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

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

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

Updated January 7, 2025

Congressional Research Service

https://crsreports.congress.gov

R46797

Congressional Research Service

SUMMARY

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

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. Medicare FFS 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.

R46797

January 7, 2025

Michele L. Malloy Senior Research Librarian

Finding Medicare Fee-For-Service (FFS) Payment System Rules

Congressional Research Service

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 ........................................................................................................................ 23

Finding Medicare Fee-For-Service (FFS) Payment System Rules

Congressional Research Service 1

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. Medicare FFS 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/.

CRS-2

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

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

Payment Policies Under the Physician Fee Schedule

Medicare Physician Fee Schedule Payment (PFS)

July-August November 42 U.S.C. §1395w-4: Payment for physicians’ services (b)(1) “Before November 1 of the preceding year, for each year beginning with 1998, subject to subsection (p), the Secretary shall establish, by regulation, fee schedules that establish payment amounts for all physicians' services furnished in all fee schedule areas (as defined in subsection (j)(2)) for the year." Note: Public comment is not addressed broadly for PFS in statute. However, public comment is addressed for aspects of the physician payment system, such as the development of categories and codes.

N/A 2025 Final Rule (12/9/2024) CMS-1807-F 89 FR 97710 2025 Proposed Rule (7/31/2024) CMS-1807-P 89 FR 61596 Comments: Regulations.gov CMS-2024-0256-0045 2024 Final Rule (11/16/2023) CMS-1784-F 88 FR 78818 Corrections: 89 FR 9776 (2/12/2024) 2024 Proposed Rule (8/7/2023) CMS-1784-P 88 FR 52262 Comments: Regulations.gov CMS-2023-0121 2023 Final Rule (11/18/2022) CMS-1770-F 87 FR 69404

CRS-3

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

2023 Proposed Rule (7/29/2022) CMS-1770-P 87 FR 45860 Comments: Regulations.gov CMS-2022-0113 2022 Final Rule (11/19/2021) CMS-1751-F 86 FR 64996 2022 Proposed Rule (7/23/2021) CMS-1751-P 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) 2021 Proposed Rule (8/17/2020) CMS-1734-P 85 FR 50074 Comments: Regulations.gov CMS-2020-0088

CRS-4

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

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 Prospective Payment and Ambulatory Surgical Center Payment Systems

Hospital Outpatient Prospective Payment System (OPPS)

July-August November -December

42 U.S.C. §1395l: Payment of benefits (t) Prospective payment system for hospital outpatient department services Note: Specific timelines for rulemaking and comments are not addressed in statute.

42 C.F.R. §419.50 Annual review. 2025 Final Rule (11/27/2024) CMS-1809-FC 89 FR 93912 2025 Proposed Rule (7/22/2024) CMS-1809-P 89 FR 59186 Comments: Regulations.gov CMS-2024-0199-0002 2024 Final Rule (11/22/2023) CMS-1786-FC 88 FR 81540 Corrections: 89 FR 9002 (2/9/2024) 2024 Proposed Rule

Ambulatory Surgical Center (ASC) Payment System

July-August November -December

42 U.S.C. §1395l: Payment of benefits (i) Outpatient surgery “Taking into account the recommendations in the report under section 626(d) of Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the Secretary shall implement a revised payment

42 C.F.R. §416.130 Publication of revised payment methodologies. "Whenever CMS proposes to revise the payment rate for ASCs, CMS publishes a notice in the Federal Register describing the revision. The notice also explains the basis on which the rates were established. After reviewing public comments, CMS publishes a notice establishing the rates authorized by this section. In setting these rates, CMS may adopt reasonable

CRS-5

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

system for payment of surgical services furnished in ambulatory surgical centers." Note: Specific timelines for rulemaking and comments beyond the initial year are not addressed in statute.

classifications of facilities and may establish different rates for different types of surgical procedures."

(7/31/2023) CMS-1786-P 88 FR 49552 Comments: Regulations.gov CMS-2023-0120 Corrections: 88 FR 57029 (8/22/2023) 2023 Final Rule (11/23/2022) CMS-1772-FC 87 FR 71748 2023 Proposed Rule (7/26/2022) CMS-1772-P 87 FR 44502 Comments: Regulations.gov CMS-2022-0118 2022 Final Rule (11/16/2021) CMS-1753-FC 86 FR 63458 2022 Proposed Rule (8/4/2021) CMS-1753-P 86 FR 42018 Comments: Regulations.gov CMS-2021-0124 2021 Final Rule

CRS-6

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

(12/29/2020) CMS-1736-FC 85 FR 85866 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

Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System

Acute Inpatient Prospective Payment System (IPPS)

April-May August- October

42 U.S.C. §1395ww: Payments to hospitals for inpatient hospital services (e)(1)(C)(5) “The Secretary shall cause to have published in the Federal Register, not later than- (A) the April 1 before each fiscal year

42 C.F.R. §412.8 Publication of schedules for determining prospective payment rates. "(b) Annual publication of schedule for determining prospective payment rates. (1) CMS proposes changes in the methods, amounts, and factors used to determine inpatient prospective payment rates in a Federal Register document published for public comment not later than the April 1 before the

2025 Final Rule (8/28/2024) CMS-1808-F 89 FR 68986 2025 Proposed Rule (5/2/2024) CMS-1808-P 89 FR 35934

CRS-7

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

(beginning with fiscal year 1986), the Secretary’s proposed recommendations under paragraph (4) for that fiscal year for public comment, and (B) the August 1 before such fiscal year after such consideration of public comment on the proposal as is feasible in the time available, the Secretary's final recommendations under such paragraph for that year."

beginning of the Federal fiscal year in which the proposed changes would apply. (2) Except as provided in paragraph (c) of this section, CMS publishes a Federal Register document setting forth final methods, amounts, and factors for determining inpatient prospective payment rates not later than the August 1 before the Federal fiscal year in which the rates would apply."

Comments: Regulations.gov CMS-2024-0131-0025 2024 Final Rule (8/28/2023) CMS-1785-F 88 FR 58640 Corrections: 88 FR 68482 (10/4/2023) and 88 FR 77211 (11/9/2023) 2024 Proposed Rule (5/1/2023) CMS-1785-P 88 FR 26658 Comments: Regulations.gov CMS-2023-0057 2023 Final Rule (8/10/2022) CMS-1771-F 87 FR 48780 2023 Proposed Rule (5/10/2022) CMS-1771-P 87 FR 28108 Comments: Regulations.gov CMS-2022-0074 2022 Final Rule (8/13/2021) CMS-1752-F 86 FR 44774

Long-Term Care Hospital Prospective Payment System (LTCH PPS)

April-May August- October

42 U.S.C. §1395ww: Payments to hospitals for inpatient hospital services (m) Prospective payment for long-term care hospitals Note: Specific timelines for rulemaking and comments for Long-Term Care Hospital PPS are not addressed in statute.

42 C.F.R. §412.535 Publication of the Federal prospective payment rates. "Except as specified in paragraph (b), CMS publishes information pertaining to the long- term care hospital prospective payment system effective for each annual update in the Federal Register. (c) For the period beginning on or after October 1, 2009, information on the unadjusted Federal payment rates and a description of the methodology and data used to calculate the payment rates are published on or before August 1 prior to the start of the Federal fiscal year which begins October 1, unless for good cause it is published after August 1, but before September 1. (d) Information on the LTC-DRG classification and associated weighting factors is published on or before August 1 prior to the beginning of each Federal fiscal year."

CRS-8

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

2022 Proposed Rule (5/10/2021) CMS-1752-P 86 FR 25070 Corrections: 86 FR 33157 (6/24/2021) Comments: Regulations.gov CMS-2021-0070 2021 Final Rule (9/18/2020) CMS-1735-F 85 FR 58432 Corrections: 85 FR 78748 (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

CRS-9

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

Corrections: 84 FR 28263 (6/18/2019) Comments: Regulations.gov CMS-2019-0073

Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF)

Skilled Nursing Facility Prospective Payment System (SNF PPS)

April-May August 42 U.S.C. §1395yy: Payment to skilled nursing facilities for routine service costs (e)(4)(H) “The Secretary shall provide for publication in the Federal Register, before May 1, 1998 (with respect to fiscal period described in subparagraph (E)(i)) and before the August 1 preceding each succeeding fiscal year (with respect to that succeeding fiscal year), of- (i) the unadjusted Federal per diem rates to be applied to days of covered skilled nursing facility services furnished during the fiscal year, (ii) the case mix classification system to be applied under subparagraph (G)(i) with respect to such services during the fiscal year, and (iii) the factors to be applied in making the area wage adjustment under subparagraph (G)(ii) with respect to such services."

42 C.F.R. §413.345 Publication of Federal prospective payment rates. "CMS publishes information pertaining to each update of the Federal payment rates in the Federal Register. This information includes the standardized Federal rates, the resident classification system that provides the basis for case-mix adjustment, and the factors to be applied in making the area wage adjustment. This information is published before May 1 for the fiscal year 1998 and before August 1 for the fiscal years 1999 and after."

