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

Finding Medicare Fee-For-Service (FFS)
JuneSeptember 8, 2022 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 ........................................................................................................................ 1415


Congressional Research Service Congressional Research Service

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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 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

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 Final2023 Proposed Rule
Physician Fee Schedule Physician Fee Schedule
physicians’ services physicians’ services
( (11/19/2021) CMS-1751-F7/29/2022) CMS-1770-P

(b)(1) “Before November 1 of (b)(1) “Before November 1 of
86 FR 6499687 FR 45860
Medicare Physician Fee Medicare Physician Fee
the preceding year, for each year the preceding year, for each year
Comments: Regulations.gov
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 RuleCMS-2022-0113
shall establish, by regulation, fee shall establish, by regulation, fee
(7/23/2021) CMS-1751-P
schedules that establish payment schedules that establish payment
86 FR 391042022 Final Rule
amounts for all physicians' amounts for all physicians'
services furnished in all fee services furnished in all fee
Comments: Regulations.gov(11/19/2021) CMS-1751-F
schedule areas (as defined in schedule areas (as defined in
CMS-2021-011986 FR 64996
subsection (j)(2)) for the year." subsection (j)(2)) for the year."


2021 Final Rule
2022 Proposed Rule Note: Public comment is not Note: Public comment is not
( (12/28/2020) CMS-1734-F7/23/2021) CMS-1751-P
addressed broadly for PFS in addressed broadly for PFS in
85 FR 84472
statute. However, public
statute. However, public 86 FR 39104 comment is addressed for comment is addressed for
Corrections: 86 FR 5020Comments: Regulations.gov
aspects of the physician payment aspects of the physician payment
(1/19/2021) and 86 FR 14690CMS-2021-0119
system, such as the development system, such as the development
(3/18/2021)
of categories and codes. of categories and codes.

2021 ProposedFinal Rule
((8/1712/28/2020) CMS-1734-/2020) CMS-1734-PF 85 FR 84472 Corrections: 86 FR 5020 (1/19/2021) and 86 FR 14690 (3/18/2021) 2021 Proposed Rule (8/17/2020) CMS-1734-P 85 FR 50074
85 FR 50074
Comments: Regulations.gov
CMS-2020-0088

2020 Final Rule
(11/15/2019) CMS-1715-F
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)
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 (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 Final2023 Proposed Rule
Prospective Payment and Prospective Payment and
-December benefits -December benefits

( (11/16/2021) CMS-1753-FC7/26/2022) CMS-1772-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
86 FR 6345887 FR 44502
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
Hospital Outpatient Hospital Outpatient

2022 Proposed RuleCMS-2022-0118
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
86 FR 420182022 Final Rule

not addressed in statute. not addressed in statute.
rates were established. After reviewing public rates were established. After reviewing public
Comments: Regulations.gov(11/16/2021) CMS-1753-FC
Ambulatory Surgical Ambulatory Surgical

comments, CMS publishes a notice establishing comments, CMS publishes a notice establishing
CMS-2021-012486 FR 63458
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 Final2022 Proposed 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
8/4/2021) CMS-1753-P “Taking into account the “Taking into account the
procedures." procedures."
85 FR 8586686 FR 42018
recommendations in the report recommendations in the report
Corrections: 86 FR 11428
under section 626(d) of under section 626(d) of
(2/25/2021)Comments: Regulations.gov
Medicare Prescription Drug, Medicare Prescription Drug,
CMS-2021-0124 Improvement, and Modernization Improvement, and Modernization

Act of 2003, the Secretary shall CRS-3 link to page 17 Act of 2003, the Secretary shall
2021 Proposed Rule
implement a revised payment
(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

rulemaking and comments
2020 Final Rule
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
(11/27/2019) CMS-1717-F2
addressed in statute.
implement a revised payment 2021 Final Rule system for payment of surgical (12/29/2020) CMS-1736-FC services furnished in ambulatory surgical centers." 85 FR 85866 Corrections: 86 FR 11428 (2/25/2021) Note: Specific timelines for rulemaking and comments beyond the initial year are not 2021 Proposed Rule addressed in statute. (8/12/2020) CMS-1736-P 85 FR 48772 Comments: Regulations.gov CMS-2020-0090 2020 Final Rule (11/27/2019) CMS-1717-F2 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
2023 ProposedFinal Rule
Prospective Payment Prospective Payment
October October
hospitals for inpatient hospital hospitals for inpatient hospital
determining prospective payment rates. determining prospective payment rates.
( (58/10/2022) CMS-1771-/10/2022) CMS-1771-PF
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-
87 FR 87 FR 2810848780
(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
CMS-2022-00742023 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
(5/10/2022) CMS-1771-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
2022 Final Rule
Acute Inpatient87 FR 28108
(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
(8/13/2021) CMS-1752-F
Prospective PaymentCRS-4 link to page 17 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) Acute Inpatient
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
86 FR 44774
System (IPPS)
Comments: Regulations.gov Prospective Payment recommendations under recommendations under
proposed changes would apply. proposed changes would apply.


