On May 18, 2016, the U.S. House of Representatives Ways and Means Committee introduced the Helping Hospitals Improve Patient Care Act of 2016 (Act) to exempt certain newly-enrolled provider-based, off campus hospital outpatient departments (HOPDs) from reduced payments under the Bipartisan Budget Act of 2015 (BBA).
Sections 201 and 202 of the Act would exempt “mid-build” provider-based, off campus HOPDs and HOPDs of cancer hospitals from reduced payments under the BBA. Section 603 of the BBA makes newly-enrolled provider-based, off campus HOPDs ineligible for payment under the Outpatient Prospective Payment System (OPPS) beginning January 1, 2017 if the hospital did not bill for services at the location under the OPPS by November 2, 2015.
Section 201 of the Act would create a presumption for 2017 reimbursement purposes that an off-campus HOPD would not be subject to BBA section 603 payment limitations if CMS had received a provider-based attestation from the hospital prior to December 2, 2015.
Section 201 of the Act would also, for reimbursement purposes starting in 2018, allow HOPDs in “mid-build” before the enactment of the BBA to continue to receive payment under the OPPS. An HOPD would be considered “mid-build” under the Act if the hospital had a binding written agreement with an outside unrelated party for the actual construction of the HOPD before November 2, 2015. To qualify as a “mid-build” HOPD, the hospital must (1) add the facility as a provider-based, off campus HOPD by submitting a Form CMS 855A Medicare enrollment application, (2) submit written certification from the hospital’s CEO or COO that the HOPD met the definition of “mid-build” before July 1, 2016, and (3) submit an attestation to the Secretary of HHS before July 1, 2016 stating that the HOPD meets the requirements for provider-based facilities under 42 CFR 413.65. The Act would also require CMS to audit whether the hospital has met all of the above requirements. Hospital HOPDs qualifying for the mid-build exception would be eligible to receive full payment under the OPPS beginning January 1, 2018.
Section 202 of the Act would also exempt cancer hospital HOPDs from BBA section 603 payment reductions. The hospital would be required to submit an attestation that the HOPD meets the requirements for provider-based facilities within 60 days of adoption of the Act or within 60 days from the date of compliance with 42 CFR 413.65. The Act would also require CMS to audit whether the cancer hospital has met the provider-based requirement within two years of receiving the cancer hospital’s attestation.
*Wendy Wright is admitted only in North Carolina. Her practice is supervised by principals of the firm admitted in the District of Columbia.