Empowering Patient Choice of Medical Care Act

Who is affected and how:

• Hospitals: Hospitals are the most directly affected. They may be able to obtain outpatient designation for services that previously were denied only because of an "inpatient‑only" safety determination. That can change how services are scheduled, billed, and documented. Hospitals may also need to update policies and safety protocols if they move services from inpatient to outpatient settings.

• Medicare beneficiaries and patients: Medicare enrollees could see greater access to services delivered in outpatient settings (e.g., shorter stays, same‑day procedures) if providers request and receive outpatient designation. Effects on out‑of‑pocket costs depend on Medicare payment rules and beneficiary cost‑sharing differences between inpatient and outpatient classifications.

• Health care providers and clinical staff: Physicians, nurses, and outpatient clinic staff may experience shifts in where certain services are provided. Providers will need to ensure patient safety measures are in place if services transition from inpatient to outpatient settings.

• Centers for Medicare & Medicaid Services (CMS) and HHS: CMS must adjust administrative practices and potentially revise guidance or decision frameworks that relied on the inpatient‑only safety determination as a single decisive factor. CMS may face administrative workload to process more designation requests or to articulate alternative denial bases.

• Medicare program finances and payers: Reclassifying services to outpatient designation can shift payment flows (e.g., outpatient prospective payment system vs inpatient payments). The net effect on Medicare spending will depend on how many services are redesignated and how payments compare across settings.

Uncertainties and considerations:

• The provision does not change clinical standards; it only constrains one administrative reason for denial. CMS retain other authority to deny outpatient designations for clinical or statutory reasons.
• Patient safety concerns remain central; redesignation decisions will still need to account for clinical safety and appropriateness even if an inpatient‑only label cannot be the sole refusal reason.
• The actual operational and budgetary impact depends on how CMS implements the change and how many designation requests follow.