Low-Volume
Hospitals: The Bipartisan Budget Act (BiBA) retroactively extended the
enhanced low-volume payment adjustment. The Centers for Medicare & Medicaid
Services (CMS) proposes to implement this change for FY 2018 in a separate notice and, for FY 2019, in the rule. For FY 2018, low-volume
hospitals will continue to be defined as those that are more than 15 road miles
from another comparable hospital and that have up to 1,600 Medicare discharges.
In order to receive the
enhanced payments for FY 2018, a hospital must notify its Medicare
Administrative Contractor (MAC) that it qualifies by May 29, per the
instructions outlined in the notice. CMS states that it will be
issuing guidance on the exact manner in which it intends to make low-volume
payments for FY 2018, given that a portion will be made retroactively.
For FYs 2019 through 2022, the discharge thresholds would
be modified to 500 total discharges and 3,800 total discharges. To receive the
enhanced payments for FY 2019, a hospital must notify its MAC that it qualifies by Sept. 1, per
the instructions outlined in the rule.
Medicare
Dependent Hospitals (MDH): The BiBA also retroactively extended the MDH program
through FY 2022. CMS states that a provider that was classified as an MDH as of
Sept. 30, 2017, was automatically reinstated as an MDH effective Oct. 1, 2017,
with no need to reapply for MDH classification. However, as outlined in detail
in its separate notice, if the MDH had classified as a sole community hospital or
cancelled its rural classification effective on or after Oct. 1, 2017, the
effective date of MDH status may not be retroactive to Oct. 1, 2017. CMS states
that it will be issuing guidance on the exact manner in which it intends to
make MDH payments for FY 2018, given that a portion will be made retroactively.