Finding Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources

Finding Medicare Fee-For-Service (FFS)
May 21August 20, 2021 , 2021
Payment System Rules: Schedules and
Michele L. Malloy
Resources
Research Librarian Research Librarian

The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other
health care facilities based on statutorily established payment systems, most of which health care facilities based on statutorily established payment systems, most of which

are updated annually through regulations. These proposed and final rules follow are updated annually through regulations. These proposed and final rules follow
schedules based on requirements found in statute, regulation, or both. schedules based on requirements found in statute, regulation, or both.
As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health
care facilities and providers. Congressional members and committees may comment, and are often contacted by care facilities and providers. Congressional members and committees may comment, and are often contacted by
provider and beneficiary groups. Tracking the status and requirements for specific rules can be onerous, since they provider and beneficiary groups. Tracking the status and requirements for specific rules can be onerous, since they
have different schedules and web locations. have different schedules and web locations.
This report contains information on these payment system rules in a quick reference table. Specifically, the table This report contains information on these payment system rules in a quick reference table. Specifically, the table
compiles the payment systems, their main portals on the Centers for Medicare & Medicaid Services (CMS) compiles the payment systems, their main portals on the Centers for Medicare & Medicaid Services (CMS)
website, the typical rulemaking schedule, statutory and regulatory requirements, and the most recently issued website, the typical rulemaking schedule, statutory and regulatory requirements, and the most recently issued
proposed rules, public comments, final rules, and subsequent corrections. The table also includes embedded links proposed rules, public comments, final rules, and subsequent corrections. The table also includes embedded links
to the applicable resources. Not all payment systems include detailed statutory and regulatory requirements, as to the applicable resources. Not all payment systems include detailed statutory and regulatory requirements, as
noted in the table. noted in the table.
Congressional Research Service Congressional Research Service

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Contents
Introduction ..................................................................................................................................... 1
Medicare Fee-For-Service Payment System Rules: Schedules and Resources ............................... 1

Tables
Table 1. Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and
Resources ..................................................................................................................................... 2

Contacts
Author Information ........................................................................................................................ 12


Congressional Research Service Congressional Research Service

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Introduction
The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care
facilities based on statutorily established payment systems, most of which are updated annually facilities based on statutorily established payment systems, most of which are updated annually
through regulations. These proposed and final rules follow schedules based on requirements through regulations. These proposed and final rules follow schedules based on requirements
found in statute, regulation, or both. Medicare payment systems that follow annual regulatory found in statute, regulation, or both. Medicare payment systems that follow annual regulatory
updates with comment periods include the following: updates with comment periods include the following:
 Medicare Physician Fee Schedule Payment (MPFS or PFS),  Medicare Physician Fee Schedule Payment (MPFS or PFS),
 Hospital Outpatient Prospective Payment System (OPPS),  Hospital Outpatient Prospective Payment System (OPPS),
 Ambulatory Surgical Center Payment System (ASC Payment System),  Ambulatory Surgical Center Payment System (ASC Payment System),
 Acute Inpatient Prospective Payment System (IPPS),  Acute Inpatient Prospective Payment System (IPPS),
 Long-Term Care Hospital Prospective Payment System (LTCH PPS),  Long-Term Care Hospital Prospective Payment System (LTCH PPS),
 Skilled Nursing Facility Prospective Payment System (SNF PPS),  Skilled Nursing Facility Prospective Payment System (SNF PPS),
 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS),  Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS),
 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS),  Inpatient Psychiatric Facility Prospective Payment System (IPF PPS),
 Home Health Prospective Payment System (Home Health PPS),  Home Health Prospective Payment System (Home Health PPS),
 End Stage Renal Disease Prospective Payment System (ESRD PPS), and  End Stage Renal Disease Prospective Payment System (ESRD PPS), and
 Hospice Wage Index and Payment Rate.  Hospice Wage Index and Payment Rate.
As Medicare FFS payment system proposed and final rules are issued, they impact payments As Medicare FFS payment system proposed and final rules are issued, they impact payments
received by health care facilities and providers. Congressional Members and committees may received by health care facilities and providers. Congressional Members and committees may
comment, and are often contacted by provider and beneficiary groups. Tracking the status and comment, and are often contacted by provider and beneficiary groups. Tracking the status and
requirements for specific rules can be onerous, because they have different schedules and web requirements for specific rules can be onerous, because they have different schedules and web
locations. This report contains information on these payment system rules in a quick reference locations. This report contains information on these payment system rules in a quick reference
table. table.
To learn more about these payment systems, please see applicable sections of CRS Report To learn more about these payment systems, please see applicable sections of CRS Report
R40425, R40425, Medicare Primer. In addition, the Medicare Payment Advisory Commission (MedPAC) . In addition, the Medicare Payment Advisory Commission (MedPAC)
produces Payment Basics,1 a series of brief overviews of how Medicare’s payment systems produces Payment Basics,1 a series of brief overviews of how Medicare’s payment systems
function. function.
Medicare Fee-For-Service Payment System Rules:
Schedules and Resources
Medicare FFS payment system rules and the associated statutory and regulatory requirements Medicare FFS payment system rules and the associated statutory and regulatory requirements
regarding timeline and public comment can be difficult to locateregarding timeline and public comment can be difficult to locate. Table 1 compiles the payment compiles the payment
systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the
typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued
proposed and final rules, including agency docket numbers, proposed and final rules, including agency docket numbers, Federal Register citations, public citations, public
comments available on Regulations.gov, and any corrections issued. The table also includes comments available on Regulations.gov, and any corrections issued. The table also includes
embedded links to the applicable resources and notes when rulemaking timelines and comment embedded links to the applicable resources and notes when rulemaking timelines and comment
periods are not specified. Not all payment systems include detailed statutory and regulatory periods are not specified. Not all payment systems include detailed statutory and regulatory
requirements, as noted in the table. requirements, as noted in the table.

