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September 18, 2019

Federal Judge Overturns CMS Site Neutral Policy

On September 18, 2019, the D.C. District Court ruled that CMS exceeded its authority when it extended site-neutral payment to certain services in grandfathered clinics. The policy, issued as part of the November 2018 Outpatient Prospective Payment System (OPPS) Final Rule, reduced reimbursement rates for certain clinic services rendered at grandfathered off-campus provider-based departments to the lower rate paid under the Physician Fee Schedule. The path ahead is unclear. While the court vacated the challenged portion of the OPPS Final Rule, CMS has since asked the court to reconsider vacatur, arguing that it would result in “serious disruptive consequences to the OPPS payment system.” The court has yet to rule on CMS’ motion.