Elevance Health is expanding site-neutral payment policies across its commercial, Medicare Advantage, and Medicaid managed care plans, signaling a broader shift in how insurers reimburse hospitals for outpatient services. As reported by the Healthcare Financial Management Association (HFMA), the policies, rolling out through 2027, will require greater transparency regarding where services are delivered and may reduce reimbursement for certain off-campus hospital services to non-facility rates. The changes reflect growing efforts by insurers and policymakers to address payment disparities between hospital-owned outpatient facilities and independent physician practices.
In its coverage, HFMA referenced analysis by Payal Amin and Jesse Dresser, highlighting how insurers are increasingly using reimbursement restrictions and prior authorization requirements to steer patients toward lower-cost care settings. Many health plans already deny or limit reimbursement for hospital outpatient department infusions when alternative treatment locations are considered clinically appropriate. These developments underscore the growing financial and operational challenges facing hospitals as payors expand site-of-care restrictions and reimbursement policies.
Senior Counsel
