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Finding Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources
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Finding Medicare Fee-For-Service (FFS)
June 28, 2023
Payment System Rules: Schedules and
Michele L. Malloy
Resources
Research Librarian
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
through regulations. These proposed and final rules follow schedules based on requirements found in statute, regulation, or both.
As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health care facilities and providers. Congressional Members and committees may comment, and are often contacted by provider and beneficiary groups. Tracking the status and requirements for specific rules can be onerous, since they have different schedules and web locations.
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 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 systems include detailed statutory and regulatory requirements, as noted in the table.
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 ........................................................................................................................ 17
Congressional Research Service
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 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 found in statute, regulation, or both. Medicare payment systems that follow annual regulatory updates with comment periods include the following:
• Medicare Physician Fee Schedule Payment (MPFS or PFS), • Hospital Outpatient Prospective Payment System (OPPS), • Ambulatory Surgical Center Payment System (ASC Payment System), • Acute Inpatient Prospective Payment System (IPPS), • Long-Term Care Hospital Prospective Payment System (LTCH PPS), • Skilled Nursing Facility Prospective Payment System (SNF PPS), • Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS), • Inpatient Psychiatric Facility Prospective Payment System (IPF PPS), • Home Health Prospective Payment System (Home Health PPS), • End Stage Renal Disease Prospective Payment System (ESRD PPS), and • Hospice Wage Index and Payment Rate.
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 groups. Tracking the status and 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 table.
To learn more about these payment systems, please see applicable sections of CRS Report R40425, Medicare Primer. In addition, the Medicare Payment Advisory Commission (MedPAC) produces Payment Basics,1 a series of brief overviews of how Medicare’s payment systems function.
Medicare Fee-For-Service Payment System Rules:
Schedules and Resources
Medicare FFS payment system rules and the associated statutory and regulatory requirements regarding timeline and public comment can be difficult to locate. Table 1 compiles the payment systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued proposed and final rules, including agency docket numbers, Federal Register citations, public 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 periods are not specified. Not all payment systems include detailed statutory and regulatory requirements, as noted in the table.
1 MedPAC, Payment Basics, at https://www.medpac.gov/document-type/payment-basic/.
Congressional Research Service
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
42 USC §1395w-4: Payment for
N/A
2023 Final Rule
Physician Fee Schedule
physicians’ services
(11/18/2022) CMS-1770-F
(b)(1) “Before November 1 of
87 FR 69404
Medicare Physician Fee
the preceding year, for each year
Schedule Payment (PFS)
beginning with 1998, subject to subsection (p), the Secretary
2023 Proposed Rule
shall establish, by regulation, fee
(7/29/2022) CMS-1770-P
schedules that establish payment
87 FR 45860
amounts for all physicians' services furnished in all fee
Comments: Regulations.gov
schedule areas (as defined in
CMS-2022-0113
subsection (j)(2)) for the year."
2022 Final Rule
Note: Public comment is not
(11/19/2021) CMS-1751-F
addressed broadly for PFS in statute. However, public
86 FR 64996
comment is addressed for
aspects of the physician payment
2022 Proposed Rule
system, such as the development
(7/23/2021) CMS-1751-P
of categories and codes.
86 FR 39104 Comments: Regulations.gov CMS-2021-0119
2021 Final Rule (12/28/2020) CMS-1734-F 85 FR 84472 Corrections: 86 FR 5020 (1/19/2021) and 86 FR 14690 (3/18/2021)
CRS-2
link to page 19
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 Proposed Rule (8/17/2020) CMS-1734-P 85 FR 50074 Comments: Regulations.gov CMS-2020-0088 2020 Final Rule (11/15/2019) CMS-1715-F 84 FR 62568 2020 Proposed Rule (8/14/2019) CMS-1715-P 84 FR 40482 Comments: Regulations.gov CMS-2019-0111
Hospital Outpatient
July-August November
42 USC §1395l: Payment of
42 CFR §419.50 Annual review.
2023 Final Rule
Prospective Payment and
-December benefits
(11/23/2022) CMS-1772-FC
Ambulatory Surgical
(t) Prospective payment system
Center Payment Systems
42 CFR §416.130 Publication of revised
87 FR 71748
for hospital outpatient
payment methodologies.
department services
"Whenever CMS proposes to revise the
Hospital Outpatient
2023 Proposed Rule
payment rate for ASCs, CMS publishes a notice
Prospective Payment
Note: Specific timelines for
in the Federal Register describing the revision.
