Health Care Today | Health Law Blog

In 2019, the Centers for Medicare and Medicaid Services (CMS) issued draft guidance on hospital co-location (when hospitals share space and resources with other health care entities). We previously summarized that draft guidance here. On November 12, 2021, CMS issued its final guidance and — surprise! — it changed quite a bit.

The expansion of telehealth is changing the landscape of health care. This is the third in a four-part series exploring what providers should know about this growing area.

Medicaid programs pay for telemedicine, telehealth and telemonitoring services delivered through a range of interactive video, audio or data transmission (telecommunications). Various state Medicaid programs are experiencing a significant increase in claims for these services and expect this trend to continue.

Many hospitals share space with other health care entities. Despite this, the Centers for Medicare & Medicaid Services (CMS) has given mixed signals — and never issued formal guidance — concerning the permissibility of shared spaces under the Medicare Conditions of Participation (CoP). This has created great confusion and uncertainty for hospitals as they try to meet the challenges of a rapidly changing health care system.

That’s all about to change!

The Centers for Medicare & Medicaid Services (CMS) has found that hospitals are increasingly operating “off-campus, outpatient, provider-based” departments. Services provided at these off-campus facilities are required to be billed using the off-campus facility’s address so that payment can be accurately made under the Medicare Physician Fee Schedule (MPFS) or the Outpatient Prospective Payment System (OPPS).