Sponsors (2)
The bill improves beneficiary access and stabilizes hospital revenue for certain low‑volume specialty services by paying under HOPPS at off‑campus sites, but does so at the cost of higher Medicare spending and altered payment incentives that may disadvantage some physicians and encourage site‑of‑service shifts.
Medicare beneficiaries: gain improved local access to certain low-volume specialty services at off‑campus hospital outpatient departments starting in 2027, reducing travel and increasing convenient care options.
Hospitals and off‑campus provider-based departments: receive higher or more predictable Hospital Outpatient Prospective Payment System (HOPPS) payments for eligible low‑volume specialties, improving facility revenue stability and financial planning.
Small or low‑volume physician specialties and their staff: experience administrative simplification when services furnished at off‑campus hospital sites are billed under HOPPS rather than multiple physician fee schedule claim processes.
Taxpayers and Medicare program: face higher Medicare spending per service because shifting payment to HOPPS can increase payment rates relative to the physician fee schedule, raising program costs and fiscal pressure.
Physicians in affected low‑volume specialties: may receive lower direct professional payments or altered incentives if services are billed and paid under hospital outpatient rates instead of the physician fee schedule, potentially reducing clinician revenue and changing practice behavior.
Medicare beneficiaries and the health system: could see increased shifting of services to off‑campus hospital departments because hospitals have an incentive to qualify for higher HOPPS payments, which may raise utilization, consolidation, or facility‑driven site‑of‑service changes.
Based on analysis of 2 sections of legislative text.
From 2027, certain items/services at off‑campus hospital outpatient departments will be paid under HOPPS if the physician specialty’s prior‑year PFS payments for that service category were under $2,000,000.
Allows Medicare to pay for certain items and services provided at off‑campus hospital outpatient departments under the hospital outpatient prospective payment system (HOPPS) beginning in 2027 when the physician specialty that furnished those services had less than $2,000,000 in physician fee schedule payments for that service category in the prior year. The change creates a new payment rule that shifts some low‑volume specialty services from the physician fee schedule to HOPPS for off‑campus provider‑based departments.
Introduced February 25, 2026 by John Hoeven · Last progress February 25, 2026