Key takeaways | 340B Provisions in the OPPS Proposed Rule: Overview and Opportunities for Comment

CMS’s CY 2027 OPPS Proposed Rule included several proposed changes involving the 340B program. In this webinar, we broke down the key provisions, discussed the potential implications for 340B hospitals and non-340B hospitals, and highlighted considerations for organizations preparing comments before the CMS deadline.

Key takeaways included:

1. CMS intends to rapidly accelerate the pace of the 340B budget neutrality payment claw-back, and it reaches almost every hospital paid under OPPS, not just 340B hospitals. CMS is proposing to raise the negative payment adjustment used to recoup prior payments made under the budget neutrality component of prior 340B payment cuts from 0.5% to 3%, shrinking the repayment period from roughly 16 years to about 6. Hospitals should assess the impact on their own bottom line and weigh in on whether 3% is right, whether last year’s proposed 2% is more appropriate or whether CMS should maintain the 0.5% rate.
2. CMS is proposing two separate cuts to 340B drug payments, and only one is budget neutral. The first, based on a new drug acquisition-cost survey, would reduce OPPS payments for 340B drugs to about ASP minus 33.4%, with the “savings” redistributed to all OPPS hospitals. The second extends that same reduction to “non-excepted” off-campus departments, but the savings go back to the U.S. Treasury, making it a straightforward loss for affected hospitals with no offsetting increase elsewhere.
3. New provider-based attestation requirements create a real risk of losing 340B eligibility, even though the requirement isn’t 340B-specific. Starting January 1, 2028, hospitals must file an attestation of compliance with the Medicare provider-based rules and obtain a separate NPI for each off-campus department to keep being paid as a hospital under OPPS. Locations that can’t truthfully attest to full compliance will lose that status and likely their 340B eligibility. Hospital locations that were rapidly converted from physician offices to hospital departments are at heightened risk of non-compliance with the provider-based rules and loss of 340B eligibility.
4. CMS rewards individualized, data-backed comments with workable alternatives over generic objections or form letters. Hospitals should consider submitting individualized comments on all areas of concern in the OPPS proposed rule, grounded in hospital-specific data and with specific proposed alternative approaches. Comments are due August 31, 2026, and given the likelihood of litigation, hospitals should consider preparing comments with counsel to strengthen their position.

To view the webinar presentation materials, click here.

For more information on this topic, read our related client alert, 2027 OPPS proposed rule: Four key takeaways for hospitals.