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Congress Passes 21st Century Cures Act – HOPD Mid-build Exception and Limited “Grandfathering” Extension Included

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Congress Passes 21st Century Cures Act – HOPD Mid-build Exception and Limited “Grandfathering” Extension Included

Congress just passed the 21st Century Cures Act (the “Act”).  President Obama has stated that he will sign it as soon as it reaches his desk.  The Act includes the much-anticipated hospital outpatient department (“HOPD”) mid-build exception to Section 603 of the Bipartisan Budget Act of 2015 (“the BBA”), as well as a limited “grandfathering” extension.  The Act also includes a number of provisions related to innovation of healthcare technology, various healthcare research initiatives, and mental health support.

The “mid-build” exception is defined as a provider that had a binding written agreement with an outside unrelated party for the actual construction of an off-campus HOPD before November 2, 2015.  To qualify for the “mid-build” exception, providers must submit a provider-based attestation and written certification from the hospital CEO or COO stating the HOPD meets the applicable requirements within 60 days of the Act’s enactment.

Off-campus locations meeting “mid-build” requirements and filing deadlines will receive full Outpatient Prospective Payment System (“OPPS”) payment beginning January 1, 2018, yet remain subject to modified payment provisions applicable to non-grandfathered off-campus HOPDs for CY 2017.

For more information on this modified reimbursement structure for non-grandfathered HOPDs, please see Murer’s previous post available here:

http://murer.com/deeper-dive-the-new-reimbursement-structure-for-non-excepted-off-campus-hopds/

Also, in addition to existing “grandfathering” provisions, Congress is extending grandfathering to off-campus HOPDs where the provider has submitted and CMS received a provider-based attestation for the location prior to December 2, 2015.  Full OPPS payment will be available under this provision for CY 2017.  It is not clear whether this extension applies to CY 2018 and beyond, however Murer anticipates CMS rulemaking in this regard.

Murer Consultants is a national expert in provider-based status, and is available to prepare your attestations and certification filings immediately to meet these deadlines and ensure qualification under the “mid-build” exception.

Murer Consultants will continue to closely monitor provider-based developments and will provide updates as they become available.  Should you have any questions regarding this Act or any other matter, please contact Murer Consultants at (708) 478-7030.

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