Grassley, Baucus Request
Modifications to Outlier Rule
March 21, 2003 - In a March 12 letter to Centers for
Medicare and Medicaid Services (CMS) Administrator Tom Scully,
Senate Finance Committee Chairman Charles Grassley (R-Iowa)
and Ranking Member Max Baucus (D-Mont.) requested modifications
to CMS's March 5 proposed rule on the outlier methodology
[see Washington
Highlights, March 7]. The Senators urged Administrator
Scully to lower the threshold, requested that hospitals face
no "undue burdens or uncertainty" with the calculation
of outlier payments, and asked that the rule be implemented
as soon as possible.
Applauding CMS's actions "taken so far" in response
to some hospitals receiving more than 60 percent of their
total Medicare inpatient payments from outlier payments, the
letter states "excessive outlier payments have prevented
hospitals that treat the most complicated cases from receiving
appropriate outlier payments to offset their higher costs."
The letter states general support for the proposed rule,
but requests the following modifications:
- "that you lower the outlier threshold so that CMS
can begin to pay hospitals the outlier payments they would
not have otherwise received because of the inappropriate
actions of a few hospitals," and
- "that hospitals do not face undue new burdens or
uncertainty as these outlier payments are calculated"-a
reference to the new "reconciliation" process
that would require hospitals to return excess outlier
payments if it is later determined that their per case
costs were less than what was calculated at the time the
outlier payment was made.
The letter also requests the rule to be published as soon
as possible "without a transition period to ensure that
inappropriate payments are no longer made."
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
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