Sponsor
Mark E. Green
Representative · R-TN
Representative · R-TN
The bill makes it easier for hospitals to designate nearby off‑campus sites as provider‑based—helping preserve local access and hospital finances—but likely raises Medicare spending and beneficiary cost‑sharing while putting independent providers at competitive risk.
Rural and other Medicare patients who live farther than 35 miles may keep or gain local access to hospital‑affiliated services if more off‑campus sites become provider‑based, reducing travel and improving continuity of care.
Hospitals and health systems can designate more off‑campus sites as provider‑based and bill at hospital outpatient rates, increasing revenue for local hospitals and strengthening financial stability.
Hospitals may be better able to invest in and staff off‑campus sites, supporting workforce stability and continuity of services in those communities.
Taxpayers and the Medicare program could face higher overall costs because more sites billed as provider‑based would be paid at higher hospital outpatient rates.
Medicare beneficiaries could pay higher out‑of‑pocket costs if services shift from independent clinics to hospital outpatient billing that carries higher cost‑sharing.
Independent community providers and small practices could be disadvantaged or acquired as hospitals convert off‑campus sites to provider‑based status, reducing local competition and options.
Based on analysis of 2 sections of legislative text.
Requires HHS to remove the Medicare rule that limits off‑campus provider‑based status to facilities within 35 miles of a hospital, with a 60‑day regulatory revision deadline.
Official title: To direct the Secretary of Health and Human Services to revise regulations to remove the requirement under the Medicare program that an off-campus facility or organization shall be located within a 35-mile radius of a hospital or critical access hospital.
Introduced January 28, 2025 by Mark E. Green · Last progress January 28, 2025
Removes a Medicare regulatory distance limit that has prevented many off‑campus clinics from keeping "provider‑based" status. The HHS Secretary must revise the regulation within 60 days to eliminate the rule requiring off‑campus facilities to be within 35 miles of a hospital or critical access hospital to qualify for provider‑based status. The change aims to expand access for rural and other communities by allowing more off‑campus outpatient sites to qualify for Medicare provider‑based treatment and associated payment rules previously tied to proximity to a hospital campus.