{"abstract":"We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2020 and to implement certain recent legislation. We also are proposing to make changes relating to Medicare graduate medical education (GME) for teaching hospitals and payments to critical access hospital (CAHs). In addition, we are proposing to provide the market basket update that would apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2020. We are proposing to update the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2020. In this proposed rule, we are including proposals to address wage index disparities between high and low wage index hospitals; to provide for an alternative IPPS new technology add-on payment pathway for certain transformative new devices; and to revise the calculation of the IPPS new technology add-on payment. In addition, we are requesting public comments on the substantial clinical improvement criterion used for evaluating applications for both the IPPS new technology add-on payment and the OPPS transitional pass- through payment for devices, and we discuss potential revisions that we are considering adopting as final policies related to the substantial clinical improvement criterion for applications received beginning in FY 2020 for IPPS (that is, for FY 2021 and later new technology add-on payments) and beginning in CY 2020 for the OPPS. We are proposing to establish new requirements or revise existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are proposing to establish new requirements and revise existing requirements for eligible hospitals and critical access hospitals (CAHs) participating in the Medicare and Medicaid Promoting Interoperability Programs. We are proposing to update policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.","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/2019/05/03/2019-08330.html","cfr_references":[{"chapter":null,"citation_url":null,"part":412,"title":42},{"chapter":null,"citation_url":null,"part":413,"title":42},{"chapter":null,"citation_url":null,"part":495,"title":42}],"citation":"84 FR 19158","comment_url":null,"comments_close_on":"2019-06-24","correction_of":null,"corrections":[],"dates":"To be assured consideration, comments must be received at one of the addresses provided in the ADDRESSES section, no later than 5 p.m. EDT on June 24, 2019.","disposition_notes":null,"docket_ids":["CMS-1716-P"],"dockets":[],"document_number":"2019-08330","effective_on":null,"end_page":19677,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2019/05/03/2019-08330.xml","html_url":"https://www.federalregister.gov/documents/2019/05/03/2019-08330/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the","images":{"EP03MY19.026":{"large":"https://img.federalregister.gov/EP03MY19.026/EP03MY19.026_large.png","original_size":"https://img.federalregister.gov/EP03MY19.026/EP03MY19.026_original_size.png"},"EP03MY19.027":{"large":"https://img.federalregister.gov/EP03MY19.027/EP03MY19.027_large.png","original_size":"https://img.federalregister.gov/EP03MY19.027/EP03MY19.027_original_size.png"},"EP03MY19.028":{"large":"https://img.federalregister.gov/EP03MY19.028/EP03MY19.028_large.png","original_size":"https://img.federalregister.gov/EP03MY19.028/EP03MY19.028_original_size.png"},"EP03MY19.029":{"large":"https://img.federalregister.gov/EP03MY19.029/EP03MY19.029_large.png","original_size":"https://img.federalregister.gov/EP03MY19.029/EP03MY19.029_original_size.png"},"EP03MY19.022":{"large":"https://img.federalregister.gov/EP03MY19.022/EP03MY19.022_large.png","original_size":"https://img.federalregister.gov/EP03MY19.022/EP03MY19.022_original_size.png"},"EP03MY19.023":{"large":"https://img.federalregister.gov/EP03MY19.023/EP03MY19.023_large.png","original_size":"https://img.federalregister.gov/EP03MY19.023/EP03MY19.023_original_size.png"},"EP03MY19.024":{"large":"https://img.federalregister.gov/EP03MY19.024/EP03MY19.024_large.png","original_size":"https://img.federalregister.gov/EP03MY19.024/EP03MY19.024_original_size.png"},"EP03MY19.025":{"large":"https://img.federalregister.gov/EP03MY19.025/EP03MY19.025_large.png","original_size":"https://img.federalregister.gov/EP03MY19.025/EP03MY19.025_original_size.png"},"EP03MY19.020":{"large":"https://img.federalregister.gov/EP03MY19.020/EP03MY19.020_large.png","original_size":"https://img.federalregister.gov/EP03MY19.020/EP03MY19.020_original_size.png"},"EP03MY19.021":{"large":"https://img.federalregister.gov/EP03MY19.021/EP03MY19.021_large.png","original_size":"https://img.federalregister.gov/EP03MY19.021/EP03MY19.021_original_size.png"},"EP03MY19.037":{"large":"https://img.federalregister.gov/EP03MY19.037/EP03MY19.037_large.png","original_size":"https://img.federalregister.gov/EP03MY19.037/EP03MY19.037_original_size.png"},"EP03MY19.038":{"large":"https://img.federalregister.gov/EP03MY19.038/EP03MY19.038_large.png","original_size":"https://img.federalregister.gov/EP03MY19.038/EP03MY19.038_original_size.png"},"EP03MY19.039":{"large":"https://img.federalregister.gov/EP03MY19.039/EP03MY19.039_large.png","original_size":"https://img.federalregister.gov/EP03MY19.039/EP03MY19.039_original_size.png"},"EP03MY19.033":{"large":"https://img.federalregister.gov/EP03MY19.033/EP03MY19.033_large.png","original_size":"https://img.federalregister.gov/EP03MY19.033/EP03MY19.033_original_size.png"},"EP03MY19.034":{"large":"https://img.federalregister.gov/EP03MY19.034/EP03MY19.034_large.png","original_size":"https://img.federalregister.gov/EP03MY19.034/EP03MY19.034_original_size.png"},"EP03MY19.035":{"large":"https://img.federalregister.gov/EP03MY19.035/EP03MY19.035_large.png","original_size":"https://img.federalregister.gov/EP03MY19.035/EP03MY19.035_original_size.png"},"EP03MY19.036":{"large":"https://img.federalregister.gov/EP03MY19.036/EP03MY19.036_large.png","original_size":"https://img.federalregister.gov/EP03MY19.036/EP03MY19.036_original_size.png"},"EP03MY19.030":{"large":"https://img.federalregister.gov/EP03MY19.030/EP03MY19.030_large.png","original_size":"https://img.federalregister.gov/EP03MY19.030/EP03MY19.030_original_size.png"},"EP03MY19.031":{"large":"https://img.federalregister.gov/EP03MY19.031/EP03MY19.031_large.png","original_size":"https://img.federalregister.gov/EP03MY19.031/EP03MY19.031_original_size.png"},"EP03MY19.032":{"large":"https://img.federalregister.gov/EP03MY19.032/EP03MY19.032_large.png","original_size":"https://img.federalregister.gov/EP03MY19.032/EP03MY19.032_original_size.png"},"EP03MY19.050":{"large":"https://img.federalregister.gov/EP03MY19.050/EP03MY19.050_large.png","original_size":"https://img.federalregister.gov/EP03MY19.050/EP03MY19.050_original_size.png"},"EP03MY19.008":{"large":"https://img.federalregister.gov/EP03MY19.008/EP03MY19.008_large.png","original_size":"https://img.federalregister.gov/EP03MY19.008/EP03MY19.008_original_size.png"},"EP03MY19.009":{"large":"https://img.federalregister.gov/EP03MY19.009/EP03MY19.009_large.png","original_size":"https://img.federalregister.gov/EP03MY19.009/EP03MY19.009_original_size.png"},"EP03MY19.004":{"large":"https://img.federalregister.gov/EP03MY19.004/EP03MY19.004_large.png","original_size":"https://img.federalregister.gov/EP03MY19.004/EP03MY19.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