1 MedPAC, 1 MedPAC, Payment Basics, at http://medpac.gov/-documents-/payment-basics. , at http://medpac.gov/-documents-/payment-basics.
Congressional Research Service Congressional Research Service

1 1

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Table 1. Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources
Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Payment Policies Under Payment Policies Under
July-August November July-August November
42 USC §1395w-4: Payment for 42 USC §1395w-4: Payment for
N/A N/A
2021 Final Rule (12/28/2020)2022 Proposed Rule
the Physician Fee the Physician Fee
physicians’ services physicians’ services
CMS-1734-F(7/23/2021) CMS-1751-P
Schedule Schedule
(b)(1) “Before November 1 of (b)(1) “Before November 1 of
85 FR 84472 86 FR 39104

the preceding year, for each year the preceding year, for each year
Corrections: 86 FR 5020Comments: Regulations.gov
Medicare Physician Fee Medicare Physician Fee
beginning with 1998, subject to beginning with 1998, subject to
(1/19/2021) and 86 FR 14690CMS-2021-0119
Schedule Payment (PFS) Schedule Payment (PFS)
subsection (p), the Secretary subsection (p), the Secretary
(3/18/2021)
shall establish, by regulation, fee shall establish, by regulation, fee
schedules that establish payment schedules that establish payment

amounts for all physicians'
2021 Proposed Rule
services furnished in all fee
(8/17/2020) CMS-1734-P
2021 Final Rule amounts for all physicians' (12/28/2020) CMS-1734-F services furnished in all fee schedule areas (as defined in schedule areas (as defined in
85 FR 85 FR 50074
84472 subsection (j)(2)) for the year." subsection (j)(2)) for the year."
Comments:

Regulations.gov CMS-2020-
Note: public comment is not
0088
Corrections: 86 FR 5020 (1/19/2021) and 86 FR 14690 (3/18/2021) Note: Public comment is not addressed broadly for PFS in addressed broadly for PFS in

statute. However, public statute. However, public
comment is addressed for
2020 Final Rule (11/15/2019) 2021 Proposed Rule comment is addressed for (8/17/2020) CMS-1734-P
aspects of the physician payment aspects of the physician payment
CMS-1715-F
system, such as the development system, such as the development
84 FR 62568
85 FR 50074 of categories and codes. of categories and codes.

2020 Proposed Rule
(8/14/2019) CMS-1715-P
84 FR 40482
Comments: Regulations.gov CMS-2020-0088 2020 Final Rule (11/15/2019) CMS-1715-F 84 FR 62568 2020 Proposed Rule (8/14/2019) CMS-1715-P 84 FR 40482 CRS-2 link to page 14 Rule Name Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Issued Payment System(s)a Rule Final Rule Statutory Regulatory Rule(s) Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0111 CMS-2019-0111
Hospital Outpatient Hospital Outpatient
July-August November July-August November
42 USC §1395l: Payment of 42 USC §1395l: Payment of
42 CFR §419.50 Annual review. 42 CFR §419.50 Annual review.
2021 Final2022 Proposed Rule
Prospective Payment and Prospective Payment and
-December benefits -December benefits

( (12/29/2020)
8/4/2021) CMS-1753-P Ambulatory Surgical Ambulatory Surgical
(t) Prospective payment system (t) Prospective payment system
Center Payment Systems Center Payment Systems
42 CFR §416.130 Publication of revised 42 CFR §416.130 Publication of revised
CMS-1736-FC
86 FR 42018 for hospital outpatient for hospital outpatient
payment methodologies. payment methodologies.

