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S3908119th CongressWALLET

SOS: Sustaining Outpatient Services Act

Sponsored By: Senator Hoeven, John [R-ND]

Introduced

Summary

This bill would shift payment for certain off‑campus outpatient services from the physician fee schedule to the hospital outpatient prospective payment system. It targets items and services furnished at off‑campus outpatient departments and uses a prior‑year payment threshold to decide which services move beginning in 2027.

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  • Hospitals and off‑campus outpatient departments: Qualifying items and services furnished at off‑campus outpatient departments would be paid under the hospital outpatient prospective payment system instead of the physician fee schedule starting in 2027.
  • Physician specialties: A service qualifies for the change for a given year if the greatest total amount paid to that physician specialty under the physician fee schedule in the prior year was less than $2.0 million.
  • Medicare program administration: The bill changes which Medicare payment system applies to these services and relies on the law's definition of "provider" to identify affected facilities.

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Bill Overview

Analyzed Economic Effects

1 provisions identified: 0 benefits, 0 costs, 1 mixed.

Medicare reclassifies some off-campus services

This bill would change Medicare payment rules starting in 2027. Items and services provided during a year at an off‑campus outpatient department would be paid under the hospital outpatient prospective payment system (OPPS) if the physician specialty that billed most for those services had less than $2,000,000 in physician fee schedule payments for those services in the prior year. If a service is reclassified, the provider could bill as a hospital outpatient and your Medicare cost‑sharing or provider reimbursement could change. The rule uses the prior‑year specialty payments and only applies to off‑campus outpatient departments defined in current law.

Sponsors & CoSponsors

Sponsor

Hoeven, John [R-ND]

ND • R

Cosponsors

  • Sen. Klobuchar, Amy [D-MN]

    MN • D

    Sponsored 2/25/2026

Roll Call Votes

No roll call votes available for this bill.

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