Bill would end higher Medicare fees at off-campus hospital clinics

What does this do?

This bill stops hospitals from billing Medicare at hospital-level rates for services delivered at off-campus outpatient locations, including emergency departments, starting January 1, 2026. It redefines "off-campus outpatient department" and removes special billing exceptions, and requires each off-campus site to have its own unique billing identification number used on all Medicare and private insurance claims. HHS must also work with the National Association of Insurance Commissioners to develop model rules letting insurers reject claims that don't follow the new identification requirements.

Who does it affect?

The bill affects hospitals that operate off-campus outpatient facilities, insurance companies, and Medicare; patients receiving outpatient care are also affected.

Why does it matter?

Hospitals and insurers would need to update billing systems and identifiers to comply, and hospitals would lose the ability to bill hospital-level rates for care provided at smaller, off-site clinics.

Where does it stand?