110 SEC. 603. TREATMENT OF OFF-CAMPUS OUTPATIENT DE-
11 PARTMENTS OF
A PROVIDER.
12 Section 1833(t)
of the Social Security Act (42 U.S.C.
13 1395l(t)) is amended—
14 (1) in paragraph
(1)(B)—
15 (A) in clause (iii),
by striking ‘‘but’’ at
the
16 end;
17 (B) in clause (iv), by striking
the period at
18 the end and inserting ‘‘; and’’; and
19 (C) by adding at the end the following new
20 clause:
21 ‘‘(v)
does not include applicable items
22 and
services (as defined in subparagraph
23 (A) of paragraph
(21))
that
are
furnished
24 on
or
after
January 1, 2017, by an
off-
25 campus
outpatient department of a pro-
3 (2) by adding at the end the following new
4 paragraph:
5 ‘‘(21) SERVICES FURNISHED BY
AN OFF-CAM-
6 PUS
OUTPATIENT DEPARTMENT OF A PROVIDER.—
7 ‘‘(A) APPLICABLE
ITEMS AND
SERVICES.—
8 For purposes of paragraph (1)(B)(v) and this
9 paragraph, the term ‘applicable items and serv-
10 ices’ means items and services other than emer-
11 gency department
services (identified, as of
12 January 1, 2015, by HCPCS
codes 99281–
13 99285 (and as subsequently
modified
by
the
14 Secretary)).
15 ‘‘(B) OFF-CAMPUS OUTPATIENT DEPART-
16 MENT OF A PROVIDER.—
17 ‘‘(i) IN GENERAL.—For purposes
of
18 paragraph (1)(B)(v) and this
paragraph,
19 subject to clause (ii), the term ‘off-campus
20 outpatient department of a provider’
21 means a department
of a provider (as de-
22 fined in section 413.65(a)(2) of title 42 of
23 the Code of Federal Regulations, as in ef-
24 fect as of the date of the enactment
of this
25 paragraph)
that
is not located—
2 such section 413.65(a)(2)) of such
3 provider; or
4 ‘‘(II) within the distance (de-
5 scribed in such definition of campus)
6 from a remote location of a
hospital
7 facility (as defined in such section
8 413.65(a)(2)).
9 ‘‘(ii) EXCEPTION.—For purposes of
10 paragraph (1)(B)(v) and this
paragraph,
11 the term ‘off-campus outpatient depart-
12 ment of a provider’
shall not include
a de-
13 partment of a provider (as so defined)
that
14 was billing
under this subsection with re-
15 spect to covered OPD services furnished
16 prior to the date
of the enactment
of this
17 paragraph.
18 ‘‘(C) AVAILABILITY OF PAYMENT UNDER
19 OTHER PAYMENT SYSTEMS.—Payments for
ap-
20 plicable items and services
furnished by an off-
21 campus outpatient department of a provider
22 that are described
in paragraph (1)(B)(v)
shall
23 be made under the applicable payment system
24 under this part (other than under this sub-
1 section) if the requirements for such
payment
2 are otherwise
met.
3 ‘‘(D) INFORMATION NEEDED FOR IMPLE-
4 MENTATION.—Each hospital shall provide to
5 the Secretary such information as the Secretary
6 determines appropriate to implement this para-
7 graph and paragraph (1)(B)(v) (which may in-
8 clude reporting of information on a hospital
9 claim using a code or modifier
and reporting in-
10 formation about
off-campus outpatient depart-
11 ments of a provider
on the enrollment form de-
12 scribed in section 1866(j)).
13 ‘‘(E) LIMITATIONS.—There shall be no ad-
14 ministrative or judicial review under section
15 1869, section 1878,
or
otherwise
of
the
fol-
16 lowing:
17 ‘‘(i) The determination of the applica-
18 ble items and services
under subparagraph
19 (A) and applicable payment
systems under
20 subparagraph
(C).
21 ‘‘(ii) The determination of whether a
22 department of a provider meets the term
23 described in subparagraph
(B).
1 ‘‘(iii) Any information
that
hospitals
2 are required
to
report
pursuant to sub-
3 paragraph
(D).’’.
