Medicaid and outpatient hospital services / Elicia J. Herz, Sibyl Tilson.

Format:

Book

Government document

Author/Creator:

Herz, Elicia J., 1954- author.

Tilson, Sibyl, author.

Series:

CRS report for Congress.

CRS report for Congress

Language:

English

Subjects (All):

Hospitals--Outpatient services--United States.

Hospitals.

Physical Description:

1 online resource (6 pages).

Place of Publication:

Washington, District of Columbia : Congressional Research Service, 2009.

Summary:

On November 7, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a final Medicaid rule on outpatient hospital services that excluded the proposed regulatory language delineating methods for demonstrating compliance with the upper payment limit on outpatient hospital services provided in private outpatient facilities. [...] The Proposed Rule on Outpatient Hospital Services Under Medicaid The proposed rule (72 Federal Register 55158, September 28, 2007) would limit the definition and scope of Medicaid outpatient services in a hospital clinic, hospital facility, or rural health clinic. [...] Under the proposed rule, the UPL for privately operated outpatient hospital facilities would remain tied to a reasonable estimate of what Medicare would pay for the same services. [...] Justification for the Proposed Rule CMS argues that the current definition of outpatient hospital services in regulations overlaps with other covered Medicaid benefits, so that identical services are sometimes paid a higher amount under the outpatient hospital benefit than would otherwise be available under other Medicaid benefit categories. [...] Specifically, the proposed OPH services rule incorporates the new definition of hospital categories that was adopted in the final rule regarding cost limits on public providers, which eliminates references to provider ownership status; commenters argue that including this language directly contravenes the moratorium on implementing any provision of the public provider rule.

Notes:

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