CHA News Article

CMS Issues Guidance on Provider-Based Hospital Outpatient Department Exceptions
Information includes extraordinary circumstance relocation, mid-build exceptions

The Centers for Medicare & Medicaid Services (CMS) recently issued separate subregulatory guidance related to policies that impact off-campus provider-based hospital outpatient departments (PBDs) affected by the Bipartisan Budget Act of 2015 and subsequent legislation, the 21st Century Cures Act. The documents provide guidance on the extraordinary circumstance relocation exception process, as included in the calendar year 2017 outpatient prospective payment system (OPPS) final rule, as well as preliminary guidance on implementation of Sections 160001 and 160002 of the 21st Century Cures Act. The Act extends the grandfather date for facilities that were under construction as of Nov. 2, 2015, to qualify for payment under the OPPS, rather than at the lower site-neutral rate.

The extraordinary circumstance relocation exception guidance provides information on how hospitals can request a relocation exception for an excepted PBD from their CMS Regional Office for an extraordinary circumstance out of the hospital’s control, such as significant seismic building code requirements, natural disasters or public health and safety issues. The guidance describes the application review process, suggested minimum information applicants should present to their regional office and regional office staff contacts. Of note, CMS requires that — for a PBD that relocated between Nov. 2, 2015, and Dec. 31, 2016 — hospitals submit a written relocation exception request with supporting documentation to the regional office no later than Jan. 31. CHA urges hospitals undergoing this process to contact Alyssa Keefe, vice president federal regulatory affairs, at CHA continues to coordinate with CMS Region IX on the process.

The preliminary guidance on implementation of Sections 160001 and 160002 of the 21st Century Cures Act clarifies that hospitals must submit the required mid-build documents (attestation and written certification) to the hospital’s Medicare Administrative Contractor by Feb. 13, in order for the PBD to be grandfathered for OPPS payment in 2018. CMS also clarifies the use of the new “PN” modifier for HOPDs that will be grandfathered in 2018 but not in 2017. CHA has provided a detailed summary of the 21st Century Cures Act with more information.