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Alert: Congress Considers Further Reduction of Provider-Based Department Payments

On May 24, site-neutral payment language related to off-campus provider-based payments was included in a bill. Read on for details. 
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The House Energy and Commerce (EC) Committee held a meeting on April 26 to discuss additional payment reductions through expansion of site neutrality provisions. As a result, on May 24, site-neutral payment language related to off-campus provider-based payments was included in a bill titled Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023. The EC Committee unanimously approved the bill and it has been introduced in the House of Representatives.

The following summarizes the relevant sections:

  • Section 103 states for each off-campus department to continue to receive payment, beginning January 1, 2026:
    • Each off-campus OP department must obtain its own NPI.
    • Must submit, during the two-year period ending on the date services are furnished, an attestation to CMS that they are in compliance with 42 CFR Section 413.65. This requirement would require attestations to continue every two years.
    • Does not apply to on-campus or remote locations and 250 yards around a remote location.
  • Section 302 is titled “Parity in Medicare Payments for Hospital OP Department Services Furnished Off-Campus” and requires a four-year phase-in of reductions to drug administration payments from Ambulatory Payment Classification (APC) to Medicare Physician Fee Schedule.
    • This is not intended to be revenue neutral and is estimated by the AHA to reduce hospital payments by $3 billion over the next 10 years and $54.2 million in the first year.

View the PATIENT Act of 2023

Stay tuned for more updates regarding the bill’s progress through Congress. Should you have any questions or need assistance with calculating potential impacts for your hospital, please reach out to a professional at Forvis Mazars or submit the Contact Us form below.


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