department services department services
85 FR 85866
CRS-2

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Hospital Outpatient

"Whenever CMS proposes to revise the
Corrections: 86 FR 11428
Prospective Payment
Note: specific timelines for
payment rate for ASCs, CMS publishes a notice
(2/25/2021)
System (OPPS)
rulemaking and comments areComments: Regulations.gov "Whenever CMS proposes to revise the CMS-2021-0124 Hospital Outpatient payment rate for ASCs, CMS publishes a notice Prospective Payment Note: Specific timelines for
in the Federal Register describing the revision. in the Federal Register describing the revision.


not addressed in statute. System (OPPS) rulemaking and comments are
The notice also explains the basis on which the The notice also explains the basis on which the
2021 Final Rule not addressed in statute. rates were established. After reviewing public rates were established. After reviewing public
2021 Proposed Rule
(12/29/2020) CMS-1736-FC Ambulatory Surgical Ambulatory Surgical

comments, CMS publishes a notice establishing comments, CMS publishes a notice establishing
(8/12/2020)
85 FR 85866 Center (ASC) Payment Center (ASC) Payment
42 USC §1395l: Payment of
the rates authorized by this section. In setting the rates authorized by this section. In setting
System
CMS-1736-P
benefits42 USC §1395l: Payment of Corrections: 86 FR 11428 System
these rates, CMS may adopt reasonable these rates, CMS may adopt reasonable
85 FR 48772
(i) Outpatient surgerybenefits (2/25/2021)
classifications of facilities and may establish classifications of facilities and may establish
Comments:
“Taking into account the(i) Outpatient surgery
different rates for different types of surgical different rates for different types of surgical
recommendations in the report
procedures."
Regulations.gov CMS-2020-
“Taking into account the procedures." 2021 Proposed Rule recommendations in the report (8/12/2020) CMS-1736-P under section 626(d) of under section 626(d) of
009085 FR 48772
Medicare Prescription Drug, Medicare Prescription Drug,

Improvement, and Modernization Improvement, and Modernization
2020 Final RuleComments: Regulations.gov
Act of 2003, the Secretary shall Act of 2003, the Secretary shall
(11/27/2019)
CMS-2020-0090 implement a revised payment implement a revised payment
system for payment of surgical system for payment of surgical
CMS-1717-F2
2020 Final Rule services furnished in ambulatory services furnished in ambulatory
84 FR 65524
surgical centers."


2020 Proposed Rule
Note: specific timelines for
(8/9/2019)
rulemaking and comments
surgical centers." (11/27/2019) CMS-1717-F2 84 FR 65524 Note:Sspecific timelines for rulemaking and comments 2020 Proposed Rule beyond the initial year are not beyond the initial year are not
(8/9/2019) CMS-1717-P CMS-1717-P
addressed in statute. addressed in statute.
84 FR 39398 84 FR 39398
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0109 CMS-2019-0109
CRS-3 link to page 14 Rule Name Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Issued Payment System(s)a Rule Final Rule Statutory Regulatory Rule(s) Hospital Inpatient Hospital Inpatient
April-May April-May
August- August-
42 USC §1395ww: Payments to 42 USC §1395ww: Payments to
42 CFR §412.8 Publication of schedules for 42 CFR §412.8 Publication of schedules for
2022 ProposedFinal Rule
Prospective Payment Prospective Payment
October October
hospitals for inpatient hospital hospitals for inpatient hospital
determining prospective payment rates. determining prospective payment rates.
( (5/10/2021)
8/13/2021) CMS-1752-F Systems for Acute Care Systems for Acute Care
services services
"(b) Annual publication of schedule for "(b) Annual publication of schedule for
CMS-1752-P
Hospitals and the Long-Hospitals and the Long-
86 FR 44774 (e)(1)(C)(5) (e)(1)(C)(5)
determining prospective payment rates. (1) determining prospective payment rates. (1)
Term Care Hospital Term Care Hospital
86 FR 25070
CMS proposes changes in the methods, CMS proposes changes in the methods,
Prospective Payment Prospective Payment
“The Secretary shall cause to “The Secretary shall cause to
amounts, and factors used to determine amounts, and factors used to determine
Comments: Regulations.gov
2022 Proposed Rule System System
have published in the Federal have published in the Federal
CMS-2021-0070
Register, not later than- (A) the Register, not later than- (A) the
inpatient prospective payment rates in a inpatient prospective payment rates in a
Federal Register document published for public

CRS-3

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)

