Plain-English summary
Court says hospitals may seek judicial review of HHS reimbursement method for certain outpatient drugs
In American Hospital Association v. Becerra (decided June 15, 2022), the Supreme Court unanimously held that the Medicare statute does not bar courts from reviewing how HHS sets reimbursement rates for certain covered outpatient drugs provided by hospitals. The Court reversed the D.C. Circuit and remanded the case for further proceedings.
Why this matters
The decision preserves the ability of hospitals and other stakeholders to go to court to challenge HHS’s administration of Medicare reimbursement rules. That keeps a judicial check on an important federal agency’s decisions about how much Medicare pays for outpatient drugs, which can affect hospital finances and patient care.
Who may feel it
- Hospitals and health systems that provide outpatient drugs
- Medicare beneficiaries receiving outpatient drugs in hospital settings
- Health insurers and Medicare administrators
- State and regional hospital associations and providers of covered outpatient drugs
Key questions
- Does the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 preclude judicial review of HHS’s decisions about which payment methodology applies and how reimbursement rates for certain outpatient drugs are calculated?