Sponsors (3)
The bill provides targeted federal funding to raise Medicare outpatient payments for sole community hospitals in Alaska and Hawaii to preserve services in remote communities, but does so at added federal cost, without reducing patient cost-sharing, excludes many other rural hospitals, and may not deliver immediate relief.
Sole community hospitals in Alaska and Hawaii will receive higher Medicare OPPS payments (brought up to 94% of reasonable costs when current payments are lower), increasing hospital revenue and helping preserve local outpatient services and access to care for residents of remote communities and Medicare beneficiaries.
The payment increase is delivered through additional federal spending rather than being budget-neutral, providing direct supplemental support to the targeted hospitals instead of shifting payments from other providers.
Higher Medicare OPPS payments will raise federal spending and could increase the deficit or require future offsets, affecting taxpayers and federal fiscal balances.
The relief is narrowly limited to sole community hospitals in Alaska and Hawaii, leaving other rural or financially strained hospitals ineligible and potentially widening disparities in rural hospital support.
Medicare beneficiaries will still face the same copayments for outpatient department services because the change does not alter existing cost-sharing rules, so patients do not see lower out-of-pocket costs.
Based on analysis of 2 sections of legislative text.
Increases OPPS payments so sole community hospitals in Alaska and Hawaii receive at least 94% of their reasonable costs for covered outpatient department services when payments fall below that level.
Official title: 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 February 12, 2025 by Daniel Scott Sullivan · Last progress February 12, 2025
Requires the HHS Secretary to boost Medicare OPPS payments for sole community hospitals in Alaska and Hawaii when current OPPS rates cover less than 94% of the hospital’s reasonable costs; the increase fills the gap up to 94%. The bill preserves existing beneficiary copayments, specifies the payment is not budget-neutral, and directs the Secretary to issue regulations within six months with the rule effective for services furnished on or after the first January 1 following that rule date.