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Medicare Agrees to Higher Reimbursement Rate for Outpatient Clotting Factor

In early November the Centers for Medicare and Medicaid Services (CMS) released final rules for 2006 for its Hospital Outpatient Prospective Payment System (HOPPS). These rules cover how hospitals are reimbursed for care provided to Medicare recipients in an outpatient setting. Under the new rules, clotting factor for Medicare outpatients will be reimbursed at a rate of Average Sales Price (ASP) plus 6%, plus an additional $0.15 per unit furnishing fee. This represents a significant increase over the reimbursement rate from last year, and what CMS had previously proposed for 2006. Earlier in the year, CMS announced that the new reimbursement rate would be ASP plus 8%. However, the National Hemophilia Foundation (NHF) and others in the community protested that this rate was inadequate, was inconsistent with the way factor is reimbursed in other settings and could lead to reduced access to care if some institutions became reluctant to serve this population. As a result, CMS reconsidered as reflected by their announcement of the new rate. NHF will continue to monitor the way treatment for bleeding and clotting disorders is reimbursed at the public and private level, and will continue to advocate for adequate reimbursement to ensure that everyone in the community has access to high- quality care.


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