Mid-Atlantic Health Law TOPICS
When Are Outpatient Services Not "At the Hospital"?
There can be a blurry line between outpatient services that are provided "at the hospital" and services provided to outpatients at a nearby building on a hospital's campus. That line is important because Maryland's Health Services Cost Review Commission (HSCRC) only sets hospital rates for inpatient and outpatient services provided "at the hospital."
Last year, the HSCRC approved new regulations that set forth the standards for determining when an outpatient service is provided "at the hospital" and therefore subject to HSCRC regulation.
The regulations provide that a hospital seeking to provide a service "at the hospital" on an unregulated basis must first obtain a formal determination from HSCRC staff. In making such a determination, HSCRC staff is to consider the following, among other criteria:
(1) Signage that alerts the public that a given building or service is either at the hospital or not at the hospital;
(2) The location of the entrances, parking, registration, changing and waiting areas;
(3) Signage at entrances within buildings, on the campus and in parking areas;
(4) Whether the billing clearly reflects that the service is rate regulated or not rate regulated;
(5) Whether any physical connection from an unregulated facility to the hospital, such as tunnels, hallways, covered walkways, elevators or connecting bridges, is restricted to hospital staff and physicians to ensure that patients and visitors do not have access to the unregulated facility from the hospital;
(6) Whether there is any inappropriate mixing of regulated and unregulated services in the same building;
(7) Whether there is any duplication of an unregulated service within the hospital to avoid inappropriate patient steering; and
(8) Whether any Medicare Part B physician service being provided in an unregulated building also includes components of a Medicare Part A hospital service.
A hospital that fails to obtain or violates an HSCRC staff "at the hospital" determination may be subject to fines for inaccurate reporting, and paybacks for inappropriate charges. While much of these new regulations codify past policies, the penalty provisions are new, and signal heightened scrutiny by the HSCRC.
March 22, 2008