This week Congress overwhelmingly urged the Centers for Medicare & Medicaid Services to provide flexibility for hospital outpatient departments as it implements the site-neutral provisions in the Bipartisan Budget Act of 2015 in its upcoming final rule for the hospital outpatient prospective payment system. In a letter to CMS Acting Administrator Andrew Slavitt, 261 members of the House of Representatives said they “strongly believe numerous areas need more flexibility to ensure patients have continued access to care, and we urge changes in the final rule to protect our constituents who are Medicare patients.” Specifically, they cited the provisions related to relocation or rebuilding of already existing outpatient departments, and change of ownership of existing sites. In a separate letter, 45 senators said they were “extremely disappointed” CMS did not heed earlier calls for flexibility when drafting its proposed rule. “Among the most egregious problems with the proposed rule is the fact that CMS would refuse to pay a newer [HOPD] for care provided in 2017 and instead pay only the physician fee,” the senators wrote. “In addition, there is essentially no ability for an outpatient department to modernize via relocation or reconstruction, potentially denying access to our constituents. If finalized, these regulations would cripple the ability of hospitals to provide community-based outpatient care to seniors.” The letters were sponsored by Reps. Devin Nunes (R-CA) and Joseph Crowley (D-NY) and Sens. Rob Portman (R-OH) and Charles Schumer (D-NY).CMS is expected to release a final rule by Nov. 1. AHA last month urged CMS to delay implementation until it can provide fair and equitable payment to hospitals for non-excepted services. “We applaud and thank a majority of the Congress for weighing in on this important issue on behalf of patients," said AHA Executive Vice President Tom Nickels. “As proposed, CMS’s policies are unreasonable and would interfere with our members’ ability to deliver the best clinical care for patients in ways that are most convenient for them and their families.”