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HHS/CMS

RIN: 0938-AM41

Publication ID: Spring 2003

Title: ●Hospital Cost-to-Charge Ratios Used to Calculate Cost Outlier Payments Under the Medicare Short-Term Inpatient Prospective Payment System (CMS-1243-F)
Abstract: This proposed rule would change the methodology for determining payments for extraordinarily high-cost cases (cost outliers) made to Medicare-participating hospitals under the acute care hospital inpatient prospective payment system. We have become aware that, in some cases, hospitals' recent rates of charge increases greatly exceed their rates of cost increases. This disparity results in their cost-to-charge ratios being set too high, which in turn results in overestimation of their current costs per case. Therefore, we need to make revisions to our outlier payment methodology to correct those situations in which hospitals would otherwise receive overpayments for outlier cases due to excessive charge increases.
Agency: Department of Health and Human Services(HHS)	Priority: Economically Significant
RIN Status: First time published in the Unified Agenda	Agenda Stage of Rulemaking: Final Rule Stage
Major: Yes	Unfunded Mandates: No
CFR Citation: 42 CFR 412.84 42 CFR 412.116
Legal Authority: 42 USC 1102 of the Social Security Act 42 USC 1871 of the Social Security Act

Legal Deadline: None

Timetable:

Action	Date	FR Cite
NPRM	03/05/2003	68 FR 10420
NPRM Comment Period End	04/04/2003
Final Action	05/00/2003

Regulatory Flexibility Analysis Required: Yes	Government Levels Affected: None
Small Entities Affected: Businesses	Federalism: No
Included in the Regulatory Plan: No
Agency Contact: Stephen Phillips Deputy Division Director, Center for Health Plans and Providers Department of Health and Human Services Centers for Medicare & Medicaid Services C4-07-07, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-4548