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Fiscal Year 2000 Medicare Prospective Payment System: Final Rule

			AAMC Documents AAMC Summary and Analysis AAMC Comment Letter

Current Status as of September 15, 1999

On July 30, 1999, the Health Care Financing Administration (HCFA) published the final rule containing payment updates and other changes to the Medicare hospital inpatient prospective payment system (PPS) for fiscal year 2000. This rule also contains HCFA's responses to the comments it received regarding the May 7, 1999 proposed rule. The AAMC has prepared a detailed summary and analysis of the final rule.

Summary

The final rule implements the Balanced Budget Act of 1997 (BBA) requirement that PPS payments be updated by the increase in the hospital market basket (MB) less 1.8 percentage points, which provides a 1.1 percent update. Because of this update and other changes, particularly indirect medical education (IME) payment reductions, teaching hospitals with 100 or more residents will lose, on average 1.5 percent in Medicare operating payments per case. Other teaching hospitals will lose 0.6 percent and non-teaching hospitals will gain 0.2 percent.

The changes in the final rule affecting the direct graduate medical education (DGME) and IME adjustments are effective October 1, 1999 and focus on issues related to the resident limits mandated by the BBA. They include:

• Allowing hospitals to apply to HCFA for a temporary adjustment in their resident limits, if they assume the training of additional residents from a hospital that closed on or after July 1, 1996. Hospitals must identify those residents who came from the closed institution in the request and submit the request, no later than 60 days after the hospital begins training the residents.

• Hospitals that did not train residents during the 1996 cost reporting period are permitted to establish a resident limit, even if they had trained residents prior to 1996. The resident limits would be set as they would be for hospitals without previous resident training programs.

The final rule also addressed changes in the hospital wage index and made other technical changes and clarifications regarding DGME and IME.

AAMC Action

The AAMC submitted comments on the May 7 proposed rule and has prepared a detailed summary and analysis of the final regulations.

Contacts

Medicare: Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2000 Rates

Final Rule
64 Fed Reg 41489-41538

• Part I [pp. 41489-41538]: Text | PDF
• Part II [pp. 41539-41588]: Text | PDF
• Part III [pp. 41589-41638]: Text | PDF
• Part IV [pp. 41639-41641]: Text | PDF

Proposed Rule
64 Fed Reg 24715-24764

• Part I [pp. 24715-24764]: Text | PDF
• Part II [pp. 24765-24814]: Text | PDF
• Part III [pp. 24815-24854]: Text | PDF

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