What This Bill Does
This bill changes how Medicare (the federal health insurance program for people 65 and older) pays for certain medical items and services. Specifically, it allows Medicare to pay for items and services provided by off-campus outpatient departments (medical facilities that are separate from main hospitals) using a specific payment method called the prospective payment system (a method where payment amounts are set in advance).
Who It Affects
Medicare patients receiving care at off-campus outpatient departments of healthcare providers. Healthcare providers operating off-campus outpatient departments. Physicians in certain medical specialties whose total payments fall below a specific threshold.
Key Provisions
* Medicare payments for items and services furnished by off-campus outpatient departments of a provider will be included in the prospective payment system for hospital outpatient department services, starting in 2024. (Sec. 2)
* This change applies only to items and services where the total amount paid to physicians in that medical specialty under the physician fee schedule (a payment structure for doctors) for all such items and services during the previous year was less than $2,000,000. (Sec. 2)
What Changes
If this bill becomes law, Medicare will cover certain items and services provided at off-campus outpatient departments using the hospital outpatient prospective payment system starting in 2024, but only for medical specialties that received less than $2,000,000 in total physician payments the previous year.
Important Definitions
Off-campus outpatient department: Not explicitly defined in the bill text. The bill references a definition in another section of Social Security Act regulations.
Effective Date
The changes take effect beginning with the year 2024. (Sec. 2)
I
118TH CONGRESS
1ST SESSION
H. R. 955
To amend title XVIII of the Social Security Act to allow payments under
the Medicare program for certain items and services furnished by off-
campus outpatient departments of a provider to be determined under
the prospective payment system for hospital outpatient department serv-
ices, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 9, 2023
Mr. SMITH of Nebraska (for himself and Mr. MCGOVERN) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
A BILL
To amend title XVIII of the Social Security Act to allow
payments under the Medicare program for certain items
and services furnished by off-campus outpatient depart-
ments of a provider to be determined under the prospec-
tive payment system for hospital outpatient department
services, and for other purposes.
Be it enacted by the Senate and House of Representa-
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tives of the United States of America in Congress assembled,
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•HR 955 IH
SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘SOS: Sustaining Out-
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patient Services Act’’.
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SEC. 2. ALLOWING MEDICARE PAYMENTS FOR CERTAIN
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ITEMS AND SERVICES FURNISHED BY OFF-
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CAMPUS OUTPATIENT DEPARTMENTS OF A
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PROVIDER TO BE DETERMINED UNDER THE
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PROSPECTIVE PAYMENT SYSTEM FOR HOS-
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PITAL OUTPATIENT DEPARTMENT SERVICES.
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Section 1833(t)(1)(B) of the Social Security Act (42
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U.S.C. 1395l(t)(1)(B)) is amended—
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(1) in clause (iv), by striking ‘‘and’’ at the end;
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(2) in clause (v)—
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(A) by inserting before ‘‘does not include’’
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the following: ‘‘subject to clause (vi),’’; and
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(B) by striking the period at the end and
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inserting ‘‘; and’’; and
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(3) by adding at the end the following new
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clause:
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‘‘(vi) includes, with respect to a year
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(beginning with 2024), any item or serv-
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ice—
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‘‘(I) that is furnished during
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such year by an off-campus outpatient
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department of a provider (as defined
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•HR 955 IH
in subparagraph (B) of paragraph
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(21)); and
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‘‘(II) with respect to which the
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greatest total amount paid with re-
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spect to a physician speciality under
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the physician fee schedule under sec-
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tion 1848 for all such items or serv-
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ices furnished by physicians in such
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specialty during the previous year was
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less than $2,000,000.’’.
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Æ
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