14. Department of Health and Human Services · Minor · Needs Congress
Base Medicare payments on patient health status, not site of service
Printed page 465 14. Department of Health and Human Services
“Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service.”
What has happened
- Attempted
Congress did not change the statutory basis of Medicare payment, and no bill of the 119th Congress proposes site-neutral legacy Medicare payment. CMS routed around it inside existing authority: the CY 2026 OPPS/ASC final rule (effective 2026-01-01) begins a three-year elimination of the Inpatient Only list, expands the ASC Covered Procedures List, and removes the payment premium for drug administration furnished in acquired off-campus provider-based departments — CMS's stated reason being that it is "simply removing an incentive that unnecessarily increases outpatient volume for drug administration services". Under playbook § 3b that is executive action routing around a Requires-Congress ask: `attempted`, not `partial`.
Research log
What was searched, and what didn’t count as evidence
Research notes
- Queries: a search of bill titles among those we keep and search, from congress.gov, for “site neutral” or “site of service” → 0. Federal Register “site neutral” since 2025-01-20 → 13 documents, all CMS payment rules exercising existing authority; no statute.
- #1258 is the regulatory version of the same idea and takes the same Evidence at partial; this item is the legislative version and cannot rise above attempted on executive action alone.
- Action
- other
- Object
- legacy Medicare payment basis
- ID
- 1265