2025 Final Rule (8/6/2024) CMS-1802-F 89 FR 64048 2025 Proposed Rule (4/3/2024) CMS-1802-P 89 FR 23424 Comments: Regulations.gov CMS-2024-0116-0002 2024 Final Rule (8/7/2023) CMS-1779-F 88 FR 53200 Corrections: 88 FR 68486 (10/4/2023) and 89 FR 25144 (4/10/2024) 2024 Proposed Rule (4/10/2023) CMS-1779-P 88 FR 21316 Comments: Regulations.gov CMS-2023-0048 2023 Final Rule

CRS-10

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

Note: The timelines for the proposed rule and comments are not addressed in statute.

(8/3/2022) CMS-1765-F 87 FR 47502 2023 Proposed Rule (4/15/2022) CMS-1765-P 87 FR 22720 Comments: Regulations.gov CMS-2022-0069 2022 Final Rule (8/4/2021) CMS-1746-F 86 FR 42424 2022 Proposed Rule (4/15/2021) CMS- 1746-P 86 FR 19954 Comments: Regulations.gov CMS-2021-0062 2021 Final Rule (8/5/2020) CMS-1737-F 85 FR 47594 2021 Proposed Rule (4/15/2020) CMS-1737-P 85 FR 20914 Comments: Regulations.gov CMS-2020-0036

CRS-11

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

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 Facility Prospective Payment System

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)

April-May August 42 U.S.C. §1395ww: Payments to hospitals for inpatient hospital services (j)(5) “The Secretary shall provide for publication in the Federal Register, on or before August 1 before each fiscal year (beginning with fiscal year 2001), of the classification and weighting factors for case mix groups under paragraph (2) for such fiscal year and a description of the methodology and data used in computing the prospective payment rates under this subsection for that fiscal year." Note: Only the final rule deadline is specified, the

42 C.F.R. §412.628 Publication of the Federal prospective payment rates. "We publish information pertaining to the inpatient rehabilitation facility prospective payment system effective for each fiscal year in the Federal Register. This information includes the unadjusted Federal payment rates, the patient classification system and associated weighting factors, and a description of the methodology and data used to calculate the payment rates. This information is published on or before August 1 prior to the beginning of each fiscal year."

2025 Final Rule (8/6/2024) CMS-1804-F 89 FR 64276 2025 Proposed Rule (3/29/2024) CMS-1804-P 89 FR 22246 Comments: Regulations.gov CMS-2024-0111-0002 2024 Final Rule (8/2/2023) CMS-1781-F 88 FR 50956 Corrections: 88 FR 68494 (10/4/2023) 2024 Proposed Rule

CRS-12

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

proposed rule is not addressed in statute. Public comment is not addressed in statute.

(4/7/2023) CMS-1781-P 88 FR 20950 Comments: Regulations.gov CMS-2023-0047 2023 Final Rule (8/1/2022) CMS-1767-F 87 FR 47038 2023 Proposed Rule (4/6/2022) CMS-1767-P 87 FR 20218 Comments: Regulations.gov CMS-2022-0061 2022 Final Rule (8/4/2021) CMS-1748-F 86 FR 42362 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

CRS-13

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

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 Corrections: 84 FR 24734 (5/29/2019) Comments: Regulations.gov CMS-2019-0066

Inpatient Psychiatric Facilities Prospective Payment System

Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS)

April-May August 42 U.S.C. §1395ww: Payments to hospitals for inpatient hospital services (s) Prospective payment for psychiatric hospitals Note: Specific timelines for rulemaking and comments for Inpatient Psychiatric Facility PPS are not addressed in statute.

42 C.F.R. §412.428 Publication of changes to the inpatient psychiatric facility prospective payment system. “CMS will issue annually in the Federal Register information pertaining to changes to the inpatient psychiatric facility prospective payment system."

2025 Final Rule (8/7/2024) CMS-1806-F 89 FR 64582 2025 Proposed Rule (4/3/2024) CMS-1806-P 89 FR 23146 Comments: Regulations.gov CMS-2024-0119-0002

CRS-14

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

Deadlines for quality measures are specified.

2024 Final Rule (8/2/2023) CMS-1783-F 88 FR 51054 Corrections: 88 FR 68491 (10/4/2023) 2024 Proposed Rule (4/10/2023) CMS-1783-P 88 FR 21238 Comments: Regulations.gov CMS-2023-0053 2023 Final Rule (7/29/2022) CMS-1769-F 87 FR 46846 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

CRS-15

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

(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 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

CRS-16

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

Home Health Prospective Payment System

Home Health Prospective Payment System (Home Health PPS)

July November 42 U.S.C. §1395fff: Prospective payment for home health services Note: Specific timelines for rulemaking and comments for Home Health PPS are not addressed in statute.

