CMS Releases Initial Guidance on Section 603 Policy, HOPDs

January 06, 2017

Recently the Centers for Medicare & Medicaid Services (CMS) released guidance on several items that stem from the original "site neutral" payment prohibition enacted in 2015 under Section 603 of the Bipartisan Budget Act (BBA 2015). Section 603 prohibited Medicare outpatient prospective payments (OPPS) at new, provider-based, off-campus hospital outpatient departments (HOPDs).

First, CMS gives preliminary guidance on a provision enacted in late 2016 under the 21st Century Cures law, which allows certain HOPDs caught "mid-build" to gain an exemption from Section 603.

Second, CMS also released additional "sub-regulatory" guidance to its 2016 OPPS final rule with respect to HOPD relocations. While relocations, in general, will cause a loss of grandfathered status, under the final OPPS rule, CMS does allow grandfathered HOPDs to relocate if meeting certain "extraordinary circumstances."

WHA anticipates additional guidance will be forthcoming from CMS and will provide updates in future editions of The Valued Voice.

This story originally appeared in the January 06, 2017 edition of WHA Newsletter