Budget Proposal Would Limit Provider-Based Status - New Off-Campus Departments Limited to Physician Fee Schedule or ASC Payment Beginning January 1, 2017

King & Spalding

On October 26, 2015, Congressional and White House budget negotiators released the legislative text of the Bipartisan Budget Act of 2015. The Act is aimed primarily at lifting the Federal debt limit and avoiding a looming spike in Medicare Part B premiums. In addition, section 603 of the Act includes a significant change in the way CMS reimburses hospitals for outpatient services furnished in off-campus departments established on or after the enactment date of this proposed legislation.

The proposal, if enacted, would direct CMS, effective as of January 1, 2017, to use either the Physician Fee Schedule or the Ambulatory Surgery Center Payment System to pay for most services furnished in any off-campus hospital department established after the date the proposal becomes law. Off-campus provider-based departments that are in existence as of the date the proposal is signed into law would continue receiving reimbursement under the Medicare Hospital Outpatient Prospective Payment System (“OPPS”).

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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