From the January/February issue of HealthCare Business News magazine
By: Jill Rathbun
On Nov. 2, 2015, President Obama signed the Bipartisan Budget Act of 2015, a two year budget agreement that lifted the debt ceiling and increased the spending caps under sequestration for both defense and non-defense discretionary spending in FY 2016 and FY 2017.
This budget deal paved the way for an end of the year omnibus appropriations bill completing the FY 2016 spending process and the passage of a tax extenders package. Included in the Budget Act was an important policy issue for the imaging community and anyone who is monitoring the policy discussions regarding the debate over site neutral payments for health care services. Sec. 603 of the Bipartisan Budget Act of 2015 prohibits OPPS billing for provider-based facilities that:
• Are not located within 250 yards of the provider’s main hospital buildings or within 250 yards of a “remote location of a hospital” (i.e. facility owned by the hospital that has inpatient beds); AND
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• Are not “grandfathered.” The law defines the term “grandfathered” to mean a facility that was billing under the Outpatient Prospective Payment System (OPPS) on or before Nov. 2. The law does provide an exception for emergency departments. This explicit exemption allows “dedicated emergency departments” to bill under OPPS even if they do not meet the 250-yard threshold and are not grandfathered. This new policy will begin on Jan. 1, 2017. Between now and Dec. 31, 2016, non-grandfathered facilities that do not meet the distance threshold can bill OPPS — but that billing will have to cease on Jan. 1, 2017. While the hospital community tried very hard to have this policy amended in the year-end omnibus appropriations bill to have those outpatient centers under construction included in the term “grandfathered," it was not. The Ways and Means Committee has said that it will start the new year with continued work on a hospital payment policy bill and address this issue then.
And if anyone hoped that with the passage of this provision in the budget bill, that the conversation regarding site neutral payment would be over, a new report from the General Accounting Office (GAO) in late December puts that in doubt. To read this report where the GAO recommends that In order to prevent the shift of services from lower-paid settings to the higher-paid hospital outpatient department setting, Congress should consider directing the Secretary of the Department of Health and Human Services (HHS) to equalize payment rates between settings for E/M office visits — and other services that the Secretary deems appropriate, please visit http://www.gao.gov/products/GAO-16-189 as the imaging community needs to be prepared to discuss other types of policy and payment solutions to address these recommendations.