Finding Medicare Fee-For-Service (FFS)
August 20December 21, 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 are updated annually
through regulations. These proposed and final rules follow 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 care facilities and providers. Congressional
membersMembers and committees may comment, and are often contacted by 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
link to page 4 link to page 4 link to page 5 link to page 5 link to page
link to page 4 link to page 4 link to page 5 link to page 5 link to page
1516 Finding Medicare Fee-For-Service (FFS) Payment System Rules
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 ........................................................................................................................ 1213
Congressional Research Service
Congressional Research Service
link to page 5
link to page 5
Finding Medicare Fee-For-Service (FFS) Payment System Rules
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 regarding timeline and public comment can be difficult to
locatelocate. 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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1415
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
Issued Rule(s)
Payment Policies Under
Payment Policies Under
the July-August November July-August November
42 USC §1395w-4: Payment for
42 USC §1395w-4: Payment for
N/A
N/A
2022 ProposedFinal Rule
the Physician Fee Physician Fee
Schedule
physicians’ services
physicians’ services
(
(
7/2311/19/2021) CMS-1751-/2021) CMS-1751-
P
Schedule F
(b)(1) “Before November 1 of
(b)(1) “Before November 1 of
86 FR
86 FR
39104
64996
Medicare Physician Fee
the preceding year, for each year
the preceding year, for each year
Comments: Regulations.gov
Medicare Physician Fee
beginning with 1998, subject to
CMS-2021-0119
Schedule Payment (PFS)
Schedule Payment (PFS)
beginning with 1998, subject to subsection (p), the Secretary subsection (p), the Secretary
2022 Proposed Rule
shall establish, by regulation, fee shall establish, by regulation, fee
(7/23/2021) CMS-1751-P
schedules that establish payment
schedules that establish payment
2021 Final Rule 86 FR 39104
amounts for all physicians'
amounts for all physicians'
(12/28/2020) CMS-1734-F
services furnished in all fee services furnished in all fee
Comments: Regulations.gov
schedule areas (as defined in schedule areas (as defined in
85 FR 84472CMS-2021-0119
subsection (j)(2)) for the year."
subsection (j)(2)) for the year."
Corrections: 86 FR 5020
(1/19/2021) and 86 FR 14690 (3/18/2021)
Note: Public comment is not
2021 Final Rule
Note: Public comment is not
(12/28/2020) CMS-1734-F
addressed broadly for PFS in addressed broadly for PFS in
85 FR 84472
statute. However, public
statute. However, public
2021 Proposed Rule
comment is addressed for
(8/17/2020) CMS-1734-P
aspects of the physician payment comment is addressed for
Corrections: 86 FR 5020
aspects of the physician payment
(1/19/2021) and 86 FR 14690
system, such as the development system, such as the development
85 FR 50074 (3/18/2021)
of categories and codes.
of categories and codes.
Comments: Regulations.gov CMS-2020-0088
2020 Final
2021 Proposed 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 Name8/17/2020) CMS-1734-P 85 FR 50074 Comments: Regulations.gov CMS-2020-0088 2020 Final Rule (11/15/2019) CMS-1715-F 84 FR 62568
CRS-2
link to page 15
Typically Issued
Requirements: Timeline and Public Comment
Rule Name and
Proposed
Most Recently Issued
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2020 Proposed Rule (8/14/2019) CMS-1715-P 84 FR 40482 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.
2022 ProposedFinal Rule
Prospective Payment and
Prospective Payment and
-December benefits
-December benefits
(
(
8/411/16/2021) CMS-1753-/2021) CMS-1753-
PFC
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
86 FR
86 FR
4201863458
for hospital outpatient
for hospital outpatient
payment methodologies.
payment methodologies.
department services
department services
Comments: Regulations.gov
"Whenever CMS proposes to revise the
"Whenever CMS proposes to revise the
CMS-2021-0124
Hospital Outpatient Hospital Outpatient
2022 Proposed Rule
payment rate for ASCs, CMS publishes a notice payment rate for ASCs, CMS publishes a notice
Prospective Payment
Prospective Payment
Note: Specific timelines for Note: Specific timelines for
in the Federal Register describing the revision.
in the Federal Register describing the revision.
