New Budget Bill May Signal End of Provider-Based Status

October 28, 2015

Hospitals that seek to establish provider-based OPDs should complete their work soon.

A near-final discussion draft of a House budget bill, which the White House has apparently agreed to in principle, would end the provider-based status for hospital off-campus departments beginning January 1, 2017. Hospitals that already bill in a certain space under provider-based status will be grandfathered in if they do so prior to the legislation’s enactment date. Accordingly, providers that want to treat a space as provider-based but do not currently do so must convert that space quickly and begin billing for services provided there prior to the enactment date. Hospitals that already have provider-based clinics may want to verify compliance with the Provider-Based Rule to ensure that they do not permanently lose provider-based status. This legislation will also hugely affect the 340B Drug Pricing Program and providers that plan to bill under the program.


If you have any questions or would like more information on the issues discussed in this LawFlash, please contact any of the following Morgan Lewis lawyers:

Washington, DC
Andrew Ruskin
Albert W. Shay
Jacob J. Harper