Outpatient Encounter FormThe 21st Century Cures Act signed into law on December 13, 2016 is gaining significant attention as landmark legislation promoting medical innovation. But the massive Cures Act goes much further and includes some relief (though not a complete cure) for certain hospitals impacted by the site-neutral payment policies of Section 603 of the Bipartisan Budget Act of 2015 (BBA). The Cures Act incorporates provisions of the Helping Hospitals Improve Patient Care Act passed by the House in June. Section 603 addresses the differential in reimbursement to providers based on whether a location is operated as a provider-based hospital department, paid under the higher Hospital Outpatient Prospective Payment System (OPPS) rates, or a freestanding facility paid under applicable Medicare Part B payment systems. Under the BBA and CY 2017 OPPS Rule, only “excepted” off-campus departments may bill under the OPPS effective January 1, 2017.

Relief for Departments of Cancer Hospitals

Off-campus departments of certain cancer hospitals may qualify as excepted hospitals if they submit a provider-based attestation within 60 days of enactment of the Cures Act or, in the case of new departments, within 60 days after the date provider-based requirements are satisfied.

Relief for Mid-Build Departments

Hospital departments that satisfy the mid-build requirements of the Cures Act will be excepted from the BBA’s site-neutral reimbursement policy starting January 1, 2018. To qualify as “mid-build,” the provider must have had a binding written agreement for the actual construction of the off-campus department with an outside unrelated party by November 2, 2015. Additionally, the provider must satisfy the following requirements:

  1. Submit a provider-based attestation (pursuant to 42 C.F.R. Sec. 413.65) within 60 days of the Cures Act’s enactment;
  2. Include the department as part of the provider on its CMS 855A enrollment form; and
  3. Submit a written certification (for receipt by the U.S. Department of Health and Human Services [HHS] not later than 60 days after the Cures Act’s enactment) from the chief executive officer or chief operating officer of the provider that the department met the mid-build requirement on November 2, 2015.

Qualifying hospitals will be subject to site-neutral payments in 2017 but can bill under the OPPS starting January 1, 2018. The legislation requires HHS to audit each hospital department’s compliance with the mid-build requirements no later than December 31, 2018.

New Measures Furthering Payment Neutrality and Transparency

The Cures Act contains further provisions addressing payment neutrality and transparency.  Section 4012 directs the Centers for Medicare & Medicaid Services (CMS) to create a searchable internet website for Medicare beneficiaries to compare the expenses and out-of-pocket costs of surgeries in ambulatory surgery centers with those in outpatient departments. And Section 15001 requires CMS to develop HCPCS codes (used for outpatient services) associated with 10 surgical MS-DRGs (used for inpatient services) that commonly have a one-day hospital stay. This will enable CMS to develop a crosswalk identifying surgeries appropriate for site-neutral payment between inpatient and outpatient settings.

So, while the Cures Act introduces relief from Section 603 for certain hospitals, further scrutiny of site-of-service payment rates is on the horizon. Stay tuned for updates and details on additional provider-focused provisions of the Cures Act.