On October 30, the Senate voted to approve 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.
President Obama has indicated that he will sign the Act “as soon as it reaches [his] desk.” Accordingly, the date of enactment for the Act could be as early as today. 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.