CMS has proposed a long-awaited remedy to make 340B hospitals whole for nearly five years of cuts under the Medicare outpatient prospective payment system (OPPS) that the Supreme Court deemed unlawful in 2022. In welcome news, CMS has proposed to repay impacted hospitals a one-time lump sum payment that approximates the difference between what hospitals should have been paid absent the unlawful policy (ASP + 6%) and the amount actually paid (77.5% of ASP), including associated beneficiary cost-sharing amounts. Total repayments are estimated to equal $10.5 billion, $1.5 billion of which has already been reprocessed for 2022 claims, and the remainder of which is expected to be paid in late 2023 or early 2024. Individual amounts by hospital are available in Addendum AAA. CMS proposes to make the remedy budget neutral by reducing OPPS rates for non-drug items and services by $7.8 billion. Rather than a one-time budget neutrality adjustment, CMS proposes to apply a negative 0.5% conversion factor update over approximately 16 years, beginning in 2025. Comments on the proposed remedy are due September 5.