Tax Equity and Fiscal Responsibility Act (TEFRA) Reimbursement to Inpatient Prospective Payment System (IPPS) -Excluded Hospitals for Excess Costs Related to Providing CAR T-cell Therapy
The purpose of this Change Request (CR) is to inform the MACs, when CAR T-cell therapy provided to Medicare patients, in an inpatient setting, results in a TEFRA hospital’s costs exceeding its rate-of-increase ceiling, MACs and providers must not utilize cost report Worksheet E‑3 Part I, Line 17 or its subscripts to report CAR T-cell therapy costs. Instead, for cost reporting periods beginning before October 1, 2022, the costs, charges, and statistics for CAR T-cell therapy should be separately reported on the cost report using a subscript of Line 73 (Drugs Charged to Patients). Any amounts equal to interim payments received by the provider related to CAR T-cell therapy must be reported on the added subscripted Line 55.03, (CAR T-cell amount paid as an interim payment) on Worksheet D-1, Part II
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 10, 2024
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