The Department of Health and Human Services “effectively admits” that its goal in reducing payments for hospital outpatient clinic visit services furnished in off-campus provider-based departments grandfathered under Section 603 of the Bipartisan Budget Act of 2015 was to address a policy concern that Congress has already addressed through a different legislative solution, the AHA and other hospital plaintiffs told a federal district court today. Replying to the government’s defense of the policy, the plaintiffs asked the court to declare the agency’s action ultra vires (in excess of its legal authority) and to “right the agency’s clear wrong.”

The brief adds, “There is nothing in the Medicare statute that precludes this Court from holding the agency to account when it has clearly exceeded the bounds Congress imposed on its delegated authority. Indeed, this Court has recently affirmed as much in two closely analogous cases that the Government simply fails to acknowledge. Review of Plaintiffs’ ultra vires claim is available and appropriate now.”

The AHA, joined by the Association of American Medical Colleges and several member hospitals, in December filed a lawsuit against HHS for finalizing a policy to phase-in, over two years, a reduction in payments for hospital outpatient clinic visit services furnished in off-campus PBDs that are grandfathered (excepted) under Section 603 of the Bipartisan Budget Act of 2015. The cut was included in the Centers for Medicare & Medicaid Services’ outpatient prospective payment system final rule for calendar year 2019.

Medicare patients who receive care in a hospital outpatient department clinic are more likely to be poor, previously hospitalized and have severe chronic conditions than those treated in an ambulatory surgical center, according to a study by KNG Health Consulting released yesterday by the AHA.

Related News Articles

Perspective
Two weeks ago, I wrote about the
Headline
Thirteen states yesterday filed a lawsuit challenging a Department of Homeland Security final rule limiting the ability of legal immigrants to adjust or extend…
Headline
The U.S. Court of Appeals for the District of Columbia Circuit reversed the voiding of a rule that included Medicare and private insurance payments when…
Headline
The Centers for Disease Control and Prevention has released the first in a new series of free online training courses to help health care organizations prevent…
Headline
The AHA today urged the Department of Health and Human Services not to finalize certain proposed revisions to a 2016 final rule implementing the Affordable…
Headline
The AHA today proposed additional actions that the Centers for Medicare…