Medicare site-neutral outpatient payments

Administration, Congress, Press Hospitals for Reforms

Even at a time when passing major health care legislation in the near future becomes increasingly unlikely, the hospital community continues to face serious challenges from both the administration and Congress. The Centers for Medicare & Medicaid Services has proposed making more Medicare outpatient payments on a site-neutral basis and reducing Medicare payments to hospitals for prescription drugs covered by the 340B drug pricing program. It also threatens other changes in the 340B program that hospitals believe will make it more difficult – and costly – to participate in. Meanwhile, Congress is considering increasing federal oversight of the finances of [...]

joe2026-07-07T16:42:00-04:00July 8, 2026|340b, hospitals, Medicaid, Medicaid regulations|

Federal Health Policy Update for July 2

Don’t Miss: CMS proposes CY 2027 Medicare outpatient rates, reviving 340B cuts, expanding site-neutral payments CMS calls for modest Medicare home health pay hike, more ways to oust providers Court halts borrowing limit that jeopardized supply of qualified health professionals The following is the latest health policy news from the federal government for June 25-July 2. Some of the language used below is taken directly from government documents. Proposed CY 2027 Medicare Outpatient Prospective Payment and Ambulatory Surgical Center Rule CMS has published its proposed Medicare FY 2027 outpatient and ambulatory surgical center prospective payment system rule. The proposed [...]

joe2026-07-02T16:55:39-04:00July 2, 2026|340b, Accountable Care Organization, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for September 18

The following is the latest health policy news from the federal government for September 12-18. Some of the language used below is taken directly from government documents. Congress Funding for the federal government expires on September 30. Members of Congress have not yet coalesced around a plan to fund the federal government when the new federal fiscal year begins on October 1, with House Republican and Democratic leaders releasing competing legislative texts for a short-term continuing resolution (CR). House Republicans have proposed a CR to last through November 21 with very few anomalies, or policy changes, outside of regular spending. [...]

joe2025-09-18T17:11:02-04:00September 18, 2025|340b, Affordable Care Act, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

Hospitals Chart 2025 Public Policy Objectives

The hospital industry has an ambitious public policy agenda for 2025 – most of it involving defending the status quo against proposed changes. Hospitals’ advocacy in 2025 will focus on: Fighting off Medicaid cuts, work requirements, reductions in the federal Medicaid matching rate, eliminating scheduled cuts in Medicaid disproportionate share (Medicaid DSH) allotments to the states, and protecting state-directed Medicaid payments and the ability of states to raise Medicaid funding through provider taxes. Preventing a transition to site-neutral payments for Medicare-covered outpatient services. Ensuring the continuation of current section 340B prescription drug discount program practices. Preserving and even extending current [...]

joe2025-02-12T11:11:23-05:00February 13, 2025|340b, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for January 16

The following is the latest health policy news from the federal government for January 11-17. Some of the language used below is taken directly from government documents. Congress House Budget Committee Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending by between $5.3 trillion and $5.7 trillion over a period of ten years. Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending. The health care cuts the document lists (all figures are ten-year reductions) are: Medicare introducing Medicare site-neutral outpatient payments - [...]

Federal Health Policy Update for March 7

The following is the latest health policy news from the federal government for March 1-7. Some of the language used below is taken directly from government documents. Congress On Wednesday, March 16 the House passed, by a vote of 339-85, the first package of spending bills to fund some federal agencies through the remainder of the 2024 federal fiscal year. The House bills include several health care provisions extending programs that were set to expire on Friday, March 8. The bills would extend the following provisions and programs through December 31, 2024: The continued delay of cuts to Medicaid disproportionate [...]

joe2024-03-07T21:42:53-05:00March 7, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Hospitals Rally Against Medicare Site-Neutral Payments

A proposal to save Medicare nearly $4 billion over a decade is running into stiff opposition. From hospitals. – and some members of Congress. Medicare has long paid more for outpatient services provided in hospital-based outpatient departments than it has for the same services delivered in private doctors’ offices. Critics say this is unfair, that Medicare should pay the same no matter where the service is provided. Defenders of the practice maintain that hospital-based outpatient departments share higher fixed costs, including for ERs and care for uninsured patients. They also argue that reducing such Medicare outpatient payments could threaten the [...]

joe2024-02-15T13:42:15-05:00February 16, 2024|Medicare, Medicare reimbursement policy|

Federal Health Policy Update for Thursday, February 3

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, February 3. Some of the language used below is taken directly from government documents. Provider Relief Fund The reconsideration window for Provider Relief Fund Phase 4 payments and American Rescue Plan rural hospital payments is now open for providers to request reconsideration of their payments. This process is intended only for providers that believe their payment was not calculated correctly. They will not have an opportunity to submit an application if they missed a deadline; will not be able to revise or [...]

iqtsupport2022-02-03T17:46:52-05:00February 3, 2022|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Coronavirus, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Good News and Bad for Hospitals on Outpatient Payments

A federal court has provided relief to hospitals that saw reduced Medicare payments for some outpatient services in 2019. But that relief is only partial. In response to a suit filed by several hospital groups, a federal court ruled that the Centers for Medicare & Medicaid services had illegally reduced Medicare payments for services provided in some hospital off-campus outpatient departments beginning on January 1, 2019 and ordered the federal government to repay the hospitals for the Medicare revenue they lost. The reduced payments were part of a new Medicare site-neutral payment policy for outpatient services, and CMS has announced [...]

iqtsupport2019-12-17T09:40:07-05:00December 17, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare reimbursement policy|

Court Upholds Delay of Site-Neutral Payment Cut

Medicare cannot proceed with its plan to pay for outpatient care on a site-neutral basis while it appeals a court ruling rejecting that policy, a federal court has ruled. A federal judge found that Medicare has not articulated an adequate reason to delay the $380 million a year in site-neutral payment cuts while the Centers for Medicare & Medicaid Services appeals the September decision rejecting the payment policy change. The court also found that, contrary to CMS’s claim, Medicare still has an appropriate methodology for making payments that are not site-neutral and that the agency has not proved that it [...]

iqtsupport2019-10-22T06:00:38-04:00October 22, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|