CMS-2022-0074 System (IPPS) 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
August 1 before such fiscal year 2022 Final2022 Proposed Rule
Long-Term Care Hospital Long-Term Care Hospital
August 1 before such fiscal year
document setting forth final methods, amounts, document setting forth final methods, amounts,
Prospective Payment
(5/10after such consideration of public (8/13/2021) CMS-1752-/2021) CMS-1752-P
after such consideration of public F Prospective Payment and factors for determining inpatient and factors for determining inpatient
System (LTCH PPS)
comment on the proposal as is comment on the proposal as is
System (LTCH PPS) prospective payment rates not later than the prospective payment rates not later than the
86 FR 86 FR 2507044774
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
Corrections: 86 FR 33157
Secretary's final Secretary's final
the rates would apply." the rates would apply."
(6/24/2021)
recommendations under such

Comments: Regulations.gov
paragraph for that year."
recommendations under such 2022 Proposed Rule paragraph for that year." (5/10/2021) CMS-1752-P 42 CFR §412.535 Publication of the Federal 42 CFR §412.535 Publication of the Federal
CMS-2021-0070

86 FR 25070 prospective payment rates. prospective payment rates.

42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
2021 Final Rule
hospitals for inpatient hospital
publishes information pertaining to the long-
(9/18/2020) CMS-1735-F
services
term care hospital prospective payment system
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) 42 USC §1395ww: Payments to Corrections: 86 FR 33157 hospitals for inpatient hospital "Except as specified in paragraph (b), CMS (6/24/2021) services publishes information pertaining to the long-term care hospital prospective payment system Comments: Regulations.gov
(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 58432CMS-2021-0070
long-term care hospitals long-term care hospitals
Register. Register.
Corrections: 85 FR 78748

(c) For the period beginning on or after (c) For the period beginning on or after
(12/7/2020)
2021 Final Rule Note: Specific timelines for Note: Specific timelines for
October 1, 2009, information on the October 1, 2009, information on the

(9/18/2020) CMS-1735-F rulemaking and comments for rulemaking and comments for
unadjusted Federal payment rates and a unadjusted Federal payment rates and a
2021 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 85 FR 58432
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
(5/29/2020) CMS-1735-PCorrections: 85 FR 78748
or before August 1 prior to the start of the or before August 1 prior to the start of the
85 FR 32460(12/7/2020)
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
2021 Proposed Rule August 1, but before September 1. August 1, but before September 1.

(5/29/2020) CMS-1735-P (d) Information on the LTC-DRG classification (d) Information on the LTC-DRG classification
and associated weighting factors is published on and associated weighting factors is published on 2020 Final Rule
85 FR 32460 or before August 1 prior to the beginning of or before August 1 prior to the beginning of
(8/16/2019) CMS-1716-F
each Federal fiscal year."Comments: Regulations.gov each Federal fiscal year." CMS-2020-0052 2020 Final Rule (8/16/2019) CMS-1716-F CRS-5 link to page 17 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 42044 84 FR 42044

2020 Proposed Rule
(5/3/2019) CMS-1716-P(5/3/2019) CMS-1716-P
84 FR 19158 84 FR 19158
Corrections: 84 FR 28263 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
2023 ProposedFinal Rule
System and Consolidated System and Consolidated
skilled nursing facilities for skilled nursing facilities for
prospective payment rates. prospective payment rates.
( (4/158/3/2022) CMS-1765-/2022) CMS-1765-PF
Billing for Skilled Nursing Billing for Skilled Nursing
routine service costs routine service costs
"CMS publishes information pertaining to each "CMS publishes information pertaining to each
Facilities (SNF) Facilities (SNF)
87 FR 87 FR 2272047502
(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
Skilled Nursing Facility Skilled Nursing Facility
publication in the Federal publication in the Federal
standardized Federal rates, the resident standardized Federal rates, the resident
CMS-2022-0069
2023 Proposed Rule 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
(4/15/2022) CMS-1765-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
2022 Final Rule87 FR 22720
described in subparagraph (E)(i)) described in subparagraph (E)(i))
applied in making the area wage adjustment. applied in making the area wage adjustment.
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)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
(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 42424CMS-2022-0069
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-
2022 Final Rule
(i) the unadjusted Federal per (i) the unadjusted Federal per
2022 Proposed Rule
(8/4/2021) CMS-1746-F diem rates to be applied to days diem rates to be applied to days
(4/15/2021) CMS- 1746-P
of covered skilled nursing facility of covered skilled nursing facility
86 FR 86 FR 1995442424
services furnished during the services furnished during the
Comments: Regulations.gov
fiscal year, fiscal year,
CMS-2021-0062
2022 Proposed Rule (ii) the case mix classification (ii) the case mix classification

