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Supreme Court Refuses to Hear Challenge to Site-Neutral Payment Policy for Clinic Visits

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On Monday, the Supreme Court declined to hear the American Hospital Association’s challenge to the Centers for Medicare & Medicaid Services’ (CMS) calendar year (CY) 2019 site-neutral payment reduction when clinic visits are provided in off-campus hospital-based outpatient departments (HOPDs).  

Under the policy payments for clinic visits to excepted, off-campus HOPDs made under the outpatient prospective payment system are reduced by 60% to be equivalent to the payment made under the Physician Fee Schedule to an independent practice.  

The appeal to the Supreme Court was a result of a federal appeals court ruling, overturning a federal district court decision that initially found in favor of hospitals that CMS exceeded its statutory authority when it reduced payments for clinic visits provided in excepted off-campus HOPDs. Earlier this year, CMS announced that it will begin reprocessing claims before July 1, 2021, related to CY 2019, that were adjusted based on the federal district court decision.  

CHA joined more than 30 state and regional hospital associations in submitting an amicus (friend of the court) brief supporting Supreme Court review in this matter.