In an opinion filed on December 16, 2019, and published by the American Hospital Association (AHA), U.S. District Judge Rosemary M. Collyer denied a request from hospitals to halt CMS’ implementation of a site-neutral payment policy impacting hospital outpatient departments, which was struck down earlier in 2019.
Ruling
As reported, Collyer ruled against the policy in September, arguing that CMS could not reduce rates for certain hospital outpatient services in a non-budget-neutral manner. The agency had attempted to decrease the rates for the services in the final rule for the 2019 Outpatient Prospective Payment System (OPPS) in order to bring the payments in line with the rates paid to physicians performing the same services in the office setting. Despite the ruling against the site-neutral payment policy, CMS included the next phase of the policy’s implementation in the final rule for the 2020 OPPS.
The AHA argued that the 2020 rate cuts for certain hospital clinic visits are illegal given the judge’s decision to throw out the original site-neutral payment policy in the previous year’s OPPS final rule. The hospital group urged Collyer to stop CMS from enforcing the policy before the rate cuts are slated to take effect on Jan. 1, 2020. However, the judge did not grant the AHA and other hospital plaintiffs their request.
Collyer explained that her decision to block site-neutral payments cuts only applied to claims filed in 2019 and the court does not currently have jurisdiction to expand its ruling to payments that will be made in 2020. “[A]s a technical matter, the government correctly argues that the Court’s previous order was limited only to the 2019 Final Rule,” she wrote.
As further reported, the AHA’s general counsel Melinda Hatton said that the association and other plaintiffs are confident that the court system will determine the 2020 payment cuts to be illegal just as it did in 2019.
Just this past week, AHA, AAMC and several others filed an additional complaint to vacate the order and reverse CMS in their ability to enforce site neutral payments in 2020.
According to an announcement, HHS said it intends to ask the U.S. Court of Appeals to reverse the September decision.