SOS: Sustaining Outpatient Services Act
Summary
What This Bill Does
The SOS: Sustaining Outpatient Services Act changes Medicare payment for a narrow class of items and services furnished by off-campus outpatient departments of hospitals. Beginning in 2027, an item or service is included in the hospital outpatient prospective payment system when the largest total amount paid under the physician fee schedule for all such items or services furnished by physicians in the relevant specialty during the preceding year was less than $2 million.
The provision creates an exception from the lower physician-fee-schedule treatment that otherwise applies to specified off-campus departments. CMS must determine the relevant specialty-level prior-year payment total each year and apply hospital outpatient payment to qualifying services.
The bill does not restore hospital payment for every off-campus service, set a fixed payment amount, waive Medicare coverage requirements, or guarantee that a department remains open. Qualification depends on the previous year's national payment measure and begins only in 2027.
Who Benefits and How
Off-campus hospital departments providing low-volume specialty services receive hospital outpatient reimbursement rather than the site-neutral physician schedule. Hospitals may be more willing to retain services that generate limited physician-schedule spending. Patients in communities relying on those departments may preserve local access. Hospital systems and clinicians attached to qualifying departments gain revenue stability.
Who Bears the Burden and How
Medicare program spending and potentially beneficiary coinsurance may rise where outpatient prospective payments exceed physician-schedule amounts. Independent physician offices can face a payment disadvantage for comparable services. CMS must identify specialties, aggregate prior-year spending, map services, and update payment systems annually. Taxpayers and Medicare premium payers bear higher program cost.
Key Provisions
- Expands hospital outpatient payment for qualifying off-campus services.
- Begins the payment exception in 2027.
- Limits qualification to off-campus provider departments.
- Requires a prior-year physician-specialty spending test.
- Sets the qualifying threshold below $2 million.
- Preserves other Medicare coverage and payment requirements.
- Requires CMS to recalculate qualification each year.
- Limits relief to low-volume services rather than all off-campus care.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Beginning in 2027, restores Medicare hospital outpatient prospective-payment treatment for services furnished by off-campus hospital departments when prior-year physician-fee-schedule payments for the corresponding physician specialty were below $2 million.
Key Policy Areas
Medicare Outpatient Payments, Off-Campus Hospital Departments, Site-Neutral Payment, Low-Volume Medical Services, Hospital Reimbursement
Primary Purpose
Beginning in 2027, restores Medicare hospital outpatient prospective-payment treatment for services furnished by off-campus hospital departments when prior-year physician-fee-schedule payments for the corresponding physician specialty were below $2 million.
Policy Domains
Section 2 OPPS treatment for low-volume off-campus services
Identified Gains
- Off-campus departments providing low-volume services
- Hospitals retaining qualifying outpatient specialties
- Medicare patients relying on local departments
- Clinicians practicing in qualifying departments
- Communities preserving outpatient access
- Hospital employees supporting covered services
Identified Costs
- Medicare program accounts
- Beneficiaries paying outpatient coinsurance
- Independent physician offices facing payment disparities
- CMS specialty-spending analysts
- Medicare payment-system administrators
- Taxpayers funding higher reimbursements
- Medicare premium payers
Sponsors
Legislative Progress
In CommitteeReferred to the Committee on Energy and Commerce, and in …
Introduced in House
Mr. Smith of Nebraska (for himself and Mr. McGovern) introduced …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Hospital employees supporting covered services, Hospitals retaining qualifying outpatient specialties, Off-campus departments providing low-volume services
Beneficiaries paying outpatient coinsurance, Medicare patients relying on local departments, Medicare premium payers
Positive-direction: Medicare patients relying on local departments
Negative-direction: Beneficiaries paying outpatient coinsurance, Medicare premium payers
CMS specialty-spending analysts, Medicare payment-system administrators, Medicare program accounts
Communities preserving outpatient access, Taxpayers funding higher reimbursements
Positive-direction: Communities preserving outpatient access
Negative-direction: Taxpayers funding higher reimbursements
Independent physician offices facing payment disparities
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "hospital"
- → Hospital system operating an off-campus department
- "provider"
- → Off-campus outpatient department of a hospital
- "competitor"
- → Independent physician office furnishing a comparable service
- "beneficiary"
- → Medicare patient using a qualifying department
- "administrator"
- → Centers for Medicare and Medicaid Services
Note: {'scope_ids': ['low_volume_off_campus_opps'], 'description': 'The bill changes payment methodology only for services meeting an annual specialty-level threshold from 2027; it does not cover every off-campus department, guarantee a facility remains open, or waive Medicare coverage rules.'}
Key Definitions
Terms defined in this bill
The annual calculation of physician-fee-schedule spending used to decide whether a service falls below the threshold.
The Medicare hospital outpatient payment methodology restored for qualifying services beginning in 2027.
An off-campus hospital service tied to a physician specialty whose greatest relevant prior-year physician-schedule payment total was below $2 million.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology