{"abstract":"This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2- midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare- dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.","action":"Final rule with comment period; final 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 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2016.","disposition_notes":null,"docket_ids":["CMS-1633-FC","CMS-1607-F2"],"dockets":[],"document_number":"2015-27943","effective_on":null,"end_page":70607,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2015/11/13/2015-27943.xml","html_url":"https://www.federalregister.gov/documents/2015/11/13/2015-27943/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment","images":{"ER13NO15.001":{"large":"https://img.federalregister.gov/ER13NO15.001/ER13NO15.001_large.png","original_size":"https://img.federalregister.gov/ER13NO15.001/ER13NO15.001_original_size.png"},"ER13NO15.000":{"large":"https://img.federalregister.gov/ER13NO15.000/ER13NO15.000_large.png","original_size":"https://img.federalregister.gov/ER13NO15.000/ER13NO15.000_original_size.png"}},"images_metadata":{"ER13NO15.001":{"large":{"identifier":"ER13NO15.001","content_type":"image/png","size":3195,"width":408,"sha":"44253099f5d771f5941e8b67b8930859","url":"https://img.federalregister.gov/ER13NO15.001/ER13NO15.001_large.png","height":58},"original_size":{"identifier":"ER13NO15.001","content_type":"image/png","size":4565,"width":1451,"sha":"4f560797d9db7db2551d64d1ebe3e7ba","url":"https://img.federalregister.gov/ER13NO15.001/ER13NO15.001_original_size.png","height":205}},"ER13NO15.000":{"large":{"identifier":"ER13NO15.000","content_type":"image/png","size":6436,"width":823,"sha":"5ea1f9d429ee9f4d40e41eb434966127","url":"https://img.federalregister.gov/ER13NO15.000/ER13NO15.000_large.png","height":51},"original_size":{"identifier":"ER13NO15.000","content_type":"image/png","size":9552,"width":3337,"sha":"c12d07f86259c5a36faf840e096589f4","url":"https://img.federalregister.gov/ER13NO15.000/ER13NO15.000_original_size.png","height":206}}},"json_url":"https://www.federalregister.gov/api/v1/documents/2015-27943?publication_date=2015-11-13","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2015-11-13/2015-27943/mods.xml","not_received_for_publication":null,"page_length":310,"page_views":{"count":25112,"last_updated":"2026-07-27 04:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2015-11-13/pdf/2015-27943.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2015-27943.pdf?1446236131","publication_date":"2015-11-13","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2015/11/13/2015-27943.txt","regulation_id_number_info":{"0938-AS42":{"issue":"201510","html_url":"https://www.federalregister.gov/regulations/0938-AS42/cy-2016-hospital-outpatient-pps-policy-changes-and-payment-rates-and-ambulatory-surgical-center-paym","title":"CY 2016 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates (CMS-1633-FC)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201510&RIN=0938-AS42&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"},"0938-AS11":{"issue":"201404","html_url":"https://www.federalregister.gov/regulations/0938-AS11/hospital-inpatient-prospective-payment-system-for-acute-care-hospitals-and-the-long-term-care-hospit","title":"Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates (CMS-1607-P)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201404&RIN=0938-AS11&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AS11","0938-AS42"],"regulations_dot_gov_info":{"supporting_documents":[],"regulatory_plan":{"html_url":"https://www.federalregister.gov/regulations/0938-AS42/cy-2016-hospital-outpatient-pps-policy-changes-and-payment-rates-and-ambulatory-surgical-center-paym","title":"CY 2016 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates (CMS-1633-FC)"},"comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2015-0075","supporting_documents_count":null,"docket_id":"CMS-2015-0075","regulation_id_number":"0938-AS42","title":"CY 2016 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates CMS-1633-P","checked_regulationsdotgov_at":"2015-12-30T05:00:57Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":70298,"subtype":null,"title":"Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review","toc_doc":"Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review","toc_subject":"Medicare Program:","topics":["Administrative practice and procedure","Health facilities","Health professions","Hospitals","Kidney diseases","Laboratories","Medicare","Puerto Rico","Reporting and recordkeeping requirements","Rural areas","X-rays"],"type":"Rule","volume":80}