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Proposed Bill Provides Potential Relief for Some Provider-Based Departments

May 26, 2016

A bill introduced in the House last week—H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016 (HHIPCA)—would expand grandfathering to some provider-based departments affected by Section 603 of the Bipartisan Budget Act of 2015 (BBA). The HHIPCA gives hope to hospitals that were caught off-guard last fall by the passage of the BBA, which imposed site-neutral payment reductions on new off-campus hospital outpatient departments (HOPDs) that begin billing Medicare after November 2, 2015.

The proposed legislation, which has not yet become law, makes several changes to Section 603 to address the issue of HOPDs under development (or “mid-build”) at the time BBA was enacted. Specific changes include:

  • Providers that operated as an HOPD and submitted a provider-based attestation by December 2, 2015, would be fully grandfathered into the OPPS and would continue receiving OPPS reimbursement after January 1, 2017, even if they were not yet billing Medicare by November 2; and
  • Providers that operate as an HOPD and submit a provider-based attestation by July 1, 2016, include the HOPD on their Medicare enrollment form, and had a binding written agreement signed by the CEO or CFO for construction of the HOPD in place before November 2 will be grandfathered into the OPPS beginning on January 1, 2018, but will be reimbursed at the applicable PFS rates for 2017.

Links to the Bill: Summary; Section-by-Section Summary; Full Bill. HDJN is closely monitoring the development of the HHIPCA and will provide an update if the bill becomes law. If you have any questions about the BBA or the HHIPCA, please contact a member of HDJN’s Licensure, Certification, and Enrollment team.

The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel, Johnson & Nagle, PC, is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel, Johnson & Nagle, PC be liable for any direct, indirect, or consequential damages resulting from the use of this material.