(8/4/2021) CMS-1753-P
System (OPPS) System (OPPS)
rulemaking and comments are
rulemaking and comments are
The notice also explains the basis on which the
The notice also explains the basis on which the
2021 Final Rule86 FR 42018
not addressed in statute.
not addressed in statute.
rates were established. After reviewing public
rates were established. After reviewing public
(12/29/2020) CMS-1736-FC Comments: Regulations.gov
Ambulatory Surgical
Ambulatory Surgical
comments, CMS publishes a notice establishing
comments, CMS publishes a notice establishing
85 FR 85866CMS-2021-0124
Center (ASC) Payment
Center (ASC) Payment
the rates authorized by this section. In setting
the rates authorized by this section. In setting
42 USC §1395l: Payment of
42 USC §1395l: Payment of
Corrections: 86 FR 11428
System
System
these rates, CMS may adopt reasonable
these rates, CMS may adopt reasonable
benefits
benefits
(2/25/2021)
classifications of facilities and may establish classifications of facilities and may establish
2021 Final Rule
(i) Outpatient surgery (i) Outpatient surgery
different rates for different types of surgical
different rates for different types of surgical
(12/29/2020) CMS-1736-FC
“Taking into account the
“Taking into account the
procedures."
procedures."
2021 Proposed Rule85 FR 85866
recommendations in the report
recommendations in the report
(8/12/2020) CMS-1736-P Corrections: 86 FR 11428
under section 626(d) of
under section 626(d) of
85 FR 48772(2/25/2021)
Medicare Prescription Drug,
Medicare Prescription Drug,
Improvement, and Modernization Improvement, and Modernization
Comments: Regulations.gov
Act of 2003, the Secretary shall
Act of 2003, the Secretary shall
CMS-2020-00902021 Proposed Rule
implement a revised payment
implement a revised payment
system for payment of surgical
2020 Final Rule
services furnished in ambulatory surgical centers."
(11/27/2019) CMS-1717-F2
84 FR 65524
Note:Sspecific
(8/12/2020) CMS-1736-P
system for payment of surgical services furnished in ambulatory
85 FR 48772
surgical centers."
Comments: Regulations.gov
CMS-2020-0090
Note: Specific timelines for timelines for
rulemaking and comments
rulemaking and comments
2020 Proposed Rule
beyond the initial year are not
(8/9/2019) CMS-1717-P
addressed in statute.
84 FR 39398 Comments: Regulations.gov CMS-2019-0109
Final Rule
CRS-3 CRS-3
link to page
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1415
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
Issued Rule(s)
beyond the initial year are not
(11/27/2019) CMS-1717-F2
addressed in statute.
84 FR 65524 2020 Proposed Rule (8/9/2019) CMS-1717-P 84 FR 39398 Comments: Regulations.gov CMS-2019-0109
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 Final Rule
Prospective Payment
Prospective Payment
October
October
hospitals for inpatient hospital
hospitals for inpatient hospital
determining prospective payment rates.
determining prospective payment rates.
(8/13/2021) CMS-1752-F
(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
Hospitals and the Long-
Hospitals and the Long-
86 FR 44774
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
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
2022 Proposed Rule
System
System
have published in the Federal
have published in the Federal
Register, not later than- (A) the Register, not later than- (A) the
inpatient prospective payment rates in a
inpatient prospective payment rates in a
(5/10/2021) CMS-1752-P
(5/10/2021) CMS-1752-P
April 1 before each fiscal year
April 1 before each fiscal year
Federal Register document published for public
Federal Register document published for public
86 FR 25070
86 FR 25070
Acute Inpatient
Acute Inpatient
(beginning with fiscal year 1986),
(beginning with fiscal year 1986),
comment not later than the April 1 before the
comment not later than the April 1 before the
Corrections: 86 FR 33157
Corrections: 86 FR 33157
Prospective Payment
Prospective Payment
the Secretary’s proposed
the Secretary’s proposed
beginning of the Federal fiscal year in which the
beginning of the Federal fiscal year in which the
(6/24/2021)
(6/24/2021)
System (IPPS)
System (IPPS)
recommendations under
recommendations under
proposed changes would apply.
proposed changes would apply.
Comments: Regulations.gov
Comments: Regulations.gov
paragraph (4) for that fiscal year
paragraph (4) for that fiscal year
(2) Except as provided in paragraph (c) of this
(2) Except as provided in paragraph (c) of this
for public comment, and (B) the
for public comment, and (B) the
section, CMS publishes a Federal Register
section, CMS publishes a Federal Register
CMS-2021-0070
CMS-2021-0070
Long-Term Care Hospital
August 1 before such fiscal year
August 1 before such fiscal year
document setting forth final methods, amounts,
document setting forth final methods, amounts,
Long-Term CareProspective Payment
after such consideration of public and factors for determining inpatient
after such consideration of public and factors for determining inpatient
System (LTCH PPS)
2021 Final Rule
Hospital Prospective
comment on the proposal as is comment on the proposal as is
prospective payment rates not later than the
prospective payment rates not later than the
Payment System (LTCH
feasible in the time available, the feasible in the time available, the
August 1 before the Federal fiscal year in which
August 1 before the Federal fiscal year in which
(9/18/2020) CMS-1735-F
(9/18/2020) CMS-1735-F
PPS)
Secretary's final Secretary's final
the rates would apply."
the rates would apply."
