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

Finding Medicare Fee-For-Service (FFS)
December 21, 2021June 8, 2022
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 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. found in statute, regulation, or both.
As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health care facilities 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 provider and beneficiary 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 have different schedules and web groups. Tracking the status and requirements for specific rules can be onerous, since they have different schedules and web
locations. locations.
This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the 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) website, the typical 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 proposed rules, public comments, 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 to the applicable resources. Not all payment 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 noted in the table. systems include detailed statutory and regulatory requirements, as 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 ........................................................................................................................ 1314


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 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

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

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 Policies Under the July-August November Payment Policies Under the July-August November
42 USC §1395w-4: Payment for 42 USC §1395w-4: Payment for
N/A N/A
2022 Final Rule
Physician Fee Schedule Physician Fee Schedule
physicians’ services physicians’ services
(11/19/2021) CMS-1751-F (11/19/2021) CMS-1751-F

(b)(1) “Before November 1 of (b)(1) “Before November 1 of
86 FR 64996 86 FR 64996
Medicare Physician Fee Medicare Physician Fee
the preceding year, for each year the preceding year, for each year

Schedule Payment (PFS) Schedule Payment (PFS)
beginning with 1998, subject to 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 (7/23/2021) CMS-1751-P
schedules that establish payment schedules that establish payment
86 FR 39104 86 FR 39104
amounts for all physicians' amounts for all physicians'
services furnished in all fee services furnished in all fee
Comments: Regulations.gov Comments: Regulations.gov
schedule areas (as defined in schedule areas (as defined in
CMS-2021-0119 CMS-2021-0119
subsection (j)(2)) for the year." subsection (j)(2)) for the year."


2021 Final Rule
Note: Public comment is not Note: Public comment is not
(12/28/2020) CMS-1734-F (12/28/2020) CMS-1734-F
addressed broadly for PFS in addressed broadly for PFS in
85 FR 84472 85 FR 84472
statute. However, public statute. However, public
comment is addressed for comment is addressed for
Corrections: 86 FR 5020 Corrections: 86 FR 5020
aspects of the physician payment aspects of the physician payment
(1/19/2021) and 86 FR 14690 (1/19/2021) and 86 FR 14690
system, such as the development system, such as the development
(3/18/2021) (3/18/2021)
of categories and codes. of categories and codes.

2021 Proposed Rule
(8/17/2020) CMS-1734-P (8/17/2020) CMS-1734-P
85 FR 50074 85 FR 50074
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0088 CMS-2020-0088

2020 Final Rule
(11/15/2019) CMS-1715-F (11/15/2019) CMS-1715-F
84 FR 62568 84 FR 62568

CRS-2 CRS-2

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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)
2020 Proposed Rule
(8/14/2019) CMS-1715-P (8/14/2019) CMS-1715-P
84 FR 40482 84 FR 40482
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 Final Rule
Prospective Payment and Prospective Payment and
-December benefits -December benefits

(11/16/2021) CMS-1753-FC (11/16/2021) CMS-1753-FC
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 63458 86 FR 63458
for hospital outpatient for hospital outpatient
payment methodologies. payment methodologies.

department services department services

"Whenever CMS proposes to revise the "Whenever CMS proposes to revise the
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 (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
86 FR 42018 86 FR 42018

not addressed in statute. not addressed in statute.
rates were established. After reviewing public rates were established. After reviewing public
Comments: Regulations.gov Comments: Regulations.gov
Ambulatory Surgical Ambulatory Surgical

comments, CMS publishes a notice establishing comments, CMS publishes a notice establishing
CMS-2021-0124 CMS-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

System System
these rates, CMS may adopt reasonable these rates, CMS may adopt reasonable
benefits benefits
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 (12/29/2020) CMS-1736-FC
“Taking into account the “Taking into account the
procedures." procedures."
85 FR 85866 85 FR 85866
recommendations in the report recommendations in the report
Corrections: 86 FR 11428 Corrections: 86 FR 11428
under section 626(d) of under section 626(d) of
(2/25/2021) (2/25/2021)
Medicare Prescription Drug, Medicare Prescription Drug,
Improvement, and Modernization Improvement, and Modernization

Act of 2003, the Secretary shall Act of 2003, the Secretary shall
2021 Proposed Rule
implement a revised payment implement a revised payment
(8/12/2020) CMS-1736-P (8/12/2020) CMS-1736-P
system for payment of surgical system for payment of surgical
services furnished in ambulatory services furnished in ambulatory
85 FR 48772 85 FR 48772
surgical centers." surgical centers."
Comments: Regulations.gov Comments: Regulations.gov

CMS-2020-0090 CMS-2020-0090
Note: Specific timelines for Note: Specific timelines for

rulemaking and comments rulemaking and comments
2020 Final Rule
CRS-3 CRS-3

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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)
beyond the initial year are not beyond the initial year are not
(11/27/2019) CMS-1717-F2 (11/27/2019) CMS-1717-F2
addressed in statute. addressed in statute.
84 FR 65524 84 FR 65524

