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  • Washington Highlights

    51 Senators, 235 Representatives Sign Dear Colleague Letters to CMS on HOPD Issue

    Len Marquez, Senior Director, Government Relations

    Senators Rob Portman (R-Ohio) and Charles Schumer (D-N.Y.) May 19 and Representatives Devin Nunes (R-Calif.) and Joe Crowley (D-N.Y.) May 24 sent similar letters to Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt asking the agency to incorporate flexibility for several considerations as the administration develops upcoming rulemaking for Sec. 603 of the Bipartisan Budget Act of 2015 (BBA, P.L. 114-74) [see Washington Highlights, Oct. 30, 2015].

    The letters were signed by a total of 51 Senators and 235 Representatives. 

    Effective Jan., 1, 2017, Section 603 of the BBA equalizes reimbursement rates between services provided at newly established off-campus hospital outpatient departments (HOPDs) and physician offices or ambulatory surgical centers (ASC). After the date of the legislation’s enactment, any site that entered into a Medicare provider agreement but is not on the main campus of a hospital and is located more than 250 yards away from the main campus, must seek reimbursement through the ASC prospective payment system or the Medicare Physician Fee Schedule (PFS).

    The House letter references the provision’s impact on patient care stating, “The facilities impacted by this law often serve the most vulnerable patient populations in difficult-to-serve areas, and a number of clarifications in the rule are needed to ensure they can continue serving their communities. While many hospitals have projects underway or planned for the near future, others must take a longer view in their strategic planning to meet the needs of a changing population including opportunities to develop and expand needed services as patient-care needs shift.”

    The Senators similarly urged CMS to demonstrate “flexibilities to enable hospitals to continue to serve patients in these settings as well as provide predictability for the hospital field,” including “additional services provided at a dedicated emergency department (DED), relocation or rebuilding for already existing HOPDs, change of ownership, and needed expansion of services and personnel to meet patient care needs of a community.”

    The letters were sent just prior to a May 24 Ways and Means Committee markup of “The Helping Hospitals Improve Patient Care Act of 2016” (H.R. 5273), legislation that incorporated a narrow Sec. 603 exemption for “mid-build” off-campus HOPDs (see related story).