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IPPS Proposed Rule – FFY2020

CMS-1716-P drafted on 4/23/2019; Published in the Federal Register on 5/3/2019. On April 23, 2019, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that focuses the agency’s efforts on a singular objective:  transforming the healthcare delivery system through competition and innovation to provide patients with better value and results.  The proposed rule updates Medicare payment policies and rates for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), effective for discharges on or after October 1, 2019. The policies in the IPPS and LTCH PPS proposed rule would represent historic changes to the way rural hospitals are paid and help ensure access to a world-class healthcare system with access to potentially life-saving diagnostics and therapies by unleashing innovation in medical technology and removing barriers to competition. Overall, the proposed rule is projected to result in an estimated increase of $4.7B (or 3.7%) in payments to providers, ranging from 1.7% increases for urban hospitals in the New England Region up to 4.9% increases for smaller, rural hospitals. Comments must be sent to CMS no later than 5pm EDT on June 24, 2019 at the applicable address provided in each section of the Proposed Rule or submitted electronically at  When commenting, please refer to file code CMS-1716-P.
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Medicare IPPS Base Rates

CMS is proposing a base rate increase of 3.1% for hospitals, mostly driven by a market basket increase of 3.2%.

 Click here for the full base rate calculation table and comparison to prior year.

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Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes – FY 2017

From: CMS Transmittal 3626 (Pub 100-04) – 10/19/16

This transmittal reflects the instructions provided to the MACs for implementation of the FY 2017 IPPS & LTCH payment rates.  It is a very useful document and provides some very summarized descriptions of all the various elements that go into the PPS pricer program.  Consider it a quick cliff notes that can be referred to when looking for a quick explanation.  The link above takes you to the applicable page to download the transmittal (358 pages; includes table details).

We have bookmarked this file to easily navigate the document.  If you would like a copy of this file, click here.

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