85 FR 58432
85 FR 58432
recommendations under such
recommendations under such
Corrections: 85 FR 78748
Corrections: 85 FR 78748
paragraph for that year."
paragraph for that year."
42 CFR §412.535 Publication of the Federal
42 CFR §412.535 Publication of the Federal
(12/7/2020)
(12/7/2020)
prospective payment rates.
prospective payment rates.
42 USC §1395ww: Payments to
42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
"Except as specified in paragraph (b), CMS
2021 Proposed Rule
hospitals for inpatient hospital
hospitals for inpatient hospital
publishes information pertaining to the long-
publishes information pertaining to the long-
(5/29/2020) CMS-1735-P
(5/29/2020) CMS-1735-P
services
services
term care hospital prospective payment system
term care hospital prospective payment system
85 FR 32460CRS-4
link to page 15
Typically Issued
Requirements: Timeline and Public Comment
Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
(m) Prospective payment for
(m) Prospective payment for
effective for each annual update in the Federal
effective for each annual update in the Federal
85 FR 32460
long-term care hospitals long-term care hospitals
Register.
Register.
Comments: Regulations.gov
Comments: Regulations.gov
CMS-2020-0052
(c) For the period beginning on or after
(c) For the period beginning on or after
CMS-2020-0052
Note: Specific timelines for
Note: Specific timelines for
October 1, 2009, information on the
October 1, 2009, information on the
rulemaking and comments for
rulemaking and comments for
unadjusted Federal payment rates and a
unadjusted Federal payment rates and a
2020 Final Rule
Long-Term Care Hospital PPS
Long-Term Care Hospital PPS
description of the methodology and data used
description of the methodology and data used
(8/16/2019) CMS-1716-F
are not addressed in statute. are not addressed in statute.
to calculate the payment rates are published on
to calculate the payment rates are published on
(8/16/2019) CMS-1716-F
or before August 1 prior to the start of the or before August 1 prior to the start of the
84 FR 42044
84 FR 42044
Federal fiscal year which begins October 1,
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 unless for good cause it is published after
2020 Proposed Rule
August 1, but before September 1. August 1, but before September 1.
(5/3/2019) CMS-1716-P 2020 Proposed Rule
(d) Information on the LTC-DRG classification
(d) Information on the LTC-DRG classification
84 FR 19158(5/3/2019) CMS-1716-P
and associated weighting factors is published on
and associated weighting factors is published on
84 FR 19158
or before August 1 prior to the beginning of or before August 1 prior to the beginning of
Corrections: 84 FR 28263
Corrections: 84 FR 28263
each Federal fiscal year."
each Federal fiscal year."
(6/18/2019)
(6/18/2019)
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0073 CMS-2019-0073
Prospective Payment
Prospective Payment
April-May
April-May
August
August
42 USC §1395yy: Payment to
42 USC §1395yy: Payment to
42 CFR §413.345 Publication of Federal
42 CFR §413.345 Publication of Federal
2022 Final Rule
System and
System and
skilledConsolidated
skil ed nursing facilities for nursing facilities for
prospective payment rates.
prospective payment rates.
(8/4/2021) CMS-1746-F
(8/4/2021) CMS-1746-F
Consolidated Billing forBil ing for Skil ed Nursing
routine service costs
routine service costs
"CMS publishes information pertaining to each
"CMS publishes information pertaining to each
Skilled Nursing FacilitiesFacilities (SNF)
86 FR 42424
86 FR 42424
(e)(4)(H)
(e)(4)(H)
update of the Federal payment rates in the
update of the Federal payment rates in the
(SNF)
“The Secretary shall provide for
“The Secretary shall provide for
Federal Register. This information includes the
Federal Register. This information includes the
Skil ed Nursing Facility
publication in the Federal
publication in the Federal
standardized Federal rates, the resident
standardized Federal rates, the resident
2022 Proposed Rule
Skilled Nursing FacilityProspective Payment
Register, before May 1, 1998
Register, before May 1, 1998
classification system that provides the basis for
classification system that provides the basis for
(4/15/2021) CMS- 1746-P
(4/15/2021) CMS- 1746-P
Prospective PaymentSystem (SNF PPS)
(with respect to fiscal period
(with respect to fiscal period
case-mix adjustment, and the factors to be
case-mix adjustment, and the factors to be
86 FR 19954
86 FR 19954
System (SNF PPS)
described in subparagraph (E)(i)) described in subparagraph (E)(i))
applied in making the area wage adjustment.
applied in making the area wage adjustment.