(7/26/2022) CMS-1772-P
System (OPPS)
rulemaking and comments are
The notice also explains the basis on which the
87 FR 44502
not addressed in statute.
rates were established. After reviewing public
Comments: Regulations.gov
Ambulatory Surgical
comments, CMS publishes a notice establishing
CMS-2022-0118
Center (ASC) Payment
the rates authorized by this section. In setting
42 USC §1395l: Payment of
System
these rates, CMS may adopt reasonable
benefits
classifications of facilities and may establish
2022 Final Rule
(i) Outpatient surgery
different rates for different types of surgical
(11/16/2021) CMS-1753-FC
“Taking into account the
procedures."
86 FR 63458
recommendations in the report
CRS-3
link to page 19
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)
under section 626(d) of
Medicare Prescription Drug,
2022 Proposed Rule
Improvement, and Modernization Act of 2003, the Secretary shall
(8/4/2021) CMS-1753-P
implement a revised payment
86 FR 42018
system for payment of surgical
Comments: Regulations.gov
services furnished in ambulatory
CMS-2021-0124
surgical centers."
2021 Final Rule
Note: Specific timelines for
(12/29/2020) CMS-1736-FC
rulemaking and comments beyond the initial year are not
85 FR 85866
addressed in statute.
Corrections: 86 FR 11428 (2/25/2021) 2021 Proposed Rule
(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 2020 Proposed Rule
(8/9/2019) CMS-1717-P 84 FR 39398 Comments: Regulations.gov CMS-2019-0109
CRS-4
link to page 19
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)
Hospital Inpatient
April-May
August-
42 USC §1395ww: Payments to
42 CFR §412.8 Publication of schedules for
2024 Proposed Rule
Prospective Payment
October
hospitals for inpatient hospital
determining prospective payment rates.
(5/1/2023) CMS-1785-P
Systems for Acute Care
services
"(b) Annual publication of schedule for
Hospitals and the Long-
88 FR 26658
(e)(1)(C)(5)
determining prospective payment rates. (1)
Term Care Hospital
CMS proposes changes in the methods,
Comments: Regulations.gov
Prospective Payment
“The Secretary shall cause to
amounts, and factors used to determine
CMS-2023-0057
System
have published in the Federal Register, not later than- (A) the
inpatient prospective payment rates in a
April 1 before each fiscal year
Federal Register document published for public
2023 Final Rule
Acute Inpatient
(beginning with fiscal year 1986),
comment not later than the April 1 before the
(8/10/2022) CMS-1771-F
Prospective Payment
the Secretary’s proposed
beginning of the Federal fiscal year in which the
87 FR 48780
System (IPPS)
recommendations under
proposed changes would apply.
paragraph (4) for that fiscal year
(2) Except as provided in paragraph (c) of this
for public comment, and (B) the
section, CMS publishes a Federal Register
2023 Proposed Rule
Long-Term Care Hospital
August 1 before such fiscal year
document setting forth final methods, amounts,
Prospective Payment
(5/10/2022) CMS-1771-P
after such consideration of public and factors for determining inpatient
System (LTCH PPS)
comment on the proposal as is
prospective payment rates not later than the
87 FR 28108
feasible in the time available, the
August 1 before the Federal fiscal year in which
Comments: Regulations.gov
Secretary's final
the rates would apply."
CMS-2022-0074
recommendations under such
paragraph for that year."
42 CFR §412.535 Publication of the Federal
2022 Final Rule
prospective payment rates.
(8/13/2021) CMS-1752-F
42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
86 FR 44774
hospitals for inpatient hospital
publishes information pertaining to the long-
services
term care hospital prospective payment system
(m) Prospective payment for
effective for each annual update in the Federal
2022 Proposed Rule
long-term care hospitals
Register.
