{"abstract":"In this proposed rule, we are proposing to change the methodology for determining payments for extraordinarily high-cost cases (cost outliers) made to Medicare-participating hospitals under the acute care hospital inpatient prospective payment system. Under the existing outlier methodology, the cost-to-charge ratios from hospitals' latest settled cost reports are used in determining a fixed-loss amount cost outlier threshold. We have become aware that, in some cases, hospitals' recent rates of charge increases greatly exceed their rates of cost increases. This disparity results in their cost-to-charge ratios being set too high, which in turn results in an overestimation of their current costs per case. Therefore, we need to make revisions to our outlier payment methodology to correct those situations in which hospitals would otherwise receive overpayments for outlier cases due to excessive charge increases.","action":"Proposed rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2003/03/05/03-5121.html","cfr_references":[{"chapter":null,"citation_url":null,"part":412,"title":42}],"citation":"68 FR 10420","comment_url":null,"comments_close_on":"2003-04-04","correction_of":null,"corrections":[],"dates":"Comments will be considered if we receive them at the appropriate address, as provided below, no later than 5 p.m. on April 4, 2003.","disposition_notes":null,"docket_ids":["CMS-1243-P"],"dockets":[],"document_number":"03-5121","effective_on":null,"end_page":10429,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2003/03/05/03-5121.xml","html_url":"https://www.federalregister.gov/documents/2003/03/05/03-5121/medicare-program-proposed-change-in-methodology-for-determining-payment-for-extraordinarily","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/03-5121?publication_date=2003-03-05","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2003-03-05/03-5121/mods.xml","not_received_for_publication":null,"page_length":10,"page_views":{"count":244,"last_updated":"2026-10-25 02:15:05 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2003-03-05/pdf/03-5121.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2003-03-05","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2003/03/05/03-5121.txt","regulation_id_number_info":{"0938-AM41":{"issue":"200304","html_url":"https://www.federalregister.gov/regulations/0938-AM41/hospital-cost-to-charge-ratios-used-to-calculate-cost-outlier-payments-under-the-medicare-short-term","title":"Hospital Cost-to-Charge Ratios Used to Calculate Cost Outlier Payments Under the Medicare Short-Term Inpatient Prospective Payment System (CMS-1243-F)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=200304&RIN=0938-AM41&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AM41"],"regulations_dot_gov_info":{},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":10420,"subtype":null,"title":"Medicare Program; Proposed Change in Methodology for Determining Payment for Extraordinarily High-Cost Cases (Cost Outliers) Under the Acute Care Hospital Inpatient Prospective Payment System","toc_doc":"Acute care hospital inpatient prospective payment system; payment methodology for extraordinarily high-cost cases","toc_subject":"Medicare and medicaid:","topics":["Administrative practice and procedure","Health facilities","Medicare","Puerto Rico","Reporting and recordkeeping requirements"],"type":"Proposed Rule","volume":68}