(4/15/2021) CMS- 1746-P system to be applied under system to be applied under
86 FR 19954 subparagraph (G)(i) with respect subparagraph (G)(i) with respect
2021 Final Rule
to such services during the fiscal to such services during the fiscal
(8/5/2020) CMS-1737-F
year, and
85 FR 47594Comments: Regulations.gov year, and CMS-2021-0062 CRS-6 link to page 17 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)
(iii) the factors to be applied in (iii) the factors to be applied in

making the area wage adjustment making the area wage adjustment
2021 Final Rule under subparagraph (G)(ii) with under subparagraph (G)(ii) with
2021 Proposed Rule
respect to such services." respect to such services."
( (4/158/5/2020) CMS-1737-/2020) CMS-1737-PF

85 FR 85 FR 2091447594
Note: The timeline for the Note: The timeline for the
Comments: Regulations.gov
proposed rule and comments are proposed rule and comments are
CMS-2020-00362021 Proposed Rule
not addressed in statute. not addressed in statute.

(4/15/2020) CMS-1737-P 85 FR 20914 Comments: Regulations.gov CMS-2020-0036 2020 Final Rule
(8/7/2019) CMS-1718-F (8/7/2019) CMS-1718-F
84 FR 38728 84 FR 38728

2020 Proposed Rule
(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-2019-0070CMS-2019-0070
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)
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
2023 ProposedFinal Rule
Facility Prospective Facility Prospective
hospitals for inpatient hospital hospitals for inpatient hospital
prospective payment rates. prospective payment rates.
( (4/68/1/2022) CMS-1767-/2022) CMS-1767-PF
Payment System Payment System
services services
"We publish information pertaining to the "We publish information pertaining to the
87 FR 87 FR 2021847038

(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
CMS-2022-00612023 Proposed Rule
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
(4/6/2022) CMS-1767-P
before each fiscal year (beginning before each fiscal year (beginning
patient classification system and associated patient classification system and associated
2022 Final Rule87 FR 20218
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
(8/4/2021) CMS-1748-FComments: Regulations.gov
classification and weighting classification and weighting
methodology and data used to calculate the methodology and data used to calculate the
CRS-7 link to page 17 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) factors for case mix groups factors for case mix groups
payment rates. This information is published on payment rates. This information is published on
86 FR 42362CMS-2022-0061
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."
2022 Proposed Rule
the methodology and data used the methodology and data used
2022 Final Rule in computing the prospective in computing the prospective
( (4/128/4/2021) CMS-1748-/2021) CMS-1748-PF
payment rates under this payment rates under this
86 FR 86 FR 1908642362
subsection for that fiscal year." subsection for that fiscal year."
Comments: Regulations.gov

CMS-2021-0057
Note: Only the final rule

2022 Proposed Rule Note: Only the final rule (4/12/2021) CMS-1748-P deadline is specified, the deadline is specified, the
2021 Final Rule
proposed rule is not addressed proposed rule is not addressed
86 FR 19086 in statute. Public comment is not in statute. Public comment is not
Comments: Regulations.gov addressed in statute. CMS-2021-0057 2021 Final Rule (8/10/2020) CMS-1729-F (8/10/2020) CMS-1729-F
addressed in statute.
85 FR 48424 85 FR 48424

2021 Proposed Rule
(4/21/2020) CMS-1729-P (4/21/2020) CMS-1729-P
85 FR 22065 85 FR 22065
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0039 CMS-2020-0039

2020 Final Rule
(8/8/2019) CMS-1710-F(8/8/2019) CMS-1710-F
84 FR 39054 2020 Proposed Rule (4/24/2019) CMS-1710-P CRS-8 CRS-7

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link to page link to page 1617

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 84 FR 39054

2020 Proposed Rule
(4/24/2019) CMS-1710-P
84 FR 17244 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
2023 ProposedFinal Rule
Facilities Prospective Facilities Prospective
hospitals for inpatient hospital hospitals for inpatient hospital
inpatient psychiatric facility prospective inpatient psychiatric facility prospective
( (4/47/29/2022) CMS-1769-/2022) CMS-1769-PF
Payment System Payment System
services services
payment system. payment system.
87 FR 87 FR 1941546846