Comments: Regulations.gov
Comments: Regulations.gov
and before the August 1
and before the August 1
This information is published before May 1 for
This information is published before May 1 for
CMS-2021-0062
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
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-
2021 Final Rule
(i) the unadjusted Federal per
(i) the unadjusted Federal per
(8/5/2020) CMS-1737-F
(8/5/2020) CMS-1737-F
diem rates to be applied to days
diem rates to be applied to days
85 FR 47594
85 FR 47594
of covered
of covered
skilledskil ed nursing facility
CRS-5
link to page 15
Typically Issued
Requirements: Timeline and Public Comment
Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
nursing facility services furnished during the services furnished during the
fiscal year,
fiscal year,
2021 Proposed Rule
(
(
iii ) the case mix classification ) the case mix classification
(4/15/2020) CMS-1737-P
(4/15/2020) CMS-1737-P
system to be applied under
system to be applied under
85 FR 20914
subparagraph (G)(i) with respect subparagraph (G)(i) with respect
Comments: Regulations.gov85 FR 20914
to such services during the fiscal
to such services during the fiscal
CMS-2020-0036 Comments: Regulations.gov
year, and
year, and
(iii
CMS-2020-0036
(i i) the factors to be applied in ) the factors to be applied in
making the area wage adjustment making the area wage adjustment
2020 Final Rule
CRS-5
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)
under subparagraph (G)(iiunder subparagraph (G)(i ) with ) with
(8/7/2019) CMS-1718-F
(8/7/2019) CMS-1718-F
respect to such services."
respect to such services."
84 FR 38728
84 FR 38728
Note: The timeline for the
Note: The timeline for the
2020 Proposed Rule
proposed rule and comments are proposed rule and comments are
2020 Proposed Rule
not addressed in statute. not addressed in statute.
(4/25/2019) CMS-1718-P
(4/25/2019) CMS-1718-P
84 FR 17620 84 FR 17620
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0070 CMS-2019-0070
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 Final Rule
Facility Prospective
Facility Prospective
hospitals for inpatient hospital
hospitals for inpatient hospital
prospective payment rates.
prospective payment rates.
(8/4/2021) CMS-1748-F
(8/4/2021) CMS-1748-F
Payment System
Payment System
services
services
"We publish information pertaining to the
"We publish information pertaining to the
86 FR 42362
86 FR 42362
(j)(5)
(j)(5)
inpatient rehabilitation facility prospective
inpatient rehabilitation facility prospective
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
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
PPS)
Register, on or before August 1
Register, on or before August 1
the unadjusted Federal payment rates, the
the unadjusted Federal payment rates, the
(4/12/2021) CMS-1748-P
(4/12/2021) CMS-1748-P
PPS)
before each fiscal year (beginning before each fiscal year (beginning
patient classification system and associated
patient classification system and associated
86 FR 19086
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
Comments: Regulations.gov
Comments: Regulations.gov
classification and weighting
classification and weighting
methodology and data used to calculate the
methodology and data used to calculate the
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
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
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
in computing the prospective in computing the prospective
(8/10/2020) CMS-1729-F
(8/10/2020) CMS-1729-F
CRS-6
link to page 15
Typically Issued
Requirements: Timeline and Public Comment
Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
payment rates under this payment rates under this
85 FR 48424
85 FR 48424
subsection for that fiscal year."
subsection for that fiscal year."
2021 Proposed Rule
Note: Only the final rule
Note: Only the final rule
(4/21/2020) CMS-1729-P
(4/21/2020) CMS-1729-P
deadline is specified, the
deadline is specified, the
85 FR 22065
proposed rule is not addressed proposed rule is not addressed
85 FR 22065
in statute. Public comment is not in statute. Public comment is not
Comments: Regulations.gov
Comments: Regulations.gov
addressed in statute.
addressed in statute.
