Promoting Medicare site-neutral payments

(a) In general Section 1833(t)(21) of the Social Security Act (42 U.S.C. 1395l(t)(21)) is amended— (1) by redesignating subparagraph (E) as subparagraph (F); and (2) by inserting after subparagraph (D) the following new subparagraphs: (E) Sunset of certain exceptions The provisions of clauses (ii) and (iv) of subparagraph (B) shall not apply with respect to applicable items and services furnished on or after January 1, 2026.. (b) On-Campus outpatient departments Section 1833(t) of the Social Security Act is amended— (1) in paragraph (1)(B)— (A) in cause (iv), by striking and at the end; (B) in cause (v), by striking the period at the end and inserting; and; and (C) by inserting at the end the following new clause: (vi) does not include applicable items and services (as defined in subparagraph (A) of paragraph (23)); and; and (2) by adding at the end the following new paragraph: (23) Services furnished by an on-campus outpatient department of a provider (A) Applicable items and services For purposes of paragraph (1)(B)(v) and this paragraph, the term applicable items and services means items and services other than items and services furnished by a dedicated emergency department (as defined in section 489.24(b) of title 42 of the Code of Federal Regulations). (B) On-campus outpatient department of a provider (i) In general On-campus outpatient department of a provider— (I) on the campus (as defined in such section 413.65(a)(2) of title 42, Code of Federal Regulations) of such provider; or (II) within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section 413.65(a)(2) of title 42, Code of Federal Regulations). (ii) Exception for certain hospitals located in rural or medically underserved areas For purposes of paragraph (1)(B)(vi) and this paragraph with respect to applicable items and services, the term on-campus outpatient department of a provider shall not include a department of a provider (as so defined) if the provider is: (I) A critical access hospital (as defined in section 1861(mm)(1)). (II) A sole community hospital (as defined in section 1886(d)(5)(D)(iii)). (III) A Medicare-dependent, small rural hospital (as defined in section 1886(d)(5)(G)(iv)). (IV) Any other hospital that is located in a rural area (as defined in section 1886(d)(2)(D)). (C) Availability of payment under other payment systems With respect to items and services furnished in an on-campus provider-based department, payment under this section for such items and services shall be the amount determined under the fee schedule under section 1848 for such items and services furnished if furnished in a physician office setting..