CMS' final 2017 Hospital Outpatient Prospective Payment System rule implements site-neutral payment provisions of the Bipartisan Budget Act of 2015, and the rule doesn't include a clear exception for hospital outpatient departments that are forced to relocate.
Under the final rule, certain off-campus hospital outpatient departments will be paid under the physician fee schedule instead of the OPPS beginning Jan. 1. However, HOPDs that began billing under the OPPS before Nov. 2, 2015, are exempt from the rule.
To maintain their exemption, HOPDs must provide services and bill from the same address they did on Nov. 2, 2015. Although outpatient departments can request an exception if forced to temporarily or permanently relocate due to extraordinary circumstances, such as a natural disaster, the final rule does not include a clear exception for HOPDs that are forced to relocate due to a lease agreement, according to Bloomberg BNA.
It's common for hospitals to rent facilities for their off-campus outpatient departments, and about one-third of the lease agreements contain clauses that allow the landlord to unilaterally move the HOPD to another location, Katrina A. Pagonis, a healthcare attorney for Hooper, Lundy & Bookman, told Bloomberg BNA.
Under the final OPPS rule, it isn't clear whether CMS would grant an exception to a hospital forced to move an outpatient department under a lease agreement. However, hospitals may receive clarity on the issue in weeks to come, as CMS said it will provide further guidance on the exception process.
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