The recently enacted Bipartisan Budget Act (P. L. 114-74) included a provision that will significantly alter the future of hospital-based outpatient care.
The provision, Section 603, will exclude from Medicare’s outpatient hospital prospective payment system (“OPPS”) any new off-campus departments of a hospital, as determined by Medicare’s provider-based standards, unless it is a “dedicated emergency department” for EMTALA (the Emergency Medical Treatment and Labor Act) purposes.
Instead, those facilities will be reimbursed under a freestanding fee schedule, principally the Medicare physician fee schedule (PFS) or ambulatory surgical center prospective payment system (ASC PPS), which are generally lower than the OPPS. See our October 28 blog post on this topic: Budget Bill Aims to Kill Any New Off-Campus Provider-Based Facilities.
The purpose of Section 603 is to make Medicare reimbursement for ambulatory facilities “site neutral,” effectively banning OPPS reimbursement for many new off-campus provider-based departments.
The Congressional Budget Office (CBO) estimated that this provision will save the federal government $9.3 billion over 10 years by reducing Medicare reimbursements for many ambulatory services in hospital outpatient settings.
Foley Fact Sheet
For more information about Section 603, see our Fact Sheet, coauthored by members of Foley’s Health Care Industry Team and Government and Public Policy Team.
Upcoming Web Conference Friday, November 13th
Please join us for a web conference on Friday, November 13 at 12:00 p.m. Eastern to discuss the impact of Section 603 and the politics surrounding it. If you would like to register for the upcoming web conference, please do so by clicking here.
This blog is made available by Foley & Lardner LLP (“Foley” or “the Firm”) for informational purposes only. It is not meant to convey the Firm’s legal position on behalf of any client, nor is it intended to convey specific legal advice. Any opinions expressed in this article do not necessarily reflect the views of Foley & Lardner LLP, its partners, or its clients. Accordingly, do not act upon this information without seeking counsel from a licensed attorney.
This blog is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Communicating with Foley through this website by email, blog post, or otherwise, does not create an attorney-client relationship for any legal matter. Therefore, any communication or material you transmit to Foley through this blog, whether by email, blog post or any other manner, will not be treated as confidential or proprietary.
The information on this blog is published “AS IS” and is not guaranteed to be complete, accurate, and or up-to-date. Foley makes no representations or warranties of any kind, express or implied, as to the operation or content of the site. Foley expressly disclaims all other guarantees, warranties, conditions and representations of any kind, either express or implied, whether arising under any statute, law, commercial use or otherwise, including implied warranties of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Foley or any of its partners, officers, employees, agents or affiliates be liable, directly or indirectly, under any theory of law (contract, tort, negligence or otherwise), to you or anyone else, for any claims, losses or damages, direct, indirect special, incidental, punitive or consequential, resulting from or occasioned by the creation, use of or reliance on this site (including information and other content) or any third party websites or the information, resources or material accessed through any such websites.
In some jurisdictions, the contents of this blog may be considered Attorney Advertising. If applicable, please note that prior results do not guarantee a similar outcome. Photographs are for dramatization purposes only and may include models. Likenesses do not necessarily imply current client, partnership or employee status.