The AHA today urged the Centers for Medicare & Medicaid Services to increase payment for services furnished in "non-grandfathered" off-campus provider-based outpatient departments. The Bipartisan Budget Act of 2015, as amended by the 21st Century Cures Act, requires that, with the exception of dedicated emergency department services, services furnished in new off-campus PBDs no longer be paid under the outpatient prospective payment system. CMS’s final rule for the calendar year 2017 OPPS will pay these PBDs under the physician fee schedule at a rate that will generally be 50% of the OPPS rate. In today’s letter, AHA urged CMS to increase payment to 64% of the OPPS rate, inclusive of packaging. “[W]e are concerned that in its analysis, CMS does not consider differences between packaging amounts within the OPPS as compared to the [PFS] payment system,” wrote AHA Executive Vice President of Government Relations and Public Policy Tom Nickels. “When these differences, as well as other technical details, are accounted for, it is clear that CMS should raise its nonexcepted rate from 50 percent to 64 percent of the OPPS rate…Hospitals deserve to be paid a reasonable rate for the safe and high-quality care they furnish to beneficiaries.” In addition, AHA expressed support for CMS’s decision to allow hospitals to expand the scope and volume of services provided at their grandfathered PBDs without losing their ability to be reimbursed under the OPPS. The AHA also urged the agency to issue guidance to assist facilities that meet the mid-build provisions in the 21st Century Cures Act as soon as possible.

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