CMS-2020-0039
CMS-2020-0039
CRS-6
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)
2020 Final Rule
(8/8/2019) CMS-1710-F(8/8/2019) CMS-1710-F
84 FR 39054 84 FR 39054
2020 Proposed Rule (4/24/2019) CMS-1710-P (4/24/2019) CMS-1710-P
84 FR 17244 84 FR 17244
Corrections: 84 FR 24734 Corrections: 84 FR 24734
(5/29/2019) (5/29/2019)
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0066 CMS-2019-0066
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 Final Rule
Facilities Prospective
Facilities Prospective
hospitals for inpatient hospital
hospitals for inpatient hospital
inpatient psychiatric facility prospective
inpatient psychiatric facility prospective
(8/4/2021) CMS-1750-F
(8/4/2021) CMS-1750-F
Payment System
Payment System
services
services
payment system.
payment system.
86 FR 42608
86 FR 42608
(s) Prospective payment for
(s) Prospective payment for
“CMS
“CMS
will wil issue annually in the Federal Register issue annually in the Federal Register
Inpatient Psychiatric
Inpatient Psychiatric
Facility
psychiatric hospitals
psychiatric hospitals
information pertaining to changes to the
information pertaining to changes to the
Facility ProspectiveProspective Payment
inpatient psychiatric facility prospective
inpatient psychiatric facility prospective
2022 Proposed Rule
Payment System (IPF System (IPF
PPS)
payment system."
payment system."
Note: specific timelines for
Note: specific timelines for
(4/13/2021) CMS-1750-P
(4/13/2021) CMS-1750-P
PPS)
rulemaking and comments for rulemaking and comments for
86 FR 19480
86 FR 19480
Inpatient Psychiatric Facility PPS
Inpatient Psychiatric Facility PPS
Comments: Regulations.gov
Comments: Regulations.gov
are not addressed in statute.
are not addressed in statute.
CMS-2021-0060
CMS-2021-0060
Deadlines for quality measures are specified.
2021 Final Rule
(8/4/2020) CMS-1731-F
85 FR 47042 Corrections: 85 FR 52923 (8/27/2020) 2021 Proposed Rule
CRS-7
link to page 14CRS-7
link to page 15 link to page link to page
1415
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
Issued Rule(s)
Deadlines for quality measures
are specified.
2021 Final Rule (8/4/2020) CMS-1731-F 85 FR 47042 Corrections: 85 FR 52923 (8/27/2020) 2021 Proposed Rule Rule(s)
(4/14/2020) CMS-1731-P (4/14/2020) CMS-1731-P
85 FR 20625 85 FR 20625
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0035 CMS-2020-0035
2020 Final Rule
(8/6/2019) CMS-1712-F(8/6/2019) CMS-1712-F
84 FR 38424 84 FR 38424
2020 Proposed Rule (4/23/2019) CMS-1712-P (4/23/2019) CMS-1712-P
84 FR 16948 84 FR 16948
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0067 CMS-2019-0067
Home Health
Home Health
Prospective
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
2022 ProposedFinal Rule
Prospective Payment Payment System
payment for home health
payment for home health
unadjusted national, standardized prospective
unadjusted national, standardized prospective
(
(
7/711/9/2021) CMS-1747-/2021) CMS-1747-
P
System F
services
services
payment rates.
payment rates.
86 FR
86 FR
35874
62240
Home Health Prospective
“CMS annually updates the unadjusted national,
“CMS annually updates the unadjusted national,
Comments: Regulations.gov
Home Health
Payment System (Home
Note: Specific timelines for
Note: Specific timelines for
standardized prospective payment rate on a
standardized prospective payment rate on a
CMS-2021-0112
Prospective PaymentHealth PPS)
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
Home Health PPS are not 2022 Proposed Rule
1895(b)(1)(B) of the
1895(b)(1)(B) of the
Act)."b
PPS)
addressed in statute.
2021 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)Act)."b
(7/7/2021) CMS-1747-P
CRS-8
CRS-8
link to page
link to page
1415
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
Issued Rule(s)
Home Health PPS are not
86 FR 35874
addressed in statute.
Comments: Regulations.gov CMS-2021-0112 2021 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) Rule(s)
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0077 CMS-2020-0077
2020 Final Rule
(11/8/2019) CMS-1711-FC(11/8/2019) CMS-1711-FC
84 FR 60478 84 FR 60478
2020 Proposed Rule
(7/18/2019) CMS-1711-P(7/18/2019) 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
2022 ProposedFinal Rule
Prospective Payment
Prospective Payment
disease program
disease program
rate-setting methodologies and payment rates.
rate-setting methodologies and payment rates.
