Medicare Outlier Threshold
Reduced
August 1, 2003 - The Centers for Medicare and Medicaid
Services (CMS) Aug. 1 published in the Federal Register the
final fiscal year
(FY) 2004 Medicare inpatient PPS rule, lowering the outlier
threshold to $31,000 which is lower that the current (FY 2003)
level of $33,560 and significantly lower than the level in
the proposed rule of $50,645. The lowered threshold is due
to changes to the outlier policy that were published as part
of a final rule in June [see Washington
Highlights, June 13].
In a related development, a bipartisan group of 21 Senators,
led by Olympia Snowe (R-Maine) and Jeff Bingaman (D-N.M.),
July 25 wrote a letter to CMS Administrator Tom Scully citing
the "devastating impact" the proposed change would
have had "on hospitals across America." In the letter,
Senators offered support for "changes CMS has made to
the outlier process and believe that those changes will more
accurately identify when patient care qualifies as an outlier
payment and the level of reimbursement for those patients."
The letter goes on to state that the Senators "believe
the threshold should be lowered to a more appropriate level
between $25,000-$30,000."
The letter was signed by Sens. Robert Bennett (R-Utah), Bingaman,
Kit Bond (R-Mo.), Barbara Boxer (D-Calif.), Lincoln Chafee
(R-R.I.), Hillary Clinton (R-N.Y.), Susan Collins (R-Maine),
Kent Conrad (D-N.D.), Jon Corzine (D-N.J.), Byron Dorgan (D-N.D.),
John Edwards (D-N.C.), Russell Feingold (D-Wisc.), Dianne
Feinstein (D-Calif.), Edward Kennedy (D-Mass.), John Kerry
(D-Mass.), Patrick Leahy (D-Vt.), John McCain (R-Ariz.), Mark
Pryor (D-Ark.), Charles Schumer (R-N.Y.), Gordon Smith (R-Ore.),
and Snowe.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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