Close to a dozen hospital leaders and the Wisconsin Hospital Association were in Washington, DC September 13 to meet with a variety of Wisconsin’s Members of Congress. During those meetings, individuals highlighted the need to enact legislation that would assist certain hospital outpatient department (HOPDs) projects caught up in the “Section 603” prohibition of the Bipartisan Budget Act of 2015 (BBA 2015). The group also urged Members of Congress to sign onto two “dear colleague” letters being circulated in Congress related to the Centers for Medicare & Medicaid Services (CMS) proposed implementation of Section 603.
Section 603 of the BBA 2015 bans new off-campus provider-based HOPDs from using Medicare’s Outpatient Prospective Payment System (OPPS) beginning in 2017. The law was enacted so quickly that projects across the country already well under construction but not yet able to bill under the OPPS were no longer able to use this entire Medicare reimbursement system going forward. WHA supports enacting legislation to correct Section 603 for these “mid-build” projects. Congress has yet to pass this legislation, and attendees urged legislators to pass this fix quickly.
To complicate matters more, earlier this summer CMS released proposed implementation guidance for Section 603. As reported in the September 9 Valued Voice
, WHA submitted comments urging CMS to revamp this proposal entirely due to what it believes is a significant overreach by the Agency. For example, in the proposed rule, CMS states that complexities in its own systems would require the Agency to make no payments to hospitals in 2017 for services that are not grandfathered under the BBA 2015. For the agency to suggest that it will not reimburse hospitals in 2017 for services rendered at non-grandfathered HOPDs is completely unacceptable. Further, the agency proposes an extremely inflexible and limited view of the underlying statute that would not allow grandfathered HOPDs to relocate, rebuild or alter services without risk of losing their grandfathered status.
Health system and hospital leaders discussed how the CMS proposal would lock into place a delivery system based on one arbitrary date in time—November 2, 2015, the enactment date of BBA 2015—and would work against providing patient-centered care.
WHA urged Members of Congress to sign onto “dear colleague” letters being circulated that will be sent from Congress to CMS. Those letters will focus on the need for CMS to provide a fair, flexible policy that maintains access to care for Medicare beneficiaries.