(5/10/2021) CMS-1752-P
(c) For the period beginning on or after
86 FR 25070
Note: Specific timelines for
October 1, 2009, information on the
Corrections: 86 FR 33157
rulemaking and comments for
unadjusted Federal payment rates and a
(6/24/2021)
Long-Term Care Hospital PPS
description of the methodology and data used
Comments: Regulations.gov
are not addressed in statute.
to calculate the payment rates are published on or before August 1 prior to the start of the
CMS-2021-0070
Federal fiscal year which begins October 1,
CRS-5
link to page 19
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)
unless for good cause it is published after
2021 Final Rule
August 1, but before September 1.
(9/18/2020) CMS-1735-F
(d) Information on the LTC-DRG classification
85 FR 58432
and associated weighting factors is published on or before August 1 prior to the beginning of
Corrections: 85 FR 78748
each Federal fiscal year."
(12/7/2020) 2021 Proposed Rule (5/29/2020) CMS-1735-P 85 FR 32460 Comments: Regulations.gov CMS-2020-0052 2020 Final Rule (8/16/2019) CMS-1716-F 84 FR 42044 2020 Proposed Rule
(5/3/2019) CMS-1716-P
84 FR 19158 Corrections: 84 FR 28263 (6/18/2019) Comments: Regulations.gov CMS-2019-0073
Prospective Payment
April-May
August
42 USC §1395yy: Payment to
42 CFR §413.345 Publication of Federal
2024 Proposed Rule
System and Consolidated
skil ed nursing facilities for
prospective payment rates.
(4/10/2023) CMS-1779-P
Bil ing for Skil ed Nursing
routine service costs
"CMS publishes information pertaining to each
Facilities (SNF)
88 FR 21316
(e)(4)(H)
update of the Federal payment rates in the
Comments: Regulations.gov
“The Secretary shall provide for
Federal Register. This information includes the
CMS-2023-0048
publication in the Federal
standardized Federal rates, the resident classification system that provides the basis for
CRS-6
link to page 19
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)
Skil ed Nursing Facility
Register, before May 1, 1998
case-mix adjustment, and the factors to be
2023 Final Rule
Prospective Payment
(with respect to fiscal period
applied in making the area wage adjustment.
(8/3/2022) CMS-1765-F
System (SNF PPS)
described in subparagraph (E)(i))
This information is published before May 1 for
and before the August 1
the fiscal year 1998 and before August 1 for the 87 FR 47502
preceding each succeeding fiscal
fiscal years 1999 and after."
year (with respect to that
2023 Proposed Rule
succeeding fiscal year), of-
(4/15/2022) CMS-1765-P
(i) the unadjusted Federal per
87 FR 22720
diem rates to be applied to days of covered skil ed nursing facility
Comments: Regulations.gov
services furnished during the
CMS-2022-0069
fiscal year,
(i ) the case mix classification
2022 Final Rule
system to be applied under subparagraph (G)(i) with respect
(8/4/2021) CMS-1746-F
to such services during the fiscal
86 FR 42424
year, and
(i i) the factors to be applied in
2022 Proposed Rule
making the area wage adjustment
(4/15/2021) CMS- 1746-P
under subparagraph (G)(i ) with respect to such services."
86 FR 19954
Comments: Regulations.gov CMS-2021-0062
Note: The timelines for the
proposed rule and comments are
not addressed in statute.
2021 Final Rule
(8/5/2020) CMS-1737-F
85 FR 47594 2021 Proposed Rule (4/15/2020) CMS-1737-P 85 FR 20914
CRS-7
link to page 19
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-2020-0036 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
Inpatient Rehabilitation
April-May
August
42 USC §1395ww: Payments to
42 CFR §412.628 Publication of the Federal
2024 Proposed Rule
Facility Prospective
hospitals for inpatient hospital
prospective payment rates.
(5/1/2023) CMS-1785-P
Payment System
services
"We publish information pertaining to the
88 FR 26658
(j)(5)
inpatient rehabilitation facility prospective
Comments: Regulations.gov
Inpatient Rehabilitation
“The Secretary shall provide for
payment system effective for each fiscal year in
CMS-2023-0057
Facility Prospective
publication in the Federal
the Federal Register. This information includes
Payment System (IRF PPS)
Register, on or before August 1
the unadjusted Federal payment rates, the
before each fiscal year (beginning
patient classification system and associated
2023 Final Rule
with fiscal year 2001), of the
weighting factors, and a description of the
(8/1/2022) CMS-1767-F
classification and weighting
methodology and data used to calculate the
87 FR 47038
factors for case mix groups
payment rates. This information is published on
under paragraph (2) for such
or before August 1 prior to the beginning of
fiscal year and a description of
each fiscal year."