April 1 before each fiscal year
(5/10/2021) CMS-1752-P April 1 before each fiscal year Federal Register document published for public 86 FR 25070 Acute Inpatient (beginning with fiscal year 1986), comment not later than the April 1 before the comment not later than the April 1 before the
2021 Final Rule
Acute Inpatient
(beginning with fiscal year 1986),Corrections: 86 FR 33157 Prospective Payment the Secretary’s proposed
beginning of the Federal fiscal year in which the beginning of the Federal fiscal year in which the
( (9/18/2020)
Prospective Payment
the Secretary’s proposed6/24/2021) System (IPPS) recommendations under
proposed changes would apply. proposed changes would apply.
CMS-1735-F
System (IPPS)
recommendations underComments: Regulations.gov paragraph (4) for that fiscal year (2) Except as provided in paragraph (c) of this for public comment, and (B) the section, CMS publishes a Federal Register CMS-2021-0070 August 1 before such fiscal year document setting forth final methods, amounts, Long-Term Care after such consideration of public and factors for determining inpatient 2021 Final Rule Hospital Prospective comment on the proposal as is prospective payment rates not later than the Payment System (LTCH feasible in the time available, the August 1 before the Federal fiscal year in which (9/18/2020) CMS-1735-F PPS) Secretary's final the rates would apply." 85 FR 58432 recommendations under such Corrections: 85 FR 78748 paragraph for that year." 42 CFR §412.535 Publication of the Federal (12/7/2020) prospective payment rates. 42 USC §1395ww: Payments to "Except as specified in paragraph (b), CMS 2021 Proposed Rule hospitals for inpatient hospital publishes information pertaining to the long- (5/29/2020) CMS-1735-P services term care hospital prospective payment system 85 FR 32460 (m) Prospective payment for effective for each annual update in the Federal long-term care hospitals Register. Comments: Regulations.gov CMS-2020-0052 (c) For the period beginning on or after Note: Specific timelines for October 1, 2009, information on the rulemaking and comments for unadjusted Federal payment rates and a 2020 Final Rule Long-Term Care Hospital PPS description of the methodology and data used (8/16/2019) CMS-1716-F are not addressed in statute. to calculate the payment rates are published on or before August 1 prior to the start of the 84 FR 42044 Federal fiscal year which begins October 1, CRS-4 link to page 14 Rule Name Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Issued Payment System(s)a Rule Final Rule Statutory Regulatory Rule(s) unless for good cause it is published after 2020 Proposed Rule August 1, but before September 1. (5/3/2019) CMS-1716-P (d) Information on the LTC-DRG classification 84 FR 19158 and associated weighting factors is published on or before August 1 prior to the beginning of Corrections: 84 FR 28263 each Federal fiscal year." (6/18/2019) Comments: Regulations.gov CMS-2019-0073 Prospective Payment April-May August 42 USC §1395yy: Payment to 42 CFR §413.345 Publication of Federal 2022 Final Rule System and skilled nursing facilities for prospective payment rates. (8/4/2021) CMS-1746-F Consolidated Billing for routine service costs "CMS publishes information pertaining to each Skilled Nursing Facilities 86 FR 42424 (e)(4)(H) update of the Federal payment rates in the (SNF) “The Secretary shall provide for Federal Register. This information includes the publication in the Federal standardized Federal rates, the resident 2022 Proposed Rule Skilled Nursing Facility Register, before May 1, 1998 classification system that provides the basis for (4/15/2021) CMS- 1746-P Prospective Payment (with respect to fiscal period case-mix adjustment, and the factors to be 86 FR 19954
(2) Except as provided in paragraph (c) of this
paragraph (4) for that fiscal year
85 FR 58432

section, CMS publishes a Federal Register
for public comment, and (B) the
document setting forth final methods, amounts,
Corrections: 85 FR 78748

August 1 before such fiscal year
and factors for determining inpatient
(12/7/2020)
Long-Term Care
after such consideration of public prospective payment rates not later than the

Hospital Prospective
comment on the proposal as is
August 1 before the Federal fiscal year in which
Payment System (LTCH
feasible in the time available, the
2021 Proposed Rule
the rates would apply."
PPS)
Secretary's final
(5/29/2020)
recommendations under such

CMS-1735-P
paragraph for that year."
42 CFR §412.535 Publication of the Federal
85 FR 32460

prospective payment rates.
Comments: Regulations.gov
42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
CMS-2020-0052
hospitals for inpatient hospital
publishes information pertaining to the long-

services
term care hospital prospective payment system
effective for each annual update in the Federal
2020 Final Rule (8/16/2019)
(m) Prospective payment for
Register.
long-term care hospitals
CMS-1716-F
(c) For the period beginning on or after

84 FR 42044
October 1, 2009, information on the
Note: specific timelines for
unadjusted Federal payment rates and a

rulemaking and comments for
description of the methodology and data used
2020 Proposed Rule
Long-Term Care Hospital PPS
to calculate the payment rates are published on
(5/3/2019)
are not addressed in statute.
or before August 1 prior to the start of the
CMS-1716-P
Federal fiscal year which begins October 1,
unless for good cause it is published after
84 FR 19158
August 1, but before September 1.
Corrections: 84 FR 28263
(d) Information on the LTC-DRG classification
(6/18/2019)
and associated weighting factors is published on Comments:
or before August 1 prior to the beginning of
Regulations.gov CMS-2019-
each Federal fiscal year."
0073
CRS-4