2020 Proposed Rule
(8/9/2019) CMS-1717-P (8/9/2019) CMS-1717-P
84 FR 39398 84 FR 39398
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0109 CMS-2019-0109
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
2023 Proposed 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-F5/10/2022) CMS-1771-P
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 4477487 FR 28108
(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,
Comments: Regulations.gov
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
CMS-2022-0074 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

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
2022 Final Rule 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(8/13/2021) CMS-1752-F
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)86 FR 44774
System (IPPS) System (IPPS)
recommendations under recommendations under
proposed changes would apply. proposed changes would apply.
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
2022 Proposed Rule Long-Term Care Hospital 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,

Prospective Payment Prospective Payment
(5/10/2021) CMS-1752-P after such consideration of public and factors for determining inpatient after such consideration of public and factors for determining inpatient
System (LTCH PPS) System (LTCH PPS)
2021 Final Rule
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
86 FR 25070 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 Corrections: 86 FR 33157
Secretary's final Secretary's final
the rates would apply." the rates would apply."
85 FR 58432(6/24/2021)
recommendations under such recommendations under such

Corrections: 85 FR 78748Comments: Regulations.gov
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)CMS-2021-0070

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 ProposedFinal Rule
hospitals for inpatient hospital hospitals for inpatient hospital
publishes information pertaining to the long- publishes information pertaining to the long-
( (5/299/18/2020) CMS-1735-/2020) CMS-1735-PF
services services
term care hospital prospective payment system term care hospital prospective payment system
CRS-4 CRS-4

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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 85 FR 3246058432
long-term care hospitals long-term care hospitals
Register. Register.
Comments: Regulations.govCorrections: 85 FR 78748

(c) For the period beginning on or after (c) For the period beginning on or after
CMS-2020-0052(12/7/2020)
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 Final2021 Proposed 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
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-F5/29/2020) CMS-1735-P
or before August 1 prior to the start of the or before August 1 prior to the start of the
84 FR 4204485 FR 32460
Federal fiscal year which begins October 1, Federal fiscal year which begins October 1,

Comments: Regulations.gov unless for good cause it is published after unless for good cause it is published after
CMS-2020-0052 August 1, but before September 1. August 1, but before September 1.
2020 Proposed Rule
(d) Information on the LTC-DRG classification (d) Information on the LTC-DRG classification
(5/3/2019) CMS-1716-P
and associated weighting factors is published onand associated weighting factors is published on
84 FR 19158
2020 Final Rule or before August 1 prior to the beginning of or before August 1 prior to the beginning of
Corrections: 84 FR 28263(8/16/2019) CMS-1716-F
each Federal fiscal year." each Federal fiscal year."
84 FR 42044 2020 Proposed Rule (5/3/2019) CMS-1716-P 84 FR 19158 Corrections: 84 FR 28263 (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
2023 Proposed Rule System and Consolidated System and Consolidated
skil edskilled nursing facilities for nursing facilities for
prospective payment rates. prospective payment rates.
( (8/4/2021) CMS-1746-F
Bil ing for Skil ed4/15/2022) CMS-1765-P Billing for Skilled Nursing Nursing
routine service costs routine service costs
"CMS publishes information pertaining to each "CMS publishes information pertaining to each
Facilities (SNF) Facilities (SNF)
86 FR 4242487 FR 22720
(e)(4)(H) (e)(4)(H)
update of the Federal payment rates in the update of the Federal payment rates in the

Comments: Regulations.gov
“The Secretary shall provide for “The Secretary shall provide for
Federal Register. This information includes the Federal Register. This information includes the
Skil edSkilled Nursing Facility Nursing Facility
publication in the Federal publication in the Federal
standardized Federal rates, the resident standardized Federal rates, the resident
2022 Proposed Rule
CMS-2022-0069 Prospective Payment Prospective 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
System (SNF PPS) System (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 199542022 Final Rule
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.govCRS-5 link to page 16 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)
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(8/4/2021) CMS-1746-F
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 86 FR 42424
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
2022 Proposed Rule diem rates to be applied to days diem rates to be applied to days
85 FR 47594(4/15/2021) CMS- 1746-P
of covered of covered skil edskilled nursing facility 86 FR 19954 services furnished during the Comments: Regulations.gov nursing facility
CRS-5

