy.

  • CMS also aims to make it easier for Medicare beneficiaries to access certain drugs targeting antibiotic-resistant infections and through a new add-on payment.


The Trump administration proposed changes for acute care and long-term care hospitals Monday, including an approximately 1.6% increase to inpatient hospital stay payments.

The Centers for Medicare & Medicaid Services (CMS) announced the payment adjustment, which could also include potential penalties for excess readmissions. The change is expected to increase total Medicare spending on inpatient hospital services by about $2.1 billion in the fiscal year beginning in October.

It's among changes proposed as part of the agency's annual Inpatient Prospective Payment System (IPPS), which governs reimbursement for inpatient care.


Today’s payment rate announcement focuses on what matters most to help hospitals conduct their business and receive stable and consistent payment,

- Seema Verma, CMS Administrator


The proposed changes also include creating a new hospital payment category for chimeric antigen receptor (CAR) T-cell therapy it says would provide a predictable rate to hospitals offering the treatment.
 

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CAR-T therapy is the first gene therapy, and CMS began offering Medicare coverage for the treatment in some facilities in August 2019.

Currently, hospitals are paid the same for CAR-T as for bone marrow transplants and can seek additional payments through a temporary add-on for high-cost cases. That add-on expires this year, CMS said.

In the rule, CMS also aims to make it easier for Medicare beneficiaries to access certain drugs targeting antibiotic-resistant infections and through a new add-on payment that can cover high-cost therapies.
 

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In addition, CMS said it plans to collect certain data it mandated under its transparency rule, in particular hospitals' median payer-negotiated inpatient service charges in Medicare Advantage.

About CMS

The Centers for Medicare & Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services, is one of the largest purchasers of health care in the world. Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) provide health care for one in four Americans.

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