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Prospective Payment
April-May
August
42 USC §1395yy: Payment to
42 CFR §413.345 Publication of Federal
2022 Proposed Rule
System and
skilled nursing facilities for
prospective payment rates.
(4/15/2021)
Consolidated Billing for
routine service costs
"CMS publishes information pertaining to each
CMS- 1746-P
Skilled Nursing Facilities
(e)(4)(H)
update of the Federal payment rates in the
(SNF)
86 FR 19954
“The Secretary shall provide for
Federal Register. This information includes the

Comments: Regulations.gov
publication in the Federal
standardized Federal rates, the resident
CMS-2021-0062
Skilled Nursing Facility
Register, before May 1, 1998
classification system that provides the basis for
Prospective Payment
(with respect to fiscal period
case-mix adjustment, and the factors to be

System (SNF PPS)
described in subparagraph (E)(i))
applied in making the area wage adjustment.
2021 Final Rule
This information is published before May 1 for

and before the August 1
(8/5/2020)
System (SNF PPS) described in subparagraph (E)(i)) applied in making the area wage adjustment. Comments: Regulations.gov and before the August 1 This information is published before May 1 for CMS-2021-0062 preceding each succeeding fiscal preceding each succeeding fiscal
the fiscal year 1998 and before August 1 for the the fiscal year 1998 and before August 1 for the CMS-1737-F
year (with respect to that year (with respect to that
fiscal years 1999 and after." fiscal years 1999 and after."
succeeding fiscal year), of- succeeding fiscal year), of-

85 FR 47594
2021 Final Rule (i) the unadjusted Federal per (i) the unadjusted Federal per

(8/5/2020) CMS-1737-F diem rates to be applied to days diem rates to be applied to days
2021 Proposed Rule85 FR 47594
of covered skilled nursing facility of covered skilled nursing facility
(4/15/2020)
services furnished during the services furnished during the
CMS-1737-P
fiscal year, fiscal year,
85 FR 20914
2021 Proposed Rule (ii) the case mix classification (ii) the case mix classification
(4/15/2020) CMS-1737-P system to be applied under system to be applied under
Comments: Regulations.gov85 FR 20914
subparagraph (G)(i) with respect subparagraph (G)(i) with respect
CMS-2020-0036
Comments: Regulations.gov to such services during the fiscal to such services during the fiscal

CMS-2020-0036 year, and year, and
2020 Final Rule
(iii) the factors to be applied in (iii) the factors to be applied in
(8/7/2019)
making the area wage adjustmentmaking the area wage adjustment
CMS-1718-F
under subparagraph (G)(ii) with
respect to such services."
84 FR 38728


Note: the timeline for the
2020 Proposed 2020 Final Rule Rule
proposed rule and comments are
(4/25/2019)
not addressed in statute.
CMS-1718-P
84 FR 17620
Comments:
CRS-5 CRS-5

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
under subparagraph (G)(ii) with (8/7/2019) CMS-1718-F respect to such services." 84 FR 38728 Note: The timeline for the 2020 Proposed Rule proposed rule and comments are not addressed in statute. (4/25/2019) CMS-1718-P 84 FR 17620 Comments: Regulations.gov CMS-2019-Regulations.gov CMS-2019-
0070 0070
Inpatient Rehabilitation Inpatient Rehabilitation
April-May April-May
August August
42 USC §1395ww: Payments to 42 USC §1395ww: Payments to
42 CFR §412.628 Publication of the Federal 42 CFR §412.628 Publication of the Federal
2022 ProposedFinal Rule
Facility Prospective Facility Prospective
hospitals for inpatient hospital hospitals for inpatient hospital
prospective payment rates. prospective payment rates.
( (4/12/2021)
8/4/2021) CMS-1748-F Payment System Payment System
services services
"We publish information pertaining to the "We publish information pertaining to the
CMS-1748-P86 FR 42362

(j)(5) (j)(5)
inpatient rehabilitation facility prospective inpatient rehabilitation facility prospective
86 FR 19086
Inpatient Rehabilitation Inpatient Rehabilitation
“The Secretary shall provide for “The Secretary shall provide for
payment system effective for each fiscal year in payment system effective for each fiscal year in
Comments: Regulations.gov
Facility Prospective Facility Prospective
publication in the Federal publication in the Federal
the Federal Register. This information includes the Federal Register. This information includes
2022 Proposed Rule Payment System (IRF Payment System (IRF
Register, on or before August 1 Register, on or before August 1
the unadjusted Federal payment rates, the the unadjusted Federal payment rates, the
CMS-2021-0057(4/12/2021) CMS-1748-P
PPS) PPS)
before each fiscal year (beginning before each fiscal year (beginning
patient classification system and associated patient classification system and associated

