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340B OPPS Reimbursement Court Ruling

A district court has vacated the prospective portion of the 340B reimbursement rate in the 2022 OPPS Rule. Read on for details.
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On September 28, 2022, the U.S. District Court for the District of Columbia vacated the prospective portion of the 340B reimbursement rate in the 2022 Outpatient Prospective Payment System (OPPS) Rule. Reimbursement will be restored to the average sales price (ASP) plus 6% from ASP minus 22.5%. Judge Rudolph Contreras stated the 2022 reimbursement rate is “defective” and “vacating this portion of the 2022 OPPS Rule will not cause substantial disruption.” U.S. Department of Health & Human Services (HHS) had contended that vacatur would cause budget neutrality issues, though Contreras determined that “disruption would be minimal.”

The court’s order is consistent with the U.S. Supreme Court decision in June 2022 that HHS’ 2018 and 2019 reimbursement rates were unlawful and to remand the case back to the district court for remediation. The American Hospital Association (AHA) and other hospital groups have expressed appreciation for Contreras’ ruling to immediately restore unlawful cuts to reimbursement. Hospitals continue to wait for remediation for 2018 and 2019. There has yet to be a ruling for reimbursement cuts for 2020–2022.
Forvis Mazars can help healthcare organizations navigate 340B rulings and how they might impact your organization.
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