21st Century Cures Act adds exceptions for provider-based departments

December 20, 2016
Medicare Web

Additional changes are coming to site-neutral payment policies for off-campus, provider-based departments after President Barack Obama signed the 21st Century Cures Act into law, updating policies outlined in Section 603 of the Bipartisan Budget Act of 2015 and the 2017 OPPS final rule.

Section 603 included provisions that would move off-campus, provider-based departments toward a different payment methodology from the OPPS starting January 1, 2017, with few exceptions. The 2017 OPPS final rule stated that off-campus, provider-based departments that began billing after November 2, 2015, added new services lines, or moved were considered non-excepted and would bill at a non-OPPS rate for all items and services. The final rule stated that on-campus departments, dedicated emergency departments, and grandfathered off-campus, provider-based departments billing as of November 2, 2015, would be considered excepted and would bill under the OPPS.

Section 16001 of the 21st Century Cures Act expanded upon the definition of an excepted department. It states that off-campus, provider-based departments that were mid-build as of November 2, 2015, can receive OPPS payment beginning January 1, 2018. In this instance, the facility must have been under contract with a builder prior to November 2, 2015. The mid-build exception requires that providers submit written certification of a construction agreement and complete provider-based attestation within 60 days of the enactment of Section 16001. In addition, off-campus, provider-based departments that did not bill as such before November 2, 2015, and submitted provider-based attestation to CMS prior to December 2, 2015, can receive OPPS payment through the end of 2017, according to an analysis by JD Supra Business Advisor.

In addition to making changes to off-campus provider-based department payments, the 21st Century Cures Act has allocated $1 billion for opioid abuse prevention and $4.8 billion for biomedical research, including $1.8 billion for cancer research. It is also poised to strengthen access to mental health services.

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Billing and reimbursement