(
(
7/911/8/2021) CMS-1749-/2021) CMS-1749-
PF
System
System
“(b) Changes in payment rates resulting from
“(b) Changes in payment rates resulting from
86 FR
86 FR
36322
Note: Specific timelines for
61874
incorporation of updated cost data or general incorporation of updated cost data or general
Comments: Regulations.gov
End Stage Renal Disease
rulemaking and commentsCRS-9
link to page 15
Typically Issued
Requirements: Timeline and Public Comment
Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
End Stage Renal Disease
Note: Specific timelines for for
revisions of geographic labor cost adjustment
revisions of geographic labor cost adjustment
CMS-2021-0114Corrections: 86 FR 70982
Prospective Payment
Prospective Payment
ESRD PPS are not addressed inrulemaking and comments for
factors are announced by notice published in
factors are announced by notice published in
(12/14/2021)
System (ESRD PPS)
System (ESRD PPS)
statute. ESRD PPS are not addressed in
the Federal Register without opportunity for
the Federal Register without opportunity for
statute.
prior comment. Revisions of the rate-setting prior comment. Revisions of the rate-setting
2021 Final Rule
methodology are published in the Federal methodology are published in the Federal
(11/9/2020) CMS-1732-F2022 Proposed Rule
Register in accordance with the Department’s
Register in accordance with the Department’s
85 FR 71398
established rulemaking procedures."
2021 Proposed Rule
(7/13/2020) CMS-1732-P 85 FR 42132 Comments: Regulations.gov CMS-2020-0079 2020 Final Rule
CRS-9
link to page 14 link to page 14
Rule Name(7/9/2021) CMS-1749-P
established rulemaking procedures."
86 FR 36322 Comments: Regulations.gov CMS-2021-0114 2021 Final Rule (11/9/2020) CMS-1732-F 85 FR 71398 2021 Proposed Rule (7/13/2020) CMS-1732-P 85 FR 42132 Comments: Regulations.gov CMS-2020-0079 2020 Final Rule (11/8/2019) CMS-1713-F 84 FR 60648 2020 Proposed Rule (8/6/2019) CMS-1713-P 84 FR 38330 Comments: Regulations.gov CMS-2019-0110
CRS-10
link to page 15 link to page 15
Typically Issued
Requirements: Timeline and Public Comment
Rule Name and
Proposed
Most Recently Issued
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Hospice Wage Index and
Rule(s)
(11/8/2019) CMS-1713-F
84 FR 60648 2020 Proposed Rule (8/6/2019) CMS-1713-P 84 FR 38330 Comments: Regulations.gov CMS-2019-0110
Hospice Wage Index and April-May 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 Final 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
(8/4/2021) CMS-1754-F
(8/4/2021) CMS-1754-F
services
services
differences.
differences.
86 FR 42528
86 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
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
2022 Proposed Rule
Note: Specific timelines for
Note: Specific timelines for
payment rates in effect under this paragraph
payment rates in effect under this paragraph
rulemaking and comments for
rulemaking and comments for
(4/14/2021) CMS-1754-P
(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
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),
Comments: Regulations.gov
Comments: Regulations.gov
applicable to discharges occurring in the fiscal
applicable to discharges occurring in the fiscal
CMS-2021-0061
CMS-2021-0061
year."b
2021 Final Rule
(8/4/2020) CMS-1733-F (8/4/2020) CMS-1733-F
85 FR 47070 85 FR 47070
2021 Proposed Rule
(4/15/2020) CMS-1733-P (4/15/2020) 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 (4/25/2019) CMS-1714-P 84 FR 17570
CRS-11
CRS-10
link to page
link to page
1415
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
Issued Rule(s)
Rule(s)
2020 Final Rule
(8/6/2019) CMS-1714-F 84 FR 38484 2020 Proposed Rule
(4/25/2019) CMS-1714-P 84 FR 17570 Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0068 CMS-2019-0068
Source: Compiled by the Congressional Research Service (CRS). Compiled by the Congressional Research Service (CRS).
Notes: Table compiled using Centers for Medicare & Medicaid Services (CMS) websites, Table compiled using 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 are issued can vary, and the 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 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. 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.
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-
CRS-
1112
Finding Medicare Fee-For-Service (FFS) Payment System Rules
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
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material. copy or otherwise use copyrighted material.
Congressional Research Service
Congressional Research Service
R46797
R46797
· VERSION 36 · UPDATED
1213