Opposes Provider Enrollment Requirements as Overly Broad
ALEXANDRIA, VA – AMGA raised significant concerns with a plan to accelerate recovery of 340B remedy payments, cut payments for 340B-acquired drugs, and implement broad, one-size-fits-all provider enrollment requirements. In comments to the Centers for Medicare & Medicaid Services (CMS) on two Calendar Year (CY) 2027 Medicare proposed rules—the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule, and the Home Health Prospective Payment System (HH PPS) rule—AMGA urged the agency to reconsider several provisions that would impose significant financial and administrative strain on multispecialty medical groups and integrated systems of care.
The proposed CY2027 OPPS rule projects a 2.4% facility payment increase, but that figure is substantially funded by an 8.44% budget-neutral reallocation triggered by a proposed cut to 340B drug reimbursement—from ASP+6% to ASP minus 33.4%—meaning much of the “increase” is 340B hospitals’ own losses redistributed elsewhere in the system, not new money.
AMGA has similar concerns with the Home Health rule. CMS’ proposed CY2027 rule touts a 2.4% aggregate payment increase, but pairs it with a temporary 3% reduction intended to recoup an estimated $4.9 billion in alleged Patient-Driven Groupings Model overpayments from 2020 to 2025, the fifth consecutive year of downward payment adjustment to the home health sector since 2020. Layered on top of that payment pressure, AMGA warned that the rule’s proposed provider enrollment and program integrity changes, including retroactive revocation authority and expanded grounds for denial, would impose significant new administrative burden on providers, requiring additional compliance infrastructure and staff time that adds directly to provider cost at the same time reimbursement is being constrained.
“Whether it’s how CMS pays for outpatient drugs and services or how it enforces program integrity, the same principle should apply: Policy changes need to be calibrated to the actual risk or actual cost involved, not applied broadly because it’s administratively simpler,” said Jerry Penso, MD, MBA, president and chief executive officer at AMGA.
CY 2027 OPPS/ASC Comments
Among AMGA’s key recommendations on the OPPS/ASC rule:
- Withdraw the proposed increase to the annual 340B remedy offset, from 0.5% to 3%, which would compress the repayment timeline and impose steep, front-loaded cuts on safety-net hospitals.
- Reconsider the proposed reduction to 340B drug payment rates—from ASP plus 6% to ASP minus 33.4%—noting that CMS’ underlying acquisition cost survey drew usable responses from a limited share of 340B hospitals.
- Assess the cumulative impact of expanding site-neutral payment to imaging services without contrast before finalizing further reductions, given that hospital Medicare margins remain negative.
- Establish clear review timelines and procedural protections for the new off-campus hospital outpatient department attestation requirements taking effect in 2028.
- Implement patient-access safeguards before expanding prior authorization to additional botulinum toxin injection codes.
AMGA also expressed concern that reducing the OPPS conversion factor to recoup 340B remedy payments could have unintended spillover effects on Medicare Advantage contracted payment rates, which frequently reference Medicare fee-for-service rates.
CY 2027 Home Health PPS Comments
In separate comments on the CY 2027 Home Health PPS proposed rule, AMGA focused on two priorities: expanding access to palliative care under the Medicare home health benefit and ensuring that new Medicare provider enrollment and program integrity authorities are applied in a targeted, risk-based manner that does not impose unnecessary administrative cost on compliant agencies.
On palliative care, AMGA urged CMS to:
- Clarify and expand access to palliative care under home health while preserving a clear distinction from hospice.
- Support interdisciplinary care, advance care planning, caregiver engagement, and non-visit-based care coordination.
- Avoid creating new documentation or certification requirements specific to palliative care.
- Continue developing complementary value-based and Innovation Center pathways for seriously ill beneficiaries who do not qualify for home health.
On provider enrollment and program integrity, AMGA urged CMS to:
- Use targeted, risk-based enforcement, rather than broad, one-size-fits-all requirements that add compliance costs across the board.
- Reserve severe remedies such as retroactive revocation for material program integrity violations, rather than administrative technicalities.
- Establish clear, objective standards for geographic concentration and other risk indicators.
- Provide meaningful notice, opportunities to cure deficiencies, and appeal rights before imposing enrollment penalties.
- Ensure consistent implementation of enrollment policies across CMS and its Medicare Administrative Contractors, to avoid duplicative or conflicting compliance burden.
The full text of both the OPPS/ASC letter and the HH PPS letter are available on AMGA’s website.
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About AMGA
AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high-performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.