ACCC ADVOCACY ALERT
This week, the U.S. House of Representatives proposed a policy as part of a broader budget deal that would lower reimbursement rates for services provided at newly acquired provider-based (PBD) off-campus hospital outpatient departments (HOPDs). Under the proposal, any off-campus PBD HOPD (defined as located more than 250 yards from the main campus) that is acquired after the law is passed would no longer be eligible for reimbursement under the Outpatient Prospective Payment System (OPPS) and, starting January 1, 2017, would be reimbursed under the Ambulatory Surgical Center Prospective Payment System (ASC PPS) or the Medicare Physician Fee Schedule (PFS).
While the timeline is not yet clear, Congressional watchers expect the bill may be voted on as early as the end of this week. The agreement is supported by bipartisan Congressional leaders in the House of Representatives and by the Administration. It is expected to receive the votes needed to become law.
It’s important to remember that:
- this policy does not impact programs that are currently reimbursed under OPPS, and may only lower reimbursement for newly acquired off-campus outpatient departments;
- hospitals and health systems that are considering acquiring a physician practice – including medical or radiation oncology – after this law passes should expect that reimbursement rates in these settings may be lower than originally expected; and
- this policy will only apply to Medicare reimbursement and will not affect private insurance or Medicare Advantage plans.
For more information, please contact your legislator. ACCC will continue to provide you with updates and information as they become available.
Christian Downs, JD, MHA
Association of Community Cancer Centers
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