Excepted Items and Services : CMS is finalizing its proposals that certain off-campus PBDs would be permitted to continue to bill for excepted items and services under the OPPS. Excepted items and services are items and services furnished after January 1, 2017:

• By a dedicated emergency department;
• By an off-campus PBD that was billing for covered OPD services furnished prior to November 2, 2015, (i.e., the date of enactment of section 603 of the BBA of 2015) that has not impermissibly relocated or changed ownership; or
•  In a PBD that is "on the campus," or within 250 yards, of the hospital or a remote location of the hospital.

Service Expansion in an Excepted Off-Campus PBD

CMS proposed to limit the items and services that an excepted off-campus PBD could continue to bill under the OPPS beginning January 1, 2017, to those items and services within a clinical family that were furnished and billed as of November 2, 2015. Under the proposal, additional items and services beyond those within the clinical families of services furnished and billed prior to that date would not be excepted items and services paid under the OPPS. CMS received many public comments raising concerns regarding administrative burden and complexity and potential beneficiary access issues. As a result, CMS is not finalizing the proposal at this time. CMS has decided to monitor expansion of clinical service lines by off-campus PBDs and continue to consider whether a potential limitation on service line expansion should be adopted in the future.

Relocation of Excepted Off-Campus PBDs

CMS is finalizing its proposal that items and services must continue to be furnished and billed at the same physical address of the off-campus PBD as was used as of November 2, 2015, in order for the off-campus PBD to be considered excepted from section 603 requirements. The final relocation policy includes a notable change from the proposal to allow excepted off-campus PBDs to relocate temporarily or permanently without loss of excepted status due to extraordinary circumstances outside of the hospital's control, such as natural disasters. The applicable CMS Regional Office will evaluate and determine exceptions for extraordinary circumstances, and are expected to be rare and unusual.

Changes of Ownership of Excepted Off-Campus PBDs

CMS is finalizing its proposal to allow an off-campus PBD to maintain its excepted status under the other rules outlined in this regulation if the hospital has a change of ownership and the new owners accept the existing Medicare provider agreement from the prior owner.

MPFS: Applicable Payment System for Non-Excepted Items and Services

For CY 2017, CMS is finalizing that the MPFS be the "applicable payment system" for non-excepted items and services furnished in a non-excepted off-campus PBD. In response to public comment on the proposals regarding hospital billing and payment, CMS is issuing an interim final rule with comment period to establish new interim final MPFS rates so that hospitals may be paid for these non-excepted items and services in CY 2017. The changes implemented through this process are intended to provide a billing mechanism for hospitals to report and receive payment under the MPFS for non-excepted items and services furnished by off-campus PBDs to Medicare beneficiaries in CY 2017.  Providers furnishing such services will continue to be paid on the professional claim and will be paid at the facility rate under the MPFS consistent with current payment policies for physicians practicing in an institutional setting. Under this proposal, CMS is establishing interim final site-specific rates under the MPFS for the technical component of all non-excepted items and services. Hospitals will be paid under the MPFS at these newly established MPFS rates for non-excepted items and services, which will be billed on the institutional claim and must be billed with a new claim line modifier "PN" to indicate that an item or service is a non-excepted item or service. For CY 2017, the payment rate for these services will generally be 50 percent of the OPPS rate (there are some exceptions that are spelled out in the proposal, including that payment for separately payable drugs will not be reduced). Packaging, and certain other OPPS policies, will continue to apply to such services.