86 FR 19086 with fiscal year 2001), of the with fiscal year 2001), of the
weighting factors, and a description of the weighting factors, and a description of the
2021 Final Rule (8/10/2020)Comments: Regulations.gov
classification and weighting classification and weighting
methodology and data used to calculate the methodology and data used to calculate the
CMS-1729-F
factors for case mix groups factors for case mix groups
payment rates. This information is published on payment rates. This information is published on CMS-2021-0057
under paragraph (2) for such under paragraph (2) for such
or before August 1 prior to the beginning of or before August 1 prior to the beginning of
85 FR 48424
fiscal year and a description of fiscal year and a description of
each fiscal year." each fiscal year."

2021 Final Rule the methodology and data used the methodology and data used
2021 Proposed Rule
in computing the prospective in computing the prospective
( (4/21/2020)
8/10/2020) CMS-1729-F payment rates under this payment rates under this
85 FR 48424 subsection for that fiscal year." subsection for that fiscal year."
CMS-1729-P

85 FR 22065
2021 Proposed Rule Note: Only the final rule Note: Only the final rule
Comments: Regulations.gov(4/21/2020) CMS-1729-P
deadline is specified, the deadline is specified, the
CMS-2020-003985 FR 22065
proposed rule is not addressed proposed rule is not addressed

in statute. Public comment is not in statute. Public comment is not
2020 Final Rule
Comments: Regulations.gov addressed in statute. addressed in statute.
(8/8/2019)
CMS-1710-F
84 FR 39054

2020 Proposed Rule
(4/24/2019)
84 FR 17244
CMS-2020-0039 CRS-6 CRS-6

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
2020 Final Rule (8/8/2019) CMS-1710-F 84 FR 39054 2020 Proposed Rule (4/24/2019) CMS-1710-P 84 FR 17244 Corrections: 84 FR 24734 Corrections: 84 FR 24734
(5/29/2019) (5/29/2019)
Comments: Comments:
Regulations.gov CMS-2019-Regulations.gov CMS-2019-
0066 0066
Inpatient Psychiatric Inpatient Psychiatric
April-May April-May
August August
42 USC §1395ww: Payments to 42 USC §1395ww: Payments to
42 CFR §412.428 Publication of changes to the 42 CFR §412.428 Publication of changes to the
2022 ProposedFinal Rule
Facilities Prospective Facilities Prospective
hospitals for inpatient hospital hospitals for inpatient hospital
inpatient psychiatric facility prospective inpatient psychiatric facility prospective
( (4/138/4/2021) /2021)
CMS-1750-F Payment System Payment System
services services
payment system. payment system.
CMS-1750-P86 FR 42608

(s) Prospective payment for (s) Prospective payment for
“CMS will issue annually in the Federal Register “CMS will issue annually in the Federal Register
86 FR 19480
Inpatient Psychiatric Inpatient Psychiatric
psychiatric hospitals psychiatric hospitals
information pertaining to changes to the information pertaining to changes to the
Comments: Regulations.gov
Facility Prospective Facility Prospective

inpatient psychiatric facility prospective inpatient psychiatric facility prospective
2022 Proposed Rule Payment System (IPF Payment System (IPF
payment system." payment system."
CMS-2021-0060
Note: specific timelines for Note: specific timelines for
(4/13/2021) CMS-1750-P PPS) PPS)
rulemaking and comments for rulemaking and comments for

86 FR 19480 Inpatient Psychiatric Facility PPS Inpatient Psychiatric Facility PPS
2021 Final RuleComments: Regulations.gov
are not addressed in statute. are not addressed in statute.
(8/4/2020)
CMS-2021-0060 Deadlines for quality measures Deadlines for quality measures
CMS-1731-F
are specified.
85 FR 47042
Corrections: 85 FR 52923
(8/27are specified. 2021 Final Rule (8/4/2020) CMS-1731-F 85 FR 47042 Corrections: 85 FR 52923 (8/27/2020) 2021 Proposed Rule/2020)

2021 Proposed Rule
(4/14/2020)
CMS-1731-P
85 FR 20625
Comments: Regulations.gov
CMS-2020-0035

2020 Final Rule
(8/6/2019)
CMS-1712-F
CRS-7 CRS-7

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
(4/14/2020) CMS-1731-P 85 FR 20625 Comments: Regulations.gov CMS-2020-0035 2020 Final Rule (8/6/2019) CMS-1712-F 84 FR 38424 84 FR 38424

