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Our View: Outpatient Payment Changes Threaten Access to Care in Underserved Areas

The Bipartisan Budget Act (BBA) of 2015 mandated a new payment system for off-campus hospital outpatient departments (HOPDs), resulting in a roughly 50 percent cut to clinics that opened after November 2, 2015. The law allowed clinics operating on or before that date to remain under the existing payment system. But regulators interpreted the grandfathering provision so narrowly that they left almost no leeway for those HOPDs to relocate or change ownership without losing their grandfathered status.

This onerous “site-neutral” payment policy jeopardizes access to care by making clinic expansion into our most underserved communities financially unsustainable.

We urge Congress to protect the existing grandfathering provision and to advance an exception to the payment cuts for new HOPDs that demonstrably provide access in our most underserved communities. Specifically, we propose amending the law to continue paying pre-BBA HOPD rates to clinics that:

  • provide care in Health Professionals Shortage Areas or Medically Underserved Areas; or
  • disproportionately create access to care for low-income and other vulnerable people.

Also, to ensure access for all patients over time, Congress should direct CMS to recognize a broader set of conditions under which a grandfathered HOPD might need to change its physical location and to allow flexibility for clinics that change ownership.

Read Our View: Outpatient Payment Changes Threaten Access to Care in Underserved Areas

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