42 C.F.R. §484.225 Annual update of the unadjusted national, standardized prospective payment rates. “CMS annually updates the unadjusted national, standardized prospective payment rate on a calendar year basis (in accordance with section 1895(b)(1)(B) of the Act)."b

2025 Final Rule (11/7/2024) CMS-1803-F 89 FR 88354 2025 Proposed Rule (7/3/2024) CMS-1803-P 89 FR 55312 Comments: Regulations.gov CMS-2024-0190-0002 2024 Final Rule (11/13/2023) CMS-1780-F 88 FR 77676 Corrections: 89 FR 6019 (1/31/2024) 2024 Proposed Rule (7/10/2023) CMS-1780-P 88 FR 43654 Comments: Regulations.gov CMS-2023-0113 2023 Final Rule (11/4/2022) CMS-1766-F 87 FR 66790 2023 Proposed Rule

CRS-17

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

(6/23/2022) CMS-1766-P 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-18

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

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 Prospective Payment System

End-Stage Renal Disease Prospective Payment System (ESRD PPS)

July November 42 U.S.C. §1395rr: End stage renal disease program Note: Specific timelines for rulemaking and comments for ESRD PPS are not addressed in statute.

42 C.F.R. §413.196 Notification of changes in rate-setting methodologies and payment rates. “(b) Changes in payment rates resulting from incorporation of updated cost data or general revisions of geographic labor cost adjustment factors are announced by notice published in the Federal Register without opportunity for prior comment. Revisions of the rate-setting methodology are published in the Federal Register in accordance with the Department’s established rulemaking procedures."

2025 Final Rule (11/12/2024) CMS-1805-F 89 FR 89084 2025 Proposed Rule (7/5/2024) CMS-1805-P 89 FR 55760 Comments: Regulations.gov CMS-2024-0189-0002 2024 Final Rule (11/6/2023) CMS-1782-F 88 FR 76344 2024 Proposed Rule (6/30/2023) CMS-1782-P 88 FR 42430 Comments: Regulations.gov CMS-2023-0110

CRS-19

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

2023 Final Rule (11/7/2022) CMS-1768-F 87 FR 67136 2023 Proposed Rule (6/28/2022) CMS-1768-P 87 FR 38464 Comments: Regulations.gov 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 Comments: Regulations.gov CMS-2021-0114 2021 Final Rule (11/9/2020) CMS-1732-F 85 FR 71398 2021 Proposed Rule

CRS-20

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

(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 Payment Rate

Hospice Wage Index and Payment Rate

April-May August 42 U.S.C. §1395f: Conditions of and limitations on payment for services (i) Payment for hospice care Note: Specific timelines for rulemaking and comments for hospice payment rates are not addressed in statute.

42 C.F.R. §418.306 Annual update of the payment rates and adjustment for area wage differences. “(b) Annual update of the payment rates. The payment rates for routine home care and other services included in hospice care are the payment rates in effect under this paragraph during the previous fiscal year increased by the hospice payment update percentage increase (as defined in sections1814(i)(1)(C) of the Act), applicable to discharges occurring in the fiscal year."b

2025 Final Rule (8/6/2024) CMS-1810-F 89 FR 64202 2025 Proposed Rule (4/4/2024) CMS-1810-P 89 FR 23778 Comments: Regulations.gov CMS-2024-0118-0002 2024 Final Rule (8/2/2023) CMS-1787-F 88 FR 51164

CRS-21

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

2024 Proposed Rule (4/4/2023) CMS-1787-P 88 FR 20022 Comments: Regulations.gov CMS-2023-0051 2023 Final Rule (7/29/2022) CMS-1773-F 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

CRS-22

Typically Issued Requirements: Timeline and Public Comment

Rule Name and

Payment System(s)a

Proposed

Rule Final Rule Statutory Regulatory

Most Recently

Issued Rule(s)

(8/4/2020) CMS-1733-F 85 FR 47070 2021 Proposed Rule (4/15/2020) CMS-1733-P 85 FR 20949 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, multiple payment systems are covered by one rule, so they are combined under one header and rule column, but include separate rows for their payment system name as well as the statutory and regulatory requirements. Typical months when proposed and final rules are issued can vary, and the months listed 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.

Finding Medicare Fee-For-Service (FFS) Payment System Rules

Congressional Research Service R46797 · VERSION 14 · UPDATED 23

Author Information

Michele L. Malloy Senior 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

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