CMS is moving forward with price transparency efforts despite a pending legal challenge from the American Hospital Association.
CMS' Inpatient Prospective Payment System proposed rule for 2021 builds on the price transparency rule CMS finalized last year. The new proposal would require hospitals to list their median payer-specific negotiated rates for inpatient services, by Medicare Severity-Diagnosis Related Group, on Medicare cost reports. CMS is also seeking feedback on using these rates to determine DRG weights.
The AHA sued the federal government over the rule finalized last year, and recently argued in the U.S. District Court for the District of Columbia that requiring hospitals to disclose rates negotiated with payers violates the First Amendment.
In a statement released May 11, the AHA blasted the new price transparency proposals.
"We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms," AHA Executive Vice President Tom Nickels said. "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 IPPS proposed rule for 2021 would also create a new DRG for CAR T-cell therapy, provide new technology add-on payments for certain antimicrobials and raise overall payments for inpatient services by about 1.6 percent.
Read more about the IPPS proposed rule for 2021 here.