CMS releases preliminary guidance on site-neutral payment exceptions

CMS recently provided preliminary guidance on provisions of the 21st Century Cures Act that affect site-neutral payment provisions of the Bipartisan Budget Act of 2015.

The 21st Century Cures Act, signed into law by President Barack Obama Dec. 13, revised the site-neutral payment policy enacted by Section 603 of the Bipartisan Budget Act.

Under Section 603, certain off-campus provider-based departments that began billing under the Outpatient Prospective Payment System on or after Nov. 2, 2015, will no longer be paid for most services under the OPPS beginning this year. Under the 21st Century Cures Act, newly built off-campus outpatient departments that were poised to accept patients prior to Dec. 2, 2015, and submitted proper attestation to CMS are exempted from the Bipartisan Budget Act's site-neutral payment provisions.

The 21st Century Cures Act also exempts facilities that had concrete plans in place to build a new off-campus outpatient department before Nov. 2, 2015, when the Bipartisan Budget Act was passed. CMS recently released guidance on this exception. 

The guidance clarifies that these facilities will be exempt from the site-neutral payment provisions in 2018 if they meet mid-build requirements. To be exempted, the hospital must have had a binding written agreement in place before Nov. 2, 2015, for the actual construction of the off-campus department. To qualify for the exemption in 2018, the hospital must submit the required attestation and certification documents to its Medicare Administrative Contractor by Feb. 13, 2017.

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