2023 Proposed Rule
the methodology and data used
(4/6/2022) CMS-1767-P
in computing the prospective payment rates under this
87 FR 20218
subsection for that fiscal year."
Comments: Regulations.gov
CMS-2022-0061
CRS-8
link to page 19
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: Only the final rule
2022 Final Rule
deadline is specified, the
(8/4/2021) CMS-1748-F
proposed rule is not addressed in statute. Public comment is not
86 FR 42362
addressed in statute.
2022 Proposed Rule (4/12/2021) CMS-1748-P 86 FR 19086 Comments: Regulations.gov CMS-2021-0057 2021 Final Rule (8/10/2020) CMS-1729-F 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
84 FR 39054 2020 Proposed Rule (4/24/2019) CMS-1710-P 84 FR 17244
CRS-9
link to page 19
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: 84 FR 24734 (5/29/2019) Comments: Regulations.gov CMS-2019-0066
Inpatient Psychiatric
April-May
August
42 USC §1395ww: Payments to
42 CFR §412.428 Publication of changes to the
2024 Proposed Rule
Facilities Prospective
hospitals for inpatient hospital
inpatient psychiatric facility prospective
(4/10/2023) CMS-1783-P
Payment System
services
payment system.
88 FR 21238
(s) Prospective payment for
“CMS wil issue annually in the Federal Register
Comments: Regulations.gov
Inpatient Psychiatric Facility
psychiatric hospitals
information pertaining to changes to the
CMS-2023-0053
Prospective Payment
inpatient psychiatric facility prospective
System (IPF PPS)
payment system."
Note: Specific timelines for rulemaking and comments for
2023 Final Rule
Inpatient Psychiatric Facility PPS
(7/29/2022) CMS-1769-F
are not addressed in statute.
87 FR 46846
Deadlines for quality measures
are specified.
2023 Proposed Rule
(4/4/2022) CMS-1769-P 87 FR 19415 Comments: Regulations.gov CMS-2022-0062
2022 Final Rule
(8/4/2021) CMS-1750-F 86 FR 42608
2022 Proposed Rule (4/13/2021) CMS-1750-P 86 FR 19480 Comments: Regulations.gov
CRS-10
link to page 19
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)
CMS-2021-0060 2021 Final Rule
(8/4/2020) CMS-1731-F
85 FR 47042 Corrections: 85 FR 52923 (8/27/2020) 2021 Proposed Rule (4/14/2020) CMS-1731-P 85 FR 20625 Comments: Regulations.gov CMS-2020-0035 2020 Final Rule
(8/6/2019) CMS-1712-F
84 FR 38424 2020 Proposed Rule (4/23/2019) CMS-1712-P 84 FR 16948 Comments: Regulations.gov CMS-2019-0067
Home Health Prospective
July
November
42 USC §1395fff: Prospective
42 CFR §484.225 Annual update of the
2023 Final Rule
Payment System
payment for home health
unadjusted national, standardized prospective
(11/4/2022) CMS-1766-F
services
payment rates.
87 FR 66790
Home Health Prospective
“CMS annually updates the unadjusted national,
Payment System (Home
Note: Specific timelines for
standardized prospective payment rate on a
Health PPS)
rulemaking and comments for
2023 Proposed Rule
CRS-11
link to page 19 link to page 19
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
calendar year basis (in accordance with section
(6/23/2022) CMS-1766-P
addressed in statute.
