Ensuring Outpatient Quality for Rural States Act
This bill, the Ensuring Outpatient Quality for Rural States Act, would add a new provision to the Medicare statute (Title XVIII) to allow, starting January 1, 2026, adjustments to the non-labor related portion of payments for hospital outpatient department (OPD) services furnished in Alaska and Hawaii. The adjustment would be made in the same way as the cost-of-living adjustment (COLA) mechanism used under another Medicare provision (section 1886(d)(5)(H)) to account for the higher or different costs faced by hospitals in these states. The Secretary of Health and Human Services would have discretion to implement these adjustments, and the bill specifies that the adjustment is not required to be budget-neutral. In short, the bill aims to better reflect the cost structure of operating OPD services in Alaska and Hawaii by adjusting the non-labor portion of reimbursements.
Key Points
- 1Adds a new provision (1833(t)(23)) to allow COLA-based adjustments to the non-labor portion of Medicare OPD payments for services furnished in Alaska and Hawaii.
- 2The adjustments would begin with OPD services furnished on or after January 1, 2026.
- 3The adjustment mechanism would mirror the way the COLA is applied under section 1886(d)(5)(H) for Alaska and Hawaii, to reflect their unique hospital cost circumstances.
- 4The Secretary would have the authority to implement these adjustments, but the bill does not mandate a budget-neutral approach.
- 5The bill is named to focus on rural-state outpatient quality and would apply specifically to the non-labor portion of OPD payments, not the entire payment rate.