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Bill Proposes Modifying Ban on Higher Medicare Outpatient Payments

A new bill introduced in the House Ways and Means Committee would limit a recent prohibition on establishing new off-campus hospital outpatient facilities that can receive hospital-based Medicare outpatient payments.

ways and meansUnder the Bipartisan Budget Act of 2015, new off-campus, hospital-based outpatient facilities would be paid for Medicare-covered outpatient services like regular physician offices and not like hospital outpatient departments. The Helping Hospitals Improve Patient Care Act of 2016, however, would permit new outpatient departments that were in “mid-build” at the time the 2015 law passed to be exempt from that law’s limits on outpatient payments.

According to a Ways and Means summary of the bill,

Section 201 provides for an exception to section 603 of the Bipartisan Budget Act of 2015 (BBA’15) for those hospital outpatient departments (HOPDs) that were defined as “mid-build” prior to November 2, 2015. “Mid-build” is defined as a provider that had a binding written agreement with an outside, unrelated, party for the actual construction of the HOPD. To qualify as “mid-build,” each HOPD will be required to submit a certification from the provider’s Chief Executive Officer/Chief Operating Officer that the HOPD meets the definition of mid- build prior to July 1, 2016. Further, each mid-build HOPD will be required to submit an attestation that it meets the requirements of being provider-based (42 Code of Federal Regulations 413.65) by July 1, 2016. In addition, the section also requires the Secretary to audit the accuracy of these attestations. HOPDs that meet all of above requirements will receive the full HOPD payment rate beginning January 1, 2018 instead of the lower physician fee schedule or ambulatory surgical center payments required under the BBA’ 15. Finally, those off-campus HOPDs that submitted a voluntary attestation prior to December 2, 2015 will receive the full HOPD payment rate beginning January 1, 2017.

To learn more about this and other provisions of H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016, go here to see the Ways and Means Committee’s summary of the bill and go here to see the bill itself.

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