CMS proposed removing some provisions in the expansion exception process for physician-owned hospitals that serve high numbers of Medicaid inpatients in the 2021 Outpatient Prospective Payment System proposed rule.
Four things to know:
1. CMS proposed eliminating the cap on the number of additional operating rooms, procedure rooms and beds that could be approved as an exception to the moratorium on physician-owned hospitals for high-Medicaid facilities, defined as those serving more Medicaid inpatients than other hospitals in their counties.
2. The agency also proposed removing the provision that restricts approved expansion to the hospital's main campus.
3. High-Medicaid facilities are able to apply for exceptions more than once every two years but can only submit one request at a time.
4. CMS proposed defining bed count as the number of licensed beds regardless of the number of beds on the physical license issued by the state to determine the hospital's baseline bed count. The update would give physician-owned hospitals more flexibility to qualify as high-Medicaid facilities.
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