Clinic visit policy exceeds CMS’s authority, hospital groups tell court

The Centers for Medicare & Medicaid Services exceeded its statutory authority when it reduced payments for hospital outpatient services provided in off-campus provider-based departments grandfathered under the Bipartisan Budget Act of 2015, the AHA, Association of American Medical Colleges and several member hospitals today told a federal court, requesting summary judgment in their lawsuit challenging the policy. “It is a fundamental principle of administrative law that federal agencies may not act unless authorized to do so by Congress,” the brief states. “…When a federal agency acts in blatant excess of its statutory authority, that action is ultra vires and should be vacated. … CMS’s conduct here easily meets this standard.” The hospital groups asked the court to vacate the relevant portions of the agency’s outpatient prospective payment system final rule for calendar year 2019, prevent CMS from enforcing the clinic visit policy included in the final rule, and order the agency to immediately repay any improperly withheld amounts. The brief will be posted later today at https://www.aha.org/legal/litigation.