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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)
services furnished during the

fiscal year,
2021 Proposed Rule
(i fiscal year, CMS-2021-0062 (ii) the case mix classification ) the case mix classification
(4/15/2020) CMS-1737-P
system to be applied under system to be applied under
subparagraph (G)(i) with respect subparagraph (G)(i) with respect
85 FR 20914
2021 Final Rule to such services during the fiscal to such services during the fiscal
Comments: Regulations.gov
year, and
CMS-2020-0036
(i i(8/5/2020) CMS-1737-F year, and 85 FR 47594 (iii) 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
under subparagraph (G)(under subparagraph (G)(i ) with
(8/7/2019) CMS-1718-F
respect to such services."
84 FR 38728


ii) with 2021 Proposed Rule respect to such services." (4/15/2020) CMS-1737-P 85 FR 20914 Note: The timeline for the Note: The timeline for the
Comments: Regulations.gov proposed rule and comments are proposed rule and comments are
2020 Proposed RuleCMS-2020-0036
not addressed in statute. not addressed in statute.
(4/25/2019) CMS-1718-P
84 FR 17620
Comments: Regulations.gov
CMS-2019-0070 2020 Final Rule (8/7/2019) CMS-1718-F 84 FR 38728 2020 Proposed Rule (4/25/2019) CMS-1718-P 84 FR 17620 Comments: Regulations.gov CMS-2019-0070 CRS-6 link to page 16 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)
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 Final2023 Proposed Rule
Facility Prospective Facility Prospective
hospitals for inpatient hospital hospitals for inpatient hospital
prospective payment rates. prospective payment rates.
( (8/4/2021) CMS-1748-F4/6/2022) CMS-1767-P
Payment System Payment System
services services
"We publish information pertaining to the "We publish information pertaining to the
86 FR 4236287 FR 20218

(j)(5) (j)(5)
inpatient rehabilitation facility prospective inpatient rehabilitation facility prospective
Comments: Regulations.gov
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
CMS-2022-0061 Payment System (IRF PPS) 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
before each fiscal year (beginning before each fiscal year (beginning
patient classification system and associated patient classification system and associated
86 FR 190862022 Final Rule
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
(8/4/2021) CMS-1748-F 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-2021-005786 FR 42362
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 Final2022 Proposed Rule
the methodology and data used the methodology and data used
in computing the prospective
(8/10/2020) CMS-1729-F
CRS-6

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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
85 FR 48424
subsection for that fiscal year."


2021 Proposed Rule
Note: Only the final rule
(4/21/2020) CMS-1729-P
deadline is specified, the
proposed rule is not addressed
85 FR 22065
in statute. Public comment is not
Comments: Regulations.gov
addressed in statute.
CMS-2020-0039

2020 Final Rule
(8/8/2019) CMS-1710-F
in computing the prospective (4/12/2021) CMS-1748-P payment rates under this 86 FR 19086 subsection for that fiscal year." Comments: Regulations.gov CMS-2021-0057 Note: Only the final rule deadline is specified, the 2021 Final Rule proposed rule is not addressed in statute. Public comment is not (8/10/2020) CMS-1729-F addressed in statute. 85 FR 48424 2021 Proposed Rule (4/21/2020) CMS-1729-P 85 FR 22065 Comments: Regulations.gov CMS-2020-0039 2020 Final Rule (8/8/2019) CMS-1710-F CRS-7 link to page 16 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) 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 Final2023 Proposed 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-F4/4/2022) CMS-1769-P
Payment System Payment System
services services
payment system. payment system.
86 FR 4260887 FR 19415

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

inpatient psychiatric facility prospective inpatient psychiatric facility prospective
2022 Proposed Rule
CMS-2022-0062 System (IPF PPS) System (IPF PPS)
payment system." payment system."
Note: specific timelines for Note: specific timelines for
(4/13/2021) CMS-1750-P
rulemaking and comments for rulemaking and comments for
86 FR 194802022 Final Rule
Inpatient Psychiatric Facility PPS Inpatient Psychiatric Facility PPS
Comments: Regulations.gov
(8/4/2021) CMS-1750-F are not addressed in statute. are not addressed in statute.
CMS-2021-0060
CRS-7

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link to page 15 link to page 1586 FR 42608 Deadlines for quality measures are specified. 2022 Proposed Rule (4/13/2021) CMS-1750-P 86 FR 19480 Comments: Regulations.gov CMS-2021-0060 2021 Final Rule (8/4/2020) CMS-1731-F 85 FR 47042 CRS-8 link to page 16 link to page 16

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)
Deadlines for quality measures

are specified.
2021 Final Rule
(8/4/2020) CMS-1731-F
85 FR 47042
Corrections: 85 FR 52923 Corrections: 85 FR 52923
(8/27/2020) (8/27/2020)

2021 Proposed Rule
(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 Prospective 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 Final Rule
Payment System Payment System
payment for home health payment for home health
unadjusted national, standardized prospective unadjusted national, standardized prospective
(11/9/2021) CMS-1747-F (11/9/2021) CMS-1747-F

services services
payment rates. payment rates.
86 FR 62240 86 FR 62240
Home Health Prospective Home Health Prospective

