In its Physician Fee Schedule Final Rule for CY 2018, released November 2, 2017, CMS reduced the rates that will be paid for nonexcepted items and services furnished by nonexcepted off-campus provider-based departments (PBDs) for CY 2018. In CY 2017, CMS based payments to nonexcepted PBDs on the payment amount under the outpatient prospective payment system (OPPS), scaled downward by 50%, referred to as a 50% Relativity Adjuster. For CY 2018, CMS had proposed to adopt a 25% Relativity Adjuster, seeking to promote site neutrality and expressing concerns that its CY 2017 policy resulted in higher overall payments to hospitals than would be paid under the physician fee schedule in non-facility settings. The Final Rule adopts a 40% Relativity Adjuster. In its OPPS Final Rule issued November 1, 2017, CMS did not respond to comments on its PBD grandfathering policies related to service and volume expansions, relocation, and changes in ownership, but said that it would consider such comments as it considers whether to pursue further rulemaking.