In the midst of several proposals for further “site neutral” reimbursement at off-site hospital outpatient departments (HOPDs), Congress is also considering a proposal that will impact almost all hospitals. Congress may require hospitals to file mandatory “provider-based attestations” for each off-campus HOPD by January 2026. This attestation confirms compliance will all regulations at 42 CFR 413.65, often requiring 200+ pages of support to do so, and is not something to take lightly. The House may vote on H.R. 5378 as soon as this week, which includes this mandatory attestation requirement.
Advis has decades of experience with the provider-based attestation process, and strongly recommends close attention to detail in preparing and submitting these filings. There are a significant number of regulations to meet, and not demonstrating full compliance with any portion of these could lead to denials and loss of favorable reimbursement, including 340B Drug Pricing Program eligibility at your HOPDs.
In most cases, a compliance assessment of all or a sample of your off-campus HOPDs is the best place to start. From there, a work group can be established to mitigate any identified concerns, and ultimately prepare the attestation submissions. We cannot stress enough that this is no small task for entities with several HOPDs – starting sooner than later will be key to meeting the January 2026 deadline.
For more information on the “site neutral” proposals also being considered by Congress, please see below:
- PATIENT Act (H.R. 3561) and H.R. 5378 – Site neutral payment for drug administration services in off-campus HODs.
- MPACT Act (H.R. 4473 – Site neutral payment for cancer diagnosis/treatment services in on- and off-campus HODs.
- SITE Act (S. 1869) – Site neutral payment for all services in off-campus HODs at 40% of OPPS, and in off-campus ERs located more than 6 miles from a hospital at 30% of OPPS.
- The Primary Care and Health Workforce Expansion Act, Sec. 802 – Site neutral payments at “medium amount charged” in a physician’s office for all HOD services, regardless of on- or off-campus.
(See broader, third-party summaries here and here.)
Our teams are ready to assist you with this process, whether it’s being a resource, providing strategic advice or completing these attestations for your organization. Please contact your Advis consultant with any questions or for further assistance.
Published: September 20, 2023