2020 Proposed Rule
(4/23/2019) (4/23/2019)
CMS-1712-P CMS-1712-P
84 FR 16948 84 FR 16948
Comments: Comments:
Regulations.gov CMS-2019-Regulations.gov CMS-2019-
0067 0067
Home Health Home Health
July July
November November
42 USC §1395fff: Prospective 42 USC §1395fff: Prospective
42 CFR §484.225 Annual update of the 42 CFR §484.225 Annual update of the
2021 Final2022 Proposed Rule
Prospective Payment Prospective Payment
payment for home health payment for home health
unadjusted national, standardized prospective unadjusted national, standardized prospective
( (11/4/2020)
7/7/2021) CMS-1747-P System System
services services
payment rates. payment rates.
CMS-1730-F
86 FR 35874

“CMS annually updates the unadjusted national, “CMS annually updates the unadjusted national,
85 FR 70298Comments: Regulations.gov
Home Health Home Health
Note: Note: specificSpecific timelines for timelines for
standardized prospective payment rate on a standardized prospective payment rate on a
CMS-2021-0112 Prospective Payment Prospective Payment
rulemaking and comments for rulemaking and comments for
calendar year basis (in accordance with section calendar year basis (in accordance with section

System (Home Health System (Home Health
Home Health PPS are not Home Health PPS are not
1895(b)(1)(B) of the Ac 1895(b)(1)(B) of the Act)."b
2021 Proposed Rule
PPS) PPS)
addressed in statute. addressed in statute.
(6/30/2020)
CMS-1730-P
85 FR 39408
Corrections: 85 FR 43805
(7/20/2020)
Comments:
Regulations.gov CMS-2020-
0077

2020 Final Rule
(11/8/2019)
CMS-1711-FC
84 FR 604782021 Final Rule (11/4/2020) CMS-1730-F 85 FR 70298 2021 Proposed Rule (6/30/2020) CMS-1730-P 85 FR 39408 Corrections: 85 FR 43805 (7/20/2020)
CRS-8 CRS-8

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)

2020 Proposed Rule
(7/18/2019)
Comments: Regulations.gov CMS-2020-0077 2020 Final Rule (11/8/2019) CMS-1711-FC 84 FR 60478 2020 Proposed Rule (7/18/2019) CMS-1711-P CMS-1711-P
84 FR 34598 84 FR 34598
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0100 CMS-2019-0100
End-Stage Renal Disease End-Stage Renal Disease
July July
November November
42 USC §1395rr: End stage renal 42 USC §1395rr: End stage renal
42 CFR §413.196 Notification of changes in 42 CFR §413.196 Notification of changes in
2021 Final2022 Proposed Rule
Prospective Payment Prospective Payment
disease program disease program
rate-setting methodologies and payment rates. rate-setting methodologies and payment rates.
( (11/9/2020)
7/9/2021) CMS-1749-P System System

“(b) Changes in payment rates resulting from “(b) Changes in payment rates resulting from
CMS-1732-F
86 FR 36322
Note: Note: specificSpecific timelines for timelines for
incorporation of updated cost data or general incorporation of updated cost data or general
85 FR 71398Comments: Regulations.gov
End Stage Renal Disease End Stage Renal Disease
rulemaking and comments for rulemaking and comments for
revisions of geographic labor cost adjustment revisions of geographic labor cost adjustment CMS-2021-0114
Prospective Payment Prospective Payment
ESRD PPS are not addressed in ESRD PPS are not addressed in
factors are announced by notice published in factors are announced by notice published in

System (ESRD PPS) System (ESRD PPS)
statute. statute.
the Federal Register without opportunity for the Federal Register without opportunity for
2021 Proposed Rule
prior comment. Revisions of the rate-setting prior comment. Revisions of the rate-setting
(7/13/2020)
2021 Final Rule methodology are published in the Federal methodology are published in the Federal
(11/9/2020) CMS-1732-F Register in accordance with the Department’s Register in accordance with the Department’s
CMS-1732-P
85 FR 71398 established rulemaking procedures." established rulemaking procedures."
2021 Proposed Rule (7/13/2020) CMS-1732-P 85 FR 42132 85 FR 42132
Comments: Comments:
Regulations.gov CMS-2020-Regulations.gov CMS-2020-
0079 0079