(s) Prospective payment for (s) Prospective payment for
“CMS will issue annually in the Federal Register “CMS will 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
CMS-2022-00622023 Proposed Rule
System (IPF PPS) System (IPF PPS)
payment system." payment system."
Note: specific timelines for Note: specific timelines for
(4/4/2022) CMS-1769-P
rulemaking and comments for rulemaking and comments for
2022 Final Rule87 FR 19415
Inpatient Psychiatric Facility PPS Inpatient Psychiatric Facility PPS
(8/4/2021) CMS-1750-FComments: Regulations.gov
are not addressed in statute. are not addressed in statute.
86 FR 42608CMS-2022-0062
Deadlines for quality measures Deadlines for quality measures
are specified. are specified.

2022 Final Rule (8/4/2021) CMS-1750-F 86 FR 42608 2022 Proposed Rule
(4/13/2021) CMS-1750-P (4/13/2021) CMS-1750-P
86 FR 19480 86 FR 19480
Comments: Regulations.gov Comments: Regulations.gov
CMS-2021-0060 CMS-2021-0060

2021 Final Rule
(8/4/2020) CMS-1731-F (8/4/2020) CMS-1731-F
85 FR 47042 85 FR 47042
CRS- CRS-89

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link to page link to page 1617 link to page link to page 1617

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: 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 Final2023 Proposed 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-F6/23/2022) CMS-1766-P

services services
payment rates. payment rates.
86 FR 6224087 FR 37600
Home Health Prospective Home Health Prospective

“CMS annually updates the unadjusted national, “CMS annually updates the unadjusted national,
Comments: Regulations.gov
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
CMS-2022-0109 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
(7/7/2021) CMS-1747-P
addressed in statute.
86 FR 35874
Comments: Regulations.gov
CMS-2021-0112

CRS-9

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link to page 16 addressed in statute. 2022 Final Rule (11/9/2021) CMS-1747-F 86 FR 62240 CRS-10 link to page 17

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)
2022 Proposed Rule (7/7/2021) CMS-1747-P 86 FR 35874 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
CRS-11 link to page 17 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 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 Final2023 Proposed 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-F6/28/2022) CMS-1768-P
System System

“(b) Changes in payment rates resulting from “(b) Changes in payment rates resulting from
86 FR 6187487 FR 38464

Note: Specific timelines for Note: Specific timelines for
incorporation of updated cost data or general incorporation of updated cost data or general
Corrections: 86 FR 70982Comments: 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
(12/14/2021)
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
CMS-2022-0110 System (ESRD PPS) System (ESRD PPS)
statute. statute.
the Federal Register without opportunity for the Federal Register without opportunity for

prior comment. Revisions of the rate-setting prior comment. Revisions of the rate-setting
2022 ProposedFinal Rule
methodology are published in the Federal Register in accordance with the Department’s (11/8/2021) CMS-1749-F established rulemaking procedures." 86 FR 61874 Corrections: 86 FR 70982 (12/14/2021) 2022 Proposed Rule (7/9/2021) CMS-1749-P methodology are published in the Federal
CRS-10

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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
(7/9/2021) CMS-1749-P
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

CRS-12 link to page 17 link to page 17 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 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
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
2023 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
( (4/47/29/2022) CMS-1773-/2022) CMS-1773-PF

services services
differences. differences.
87 FR 87 FR 1944245669
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
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.
services included in hospice care are the 2023 Proposed Rule Note: Specific timelines for payment rates in effect under this paragraph rulemaking and comments for (4/4/2022) CMS-1773-P during the previous fiscal year increased by the hospice payment rates are not 87 FR 19442 hospice payment update percentage increase hospice payment update percentage increase
2022 Final Rule
addressed in statute. (as defined in sections1814(i)(1)(C) of the Act), (as defined in sections1814(i)(1)(C) of the Act),
(8/4/2021) CMS-1754-FComments: Regulations.gov
applicable to discharges occurring in the fiscal applicable to discharges occurring in the fiscal
86 FR 42528CMS-2022-0060
year."b

2022 Final Rule (8/4/2021) CMS-1754-F 86 FR 42528 2022 Proposed Rule
(4/14/2021) CMS-1754-P (4/14/2021) CMS-1754-P
86 FR 19700 86 FR 19700
Comments: Regulations.gov Comments: Regulations.gov
CMS-2021-0061 CMS-2021-0061

CRS-13 link to page 17 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) 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
CRS-12

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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 17570 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-1314

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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
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Congressional Research Service Congressional Research Service
R46797 R46797 · VERSION 78 · UPDATED
1415

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