​​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 no​tice 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. ​