CHA News

Federal Judge Overturns CMS Site-Neutral Payment Policy

For CEOS, CFOs, government relations staff, finance & reimbursement staff

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In a win for providers, a federal judge has ruled that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority when it reduced payments for clinic visits furnished in excepted off-campus provider-based departments, which were specifically excluded from the Balanced Budget Act of 2015.

CMS finalized the payment cut — equal to just 40% of the outpatient prospective payment system (OPPS) rate — in the calendar year 2019 OPPS final rule. With the court’s ruling, the policy is now invalid. Parties will be required to submit a joint status report by Oct. 1 to determine if additional briefing on remedies is required.

CHA strongly opposed the expansion of these site-neutral policies and supported the American Hospital Association’s lawsuit seeking a legal remedy for this punitive policy.