1895(b)(1)(B) of the Act)."b
87 FR 37600 Comments: Regulations.gov CMS-2022-0109
2022 Final Rule
(11/9/2021) CMS-1747-F 86 FR 62240
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
85 FR 70298 2021 Proposed Rule
(6/30/2020) CMS-1730-P
85 FR 39408 Corrections: 85 FR 43805 (7/20/2020) Comments: Regulations.gov CMS-2020-0077 2020 Final Rule
CRS-12
link to page 19
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)
(11/8/2019) CMS-1711-FC
84 FR 60478 2020 Proposed Rule
(7/18/2019) CMS-1711-P
84 FR 34598 Comments: Regulations.gov CMS-2019-0100
End-Stage Renal Disease
July
November
42 USC §1395rr: End stage renal
42 CFR §413.196 Notification of changes in
2023 Final Rule
Prospective Payment
disease program
rate-setting methodologies and payment rates.
(11/7/2022) CMS-1768-F
System
“(b) Changes in payment rates resulting from
87 FR 67136
Note: Specific timelines for
incorporation of updated cost data or general
End Stage Renal Disease
rulemaking and comments for
revisions of geographic labor cost adjustment
Prospective Payment
ESRD PPS are not addressed in
factors are announced by notice published in
2023 Proposed Rule
System (ESRD PPS)
statute.
the Federal Register without opportunity for
(6/28/2022) CMS-1768-P
prior comment. Revisions of the rate-setting
87 FR 38464
methodology are published in the Federal Register in accordance with the Department’s
Comments: Regulations.gov
established rulemaking procedures."
CMS-2022-0110
2022 Final Rule
(11/8/2021) CMS-1749-F 86 FR 61874 Corrections: 86 FR 70982 (12/14/2021)
2022 Proposed Rule
(7/9/2021) CMS-1749-P 86 FR 36322
CRS-13
link to page 19
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-2021-0114
2021 Final Rule
(11/9/2020) CMS-1732-F 85 FR 71398 2021 Proposed Rule
(7/13/2020) CMS-1732-P 85 FR 42132 Comments: Regulations.gov CMS-2020-0079 2020 Final Rule
(11/8/2019) CMS-1713-F
84 FR 60648 2020 Proposed Rule (8/6/2019) CMS-1713-P 84 FR 38330 Comments: Regulations.gov CMS-2019-0110
Hospice Wage Index and
April-May
August
42 USC §1395f: Conditions of
42 CFR §418.306 Annual update of the
2024 Proposed Rule
Payment Rate
and limitations on payment for
payment rates and adjustment for area wage
(4/4/2023) CMS-1787-P
services
differences.
88 FR 20022
Hospice Wage Index and
(i) Payment for hospice care
“(b) Annual update of the payment rates. The
Comments: Regulations.gov
Payment Rate
payment rates for routine home care and other services included in hospice care are the
CMS-2023-0051
Note: Specific timelines for
payment rates in effect under this paragraph
rulemaking and comments for
during the previous fiscal year increased by the
CRS-14
link to page 19 link to page 19
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 payment rates are not
hospice payment update percentage increase
2023 Final Rule
addressed in statute.
(as defined in sections1814(i)(1)(C) of the Act),
(7/29/2022) CMS-1773-F
applicable to discharges occurring in the fiscal year."b
87 FR 45669
2023 Proposed Rule
(4/4/2022) CMS-1773-P 87 FR 19442 Comments: Regulations.gov CMS-2022-0060
2022 Final Rule
(8/4/2021) CMS-1754-F 86 FR 42528
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 85 FR 47070 2021 Proposed Rule
(4/15/2020) CMS-1733-P 85 FR 20949
CRS-15
link to page 19
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-2020-0037 2020 Final Rule
(8/6/2019) CMS-1714-F 84 FR 38484 2020 Proposed Rule
(4/25/2019) CMS-1714-P 84 FR 17570 Comments: Regulations.gov CMS-2019-0068
Source: Compiled by the Congressional Research Service (CRS). Notes: Table compiled using Centers for Medicare & Medicaid Services (CMS) websites, Federal Register, 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 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
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 U.S. Code citation. The Social Security Administration provides a cross-reference table at
https://www.ssa.gov/OP_Home/comp2/G-APP-H.html.
CRS-16
Finding Medicare Fee-For-Service (FFS) Payment System Rules
Author Information
Michele L. Malloy
Research Librarian
Acknowledgments
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.
Disclaimer
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 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 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 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 copy or otherwise use copyrighted material.
Congressional Research Service
R46797 · VERSION 11 · UPDATED
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