As reported last week , on Thursday U.S. Senate Republican leadership released their latest version of the “Better Care Reconciliation Act of 2017.” The Congressional Budget Office score of the revised bill was expected today, with Senator Majority Leader Mitch McConnell intending for the full Senate to debate and vote on the legislation this week. However, last Friday Republican Senator John McCain had a surgical procedure to remove a blood clot above his left eye and will spend at least this week recovering in Arizona. Consequently, Senator McConnell has delayed indefinitely full Senate consideration of the bill until Senator McCain is able to return to his Senate duties.  Republican Senators Rand Paul and Susan Collins have announced their opposition to a procedural motion to commence debate on the legislation, and thus without Senator McCain Senator McConnell does not have enough votes for the Senate to take up the bill.  In addition, it was reported this morning that the Congressional Budget Office’s score of the revised legislation will not be released today.

Last Thursday the Centers for Medicare & Medicaid Services (CMS) issued its fiscal year 2018 proposed outpatient prospective payment system (OPPS) and ambulatory surgical center rule.  CMS proposes significant reductions in Medicare payment for separately payable drugs acquired under the 340B drug pricing program.  Specifically, CMS proposes a reduction in payments from the Average Sales Price (ASP) +6 to ASP -22.5 percent for 340B drugs paid under the OPPS.    In addition, CMS proposes substantial cuts in payments for services furnished in off-campus outpatient departments that were not billing for Medicare covered services as of November 2, 2015 (see discussion below).  The OPPS proposed rule is available at  A CMS fact sheet summarizing the proposed rule is available at  Comments on the OPPS proposed rule are due by September 11.

Also last Thursday CMS published its calendar year 2018 Medicare physician fee schedule proposed rule.  This proposed rule includes payment in 2018 for services furnished in new off-campus outpatient departments under the physician fee schedule at 25 percent of the OPPS rate, a reduction from 50 percent of the OPPS rate in 2017.  CMS explains that this reduction is intended to equalize payments for services furnished in new off-campus outpatient departments and physician offices.  This proposed rule is available at   The CMS fact sheet is available at   Comments on the Medicare physician fee schedule proposed rule are also due by September 11.

On Tuesday, July 18, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee will hold a hearing entitled “Examining HRSA’s [Health Resources and Services Administration] Oversight of the 340B Drug Pricing Program.” Hearing information, including the witness list, hearing notice, and background memorandum are available at