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CMS releases 2017 OPPS rule

By Erin Mahn Zumbrun posted 11-02-2016 12:48 PM

  

The Centers for Medicare & Medicaid Services (CMS) issued yesterday the final rule for the 2017 Hospital Outpatient Prospective Payment System (OPPS). One important piece of this rule relates to the implementation of a portion of last year’s budget deal, specifically Section 603 Site Neutral payment for new off-campus provider based department (PBD). This means the new off-campus PBD will be paid a lower reimbursement rate (either through the physician fee schedule or ambulatory surgical center fee schedule). While NRHA understands that the Bipartisan Budget Act of 2015 requires the change, we have been disappointed that the CMS rule was markedly less flexible than the law allowed.

Specifically, the proposal that a change in location, expansion of services, and change in ownership of the clinic would cause an off-campus PBD to lose its excepted status is beyond the requirements of the legislative language. NRHA and other organizations requested these reasonable modifications from the proposed rule but CMS only indicated it may allow relocation due to extraordinary circumstances like natural disasters. Unfortunately, CMS warned that even this small change would be “rare and unusual.”

This change is especially concerning at a time when far too many rural communities are losing access to care. Seventy-eight rural hospitals have closed since 2010. Right now, 673 additional facilities are vulnerable and could close—this represents over 1/3 of rural hospitals in the U.S. Off-campus PBD serve an important role in providing care to many rural Americans. When a rural hospital closes and the community examines its options for keeping necessary care available in their community, this site neutral provision eliminates one more choice to provide access to care to vulnerable rural Americans.

NRHA continues to urges CMS to allow existing off-campus PBD to continue to be paid under the OPPS system so far as is allowed by law, which includes the situations described above.

NRHA is pleased with some of the changes CMS made to the Meaningful Use program in the OPPS rule including a 90-day reporting period for this year and next.

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