Sec. 203. Parity in Medicare payments for hospital outpatient department services furnished off-campus
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Section 1833(t)(16) of the Social Security Act ( 42 U.S.C. 1395l(t)(16) ) is amended by adding at the end the following new subparagraph: Subject to clause (iii), in the case of specified OPD services (as defined in clause (v)) that are furnished during 2025 or a subsequent year by an off-campus outpatient department of a provider (as defined in clause (iv)) (or, in the case of an off-campus outpatient department of a provider that is a hospital described in section 1886(d)(1)(B)(v), or is located in a rural area or a health professional shortage area, such services that are furnished during 2026 or a subsequent year), there shall be substituted for the amount otherwise determined under this subsection for such service and year an amount equal to the payment amount that would have been payable under the applicable payment system under this part (other than under this subsection) had such services been furnished by such a department subject to such payment system pursuant to paragraph (21)(C).
In making any budget neutrality adjustments under this subsection for 2025 or a subsequent year, the Secretary shall not take into account the reduced expenditures that result from the application of this subparagraph. The Secretary shall provide for a 4-year phase-in of the application of clause (i), with clause
(i)being fully applicable for specified OPD services beginning with 2028 (or in the case of an off-campus outpatient department of a provider that is a hospital described in section 1886(d)(1)(B)(v), or is located in a rural area or a health professional shortage area, beginning with 2029). For purposes of this subparagraph, the term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65(a)(2) of title 42, Code of Federal Regulations) that is not located— on the campus (as such term is defined in such section) of such provider; or within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section). For purposes of this subparagraph: The term designated ambulatory payment classification group means an ambulatory payment classification group for drug administration services. The term health professional shortage area has the meaning given such term in section 332(a)(1)(A) of the Public Health Service Act. The term rural area has the meaning given such term in section 1886(d)(2)(D). The term specified OPD services means covered OPD services assigned to a designated ambulatory payment classification group. . Section 1833(t)(12) of the Social Security Act ( 42 U.S.C. 1395l(t)(12) ) is amended— in subparagraph (D), by striking and at the end; in subparagraph (E), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: the determination of any payment amount under paragraph (16)(H), including the transition under clause
(iii)of such paragraph. .
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Sec. 203
Parity in Medicare payments for hospital outpatient department services furnished off-campus
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