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House Ways and Means Proposes Provider-Based “Mid-Build” EXCEPTION

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House Ways and Means Proposes Provider-Based “Mid-Build” EXCEPTION

On May 18, the House Ways and Means Committee introduced the bipartisan Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273). The proposed legislation amends the Bipartisan Budget Act of 2015 (“BBA”) site-neutral reimbursement for hospital outpatient departments (“HOPDs”) that were “mid-build” when the BBA was enacted on November 2, 2015.  “Mid-build” is defined as a provider that had a binding written agreement with an outside, unrelated, party for the actual construction of the HOPD on November 2, 2015.
H.R. 5273 outlines the steps providers would take to qualify an HOPD under the “mid-build” exception. Each HOPD will be required by July 1, 2016, to: 1) submit a certification from the provider’s chief executive officer or chief operating officer that the HOPD meets the definition of mid-build prior to July 1, 2016; and, 2) submit an attestation that it meets the requirements of the CMS provider-based regulations. H.R. 5273 provides that attestations submitted on behalf of “mid-build” HOPDs will be audited for satisfaction of “mid-build” qualifications.
Importantly, HOPDs that meet the “mid-build” requirements will receive the full HOPD payment rate beginning January 1, 2018. Given the site-neutral impact of the BBA, this means that “mid-build” facilities will be reimbursed under the lower physician fee schedule or ambulatory surgical center payments from January 1, 2017, to January 1, 2018. However, those off-campus HOPDs that satisfy the mid-build requirements AND submitted a voluntary attestation prior to December 2, 2015 will receive the full HOPD payment rate beginning January 1, 2017.
While H.R. 5273 is still very preliminary, recent HOPD reimbursement rulemaking and legislation has been brief in development and application. Therefore, Murer Consultants recommends that providers evaluate any off-campus facilities or developments that could be impacted by the proposed “mid-build” exception in H.R. 5273. In the event that the “mid-build” exception becomes a reality, providers should be ready to prepare and submit documentation necessary to demonstrate the HOPD’s satisfaction of the “mid-build” requirements. Additionally, because the “mid-build” exception is currently so narrowly constructed, it is possible that additional changes to this proposed legislation may be forthcoming.
Please contact Murer Consultants at (708) 478-7030 to discuss H.R. 5273 in further detail, as well as any other BBA or provider-based issues with which your facility is confronted. 
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