2020 Final Rule
(11/8/2019)
CMS-1713-F
84 FR 60648

2020 Proposed Rule
(8/6/2019)
CMS-1713-P
CRS-9 CRS-9

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
(11/8/2019) CMS-1713-F 84 FR 60648 2020 Proposed Rule (8/6/2019) CMS-1713-P 84 FR 38330 84 FR 38330
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0110 CMS-2019-0110
Hospice Wage Index and April-May Hospice Wage Index and April-May
August August
42 USC §1395f: Conditions of 42 USC §1395f: Conditions of
42 CFR §418.306 Annual update of the 42 CFR §418.306 Annual update of the
2022 ProposedFinal Rule
Payment Rate Payment Rate
and limitations on payment for and limitations on payment for
payment rates and adjustment for area wage payment rates and adjustment for area wage
( (4/148/4/2021) /2021)
CMS-1754-F
services services
differences. differences.
CMS-1754-P86 FR 42528
Hospice Wage Index and Hospice Wage Index and
(i) Payment for hospice care (i) Payment for hospice care
“(b) Annual update of the payment rates. The “(b) Annual update of the payment rates. The
86 FR 19700
Payment Rate Payment Rate

payment rates for routine home care and other payment rates for routine home care and other
services included in hospice care are the services included in hospice care are the
Comments: Regulations.gov2022 Proposed Rule
Note: Note: specificSpecific timelines for timelines for
payment rates in effect under this paragraph payment rates in effect under this paragraph
rulemaking and comments for rulemaking and comments for
CMS-2021-0061(4/14/2021) CMS-1754-P
during the previous fiscal year increased by the during the previous fiscal year increased by the
hospice payment rates are not hospice payment rates are not

86 FR 19700 hospice payment update percentage increase hospice payment update percentage increase
addressed in statute. addressed in statute.
(as defined in sections1814(i)(1)(C) of the Act), (as defined in sections1814(i)(1)(C) of the Act),
2021 Final Rule
Comments: Regulations.gov applicable to discharges occurring in the fiscal applicable to discharges occurring in the fiscal
(8/4/2020)CMS-2021-0061
year."b
2021 Final Rule (8/4/2020) CMS-1733-F CMS-1733-F
85 FR 47070 85 FR 47070

2021 Proposed Rule
(4/15/2020) (4/15/2020)
CMS-1733-P CMS-1733-P
85 FR 20949 85 FR 20949
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0037 CMS-2020-0037

2020 Final Rule
(8/6/2019)
CMS-1714-F
84 FR 38484

2020 Proposed Rule
CRS-10 CRS-10

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
2020 Final Rule (8/6/2019) CMS-1714-F 84 FR 38484 2020 Proposed Rule (4/25/2019) (4/25/2019)
CMS-1714-P CMS-1714-P
84 FR 17570 84 FR 17570
Comments: Comments:
Regulations.gov CMS-2019-Regulations.gov CMS-2019-
0068 0068
Source: Compiled by the Congressional Research Service (CRS). Compiled by the Congressional Research Service (CRS).
Notes: Table compiled using Table compiled using the Centers for Medicare & Medicaid Services (CMS)Centers for Medicare & Medicaid Services (CMS) websites, , Federal Register, and Regulations.gov. In some cases, although multiple payment , and Regulations.gov. In some cases, although multiple payment
systems are covered by one rule, they are combined here in one row but listed separately. Typical months when proposed and final rules systems are covered by one rule, they are combined here in one row but listed separately. Typical months when proposed and final rules are issued can vary, and the months issued can vary, and the months
we list are based on CRS analysis of Federal Register publication dates from the past 10 years. Additionally, corrections are sometimes issued after the final rule. we list are based on CRS analysis of Federal Register publication dates from the past 10 years. Additionally, corrections are sometimes issued after the final rule.
a. Some Medicare FFS payment systems are not updated through notice and comment or on an annual basis, but only periodically. These include Clinical Laboratory a. Some Medicare FFS payment systems are not updated through notice and comment or on an annual basis, but only periodically. These include Clinical Laboratory
Fee Schedule, Shared Savings Program, and Ambulance Fee Schedule. Please see the embedded CMS links for more information, including the most recent rules. Fee Schedule, Shared Savings Program, and Ambulance Fee Schedule. Please see the embedded CMS links for more information, including the most recent rules.
b. At times, regulations reference the Social Security Act rather than the b. At times, regulations reference the Social Security Act rather than the U.S. Code citation. The Social Security Administration provides a cross-reference table at citation. The Social Security Administration provides a cross-reference table at
https://www.ssa.gov/OP_Home/comp2/G-APP-H.html. https://www.ssa.gov/OP_Home/comp2/G-APP-H.html.

CRS-11 CRS-11

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Finding Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resource




Author Information

Michele L. Malloy Michele L. Malloy

Research Librarian Research Librarian


Acknowledgments
CRS Analysts Jim Hahn, Marco Villagrana, and Phoenix Voorhies aided in the compilation and review of CRS Analysts Jim Hahn, Marco Villagrana, and Phoenix Voorhies aided in the compilation and review of
the statutory and regulatory requirements of selected payment system rules. the statutory and regulatory requirements of selected payment system rules.

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
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Congressional Research Service Congressional Research Service
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