Medicaid and Outpatient Hospital Services (CRS Report for Congress)
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| Release Date |
Revised May 13, 2009 |
| Report Number |
RS22852 |
| Report Type |
Report |
| Authors |
Elicia J. Herz and Sibyl Tilson, Specialists in Health Care Financing |
| Source Agency |
Congressional Research Service |
| Older Revisions |
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Summary:
On September 28, 2007, a proposed Medicaid rule was published that would (1) change the definition of outpatient hospital and rural health clinic services and (2) change the methods states must use to demonstrate compliance with the federal upper payment limit on outpatient hospital services provided in private outpatient facilities. A number of groups have expressed concern that this rule will have a significant negative impact on coverage of certain services, which may harm Medicaid beneficiaries. 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 effective date of the regulation had been December 8, 2008. As of January 26, 2009, 12 states have submitted state plan amendments in response to the regulation. The American Recovery and Reinvestment Act of 2009 (P.L. 111-5) prohibits the Secretary of Health and Human Services from taking any action until after June 30, 2009 (through regulation, regulatory guidance, use of federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or state Medicaid director letter), to implement the final regulation covering outpatient hospital facility services. On May 6, 2009, CMS issued a proposed rule that, among other actions, rescinded the final Medicaid rule defining outpatient services. Public comments on this proposal will be accepted until June 1, 2009.
