Sponsors (3)
The bill boosts Medicare outpatient payments to shore up sole community hospitals and help preserve outpatient access in remote parts of Alaska and Hawaii, but does so by increasing federal Medicare spending and without reducing patients' out-of-pocket copayments.
Patients in remote and rural communities in Alaska and Hawaii are more likely to keep local outpatient services because the bill helps prevent closures or service cuts at sole community hospitals.
Sole community hospitals in Alaska and Hawaii receive higher Medicare outpatient (OPD) payments so reimbursements are closer to 94% of their reasonable costs, improving those hospitals' financial stability.
The Medicare program will incur higher federal spending because the increased payments are not required to be budget neutral, potentially diverting resources from other Medicare priorities or increasing taxpayer costs.
Medicare beneficiaries do not get lower copayments under this bill, so patients may still face the same out-of-pocket costs for outpatient care despite hospitals receiving higher reimbursements.
Based on analysis of 2 sections of legislative text.
Requires Medicare OPD payments for sole community hospitals in Alaska and Hawaii to be raised to 94% of reasonable costs when payments fall below that level.
Requires Medicare outpatient (OPD) payments to be automatically increased for sole community hospitals in Alaska and Hawaii when payments fall below 94% of the hospital's reasonable costs, so those hospitals receive payments equal to 94% of reasonable costs. The increase does not change beneficiary copayments, is not treated as a routine adjustment, must not be applied budget-neutrally, and the Secretary must issue implementing regulations within six months; changes take effect for services furnished on or after the first January 1 following that regulation deadline.
Official title: To amend title XVIII of the Social Security Act to establish a floor on payments to sole community hospitals located in Alaska and Hawaii under the hospital outpatient prospective payment system.
Introduced June 30, 2025 by Nicholas J. Begich · Last progress June 30, 2025