“CMS annually updates the unadjusted national, “CMS annually updates the unadjusted national,

Payment System (Home Payment System (Home
Note: Specific timelines for Note: Specific timelines for
standardized prospective payment rate on a standardized prospective payment rate on a
Health PPS) Health PPS)
rulemaking and comments for rulemaking and comments for
calendar year basis (in accordance with section calendar year basis (in accordance with section
2022 Proposed Rule
Home Health PPS are not 1895(b)(1)(B) of the 1895(b)(1)(B) of the Act).Act)."b
(7/7/2021) CMS-1747-P (7/7/2021) CMS-1747-P
addressed in statute. 86 FR 35874 Comments: Regulations.gov CMS-2021-0112 CRS-9CRS-8

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link to page link to page 1516

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)
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 (11/4/2020) CMS-1730-F
85 FR 70298 85 FR 70298

2021 Proposed Rule
(6/30/2020) CMS-1730-P(6/30/2020) CMS-1730-P
85 FR 39408 85 FR 39408
Corrections: 85 FR 43805 Corrections: 85 FR 43805
(7/20/2020) (7/20/2020)
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 Final Rule
Prospective Payment Prospective Payment
disease program disease program
rate-setting methodologies and payment rates. rate-setting methodologies and payment rates.
(11/8/2021) CMS-1749-F (11/8/2021) CMS-1749-F
System System

“(b) Changes in payment rates resulting from “(b) Changes in payment rates resulting from
86 FR 61874 86 FR 61874

Note: Specific timelines for incorporation of updated cost data or general incorporation of updated cost data or general
CRS-9

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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)Corrections: 86 FR 70982
End Stage Renal Disease End Stage Renal Disease
Note: Specific timelinesrulemaking and comments for for
revisions of geographic labor cost adjustment revisions of geographic labor cost adjustment
Corrections: 86 FR 70982(12/14/2021)
Prospective Payment Prospective Payment
rulemaking and comments forESRD PPS are not addressed in
factors are announced by notice published in factors are announced by notice published in
(12/14/2021)
System (ESRD PPS)
ESRD PPS are not addressed in
System (ESRD PPS) statute. 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
2022 Proposed Rule methodology are published in the Federal methodology are published in the Federal
2022 Proposed Rule
CRS-10 link to page 16 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) Register in accordance with the Department’s Register in accordance with the Department’s
(7/9/2021) CMS-1749-P (7/9/2021) CMS-1749-P
established rulemaking procedures." established rulemaking procedures."
86 FR 36322 86 FR 36322
Comments: Regulations.gov Comments: Regulations.gov
CMS-2021-0114 CMS-2021-0114

2021 Final Rule
(11/9/2020) CMS-1732-F (11/9/2020) CMS-1732-F
85 FR 71398 85 FR 71398

2021 Proposed Rule
(7/13/2020) CMS-1732-P (7/13/2020) CMS-1732-P
85 FR 42132 85 FR 42132
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0079 CMS-2020-0079

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

2020 Proposed Rule
(8/6/2019) CMS-1713-P (8/6/2019) CMS-1713-P
84 FR 38330 84 FR 38330
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0110 CMS-2019-0110
CRS-10

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link to page 15 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)
Hospice Wage Index and 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 Final2023 Proposed 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-F4/4/2022) CMS-1773-P

services services
differences. differences.
86 FR 4252887 FR 19442
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
Comments: Regulations.gov
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
2022 Proposed Rule
Note: Specific timelines for
payment rates in effect under this paragraph
rulemaking and comments for
(4/14/2021) CMS-1754-P
during the previous fiscal year increased by the
hospice payment rates are not
86 FR 19700
hospice payment update percentage increase
addressed in statute.
(as defined in sections1814(i)(1)(C) of the Act),
Comments: Regulations.gov
applicable to discharges occurring in the fiscal
CMS-2021-0061
year."b

CRS-11 link to page 16 link to page 16 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) Note: Specific timelines for services included in hospice care are the CMS-2022-0060 rulemaking and comments for payment rates in effect under this paragraph hospice payment rates are not during the previous fiscal year increased by the addressed in statute. hospice payment update percentage increase 2022 Final Rule (as defined in sections1814(i)(1)(C) of the Act), (8/4/2021) CMS-1754-F applicable to discharges occurring in the fiscal 86 FR 42528 year."b 2022 Proposed Rule (4/14/2021) CMS-1754-P 86 FR 19700 Comments: Regulations.gov CMS-2021-0061 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 (8/6/2019) CMS-1714-F
84 FR 38484 84 FR 38484

2020 Proposed Rule
(4/25/2019) CMS-1714-P (4/25/2019) CMS-1714-P
84 FR 17570
CRS-11 CRS-12

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link to page link to page 1516

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)
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-1213

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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 67 · UPDATED
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