On October 26, House Republican leaders introduced the Bipartisan Budget Act of 2015 (Act) that would provide for a two-year budget agreement between the White House and Congress. Notably, section 603 of the Act would reduce Medicare payments to newly-enrolled provider-based, off-campus hospital outpatient departments (HOPDs), off-campus defined as a facility that is more than 250 yards from a hospital’s main buildings.

The Act provides that new provider-based, off-campus HOPDs added to a hospital’s Medicare enrollment after the date of enactment would not be eligible for payment under the Centers for Medicare and Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS) beginning January 1, 2017. Rather, to the extent eligible, payment for services furnished in these facilities would be made under either the Ambulatory Surgical Center (ASC) PPS or the Medicare Physician Fee Schedule. This change would not affect already existing and enrolled provider-based, off-campus HOPDs that are currently billing for services.

Accordingly, if by the date of enactment a hospital has not (1) submitted a CMS-855A Medicare enrollment form adding a facility as a provider-based, off-campus HOPD and (2) billed for services at the location under the OPPS, then beginning January 1, 2017, services provided at the facility may not be billed under the OPPS.

Importantly, the Act provides that any CMS determination regarding the payment system applicable to a provider-based, off-campus HOPD, including any determination regarding a location’s qualification as a provider-based, off-campus HOPD, would not be subject to administrative or judicial review.

Other relevant health care provisions of the Act include the following:

  • Section 601 maintains 2016 Medicare part B premium and deductible levels at actuarially fair rates, which equal to US $120. Without Congressional action, the estimated monthly Medicare Part B premium for beneficiaries not held harmless would be US $159.30.
  • Section 602 extends the additional inflation-based rebate currently paid on brand drugs to generic drugs, in circumstances where the price of the drug has increased faster than inflation.
  • Section 604 repeals the Affordable Care Act requirement that employers with greater than 200 employees automatically enroll new full-time employees into a qualifying health plan (if offered by the employer) and automatically continue enrollment of current employees.

The U.S. House of Representatives released a draft of the Act late Monday evening. The Act appears to be supported by a majority of both parties in Congress and by the White House. The full House is expected to vote on the Act today. The full Senate will then take up the legislation. President Obama must sign the bill into law by November 3 in order to avoid a government shutdown.

*Blake Walsh is admitted only in Tennessee. Her practice is supervised by principals of the firm admitted in the District of Columbia.

**Wendy Wright is admitted only in North Carolina. Her practice is also supervised by principals of the firm admitted in the District of Columbia.