{"abstract":"We are revising 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 making changes relating to Medicare graduate medical education (GME) for teaching hospitals and payments to critical access hospital (CAHs). In addition, we are providing the market basket update that will 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 updating 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 FY 2020 IPPS/LTCH PPS final rule, we are addressing wage index disparities impacting low wage index hospitals; providing for an alternative IPPS new technology add-on payment pathway for certain transformative new devices and qualified infectious disease products; and revising the calculation of the IPPS new technology add-on payment. In addition, we are revising and clarifying our policies related to the substantial clinical improvement criterion used for evaluating applications for the new technology add-on payment under the IPPS. We are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are establishing new requirements and revising existing requirements for eligible hospitals and critical access hospitals (CAHs) participating in the Medicare and Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.","action":"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 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/2019/08/16/2019-16762.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 42044","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"This final rule is effective October 1, 2019.","disposition_notes":null,"docket_ids":["CMS-1716-F"],"dockets":[],"document_number":"2019-16762","effective_on":"2019-10-01","end_page":42701,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2019/08/16/2019-16762.xml","html_url":"https://www.federalregister.gov/documents/2019/08/16/2019-16762/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the","images":{"ER16AU19.115":{"large":"https://img.federalregister.gov/ER16AU19.115/ER16AU19.115_large.png","original_size":"https://img.federalregister.gov/ER16AU19.115/ER16AU19.115_original_size.png"},"ER16AU19.236":{"large":"https://img.federalregister.gov/ER16AU19.236/ER16AU19.236_large.png","original_size":"https://img.federalregister.gov/ER16AU19.236/ER16AU19.236_original_size.png"},"ER16AU19.114":{"large":"https://img.federalregister.gov/ER16AU19.114/ER16AU19.114_large.png","original_size":"https://img.federalregister.gov/ER16AU19.114/ER16AU19.114_original_size.png"},"ER16AU19.235":{"large":"https://img.federalregister.gov/ER16AU19.235/ER16AU19.235_large.png","original_size":"https://img.federalregister.gov/ER16AU19.235/ER16AU19.235_original_size.png"},"ER16AU19.117":{"large":"https://img.federalregister.gov/ER16AU19.117/ER16AU19.117_large.png","original_size":"https://img.federalregister.gov/ER16AU19.117/ER16AU19.117_original_size.png"},"ER16AU19.238":{"large":"https://img.federalregister.gov/ER16AU19.238/ER16AU19.238_large.png","original_size":"https://img.federalregister.gov/ER16AU19.238/ER16AU19.238_original_size.png"},"ER16AU19.116":{"large":"https://img.federalregister.gov/ER16AU19.116/ER16AU19.116_large.png","original_size":"https://img.federalregister.gov/ER16AU19.116/ER16AU19.116_original_size.png"},"ER16AU19.237":{"large":"https://img.federalregister.gov/ER16AU19.237/ER16AU19.237_large.png","original_size":"https://img.federalregister.gov/ER16AU19.237/ER16AU19.237_original_size.png"},"ER16AU19.111":{"large":"https://img.federalregister.gov/ER16AU19.111/ER16AU19.111_large.png","original_size":"https://img.federalregister.gov/ER16AU19.111/ER16AU19.111_original_size.png"},"ER16AU19.232":{"large":"https://img.federalregister.gov/ER16AU19.232/ER16AU19.232_large.png","original_size":"https://img.federalregister.gov/ER16AU19.232/ER16AU19.232_original_size.png"},"ER16AU19.110":{"large":"https://img.federalregister.gov/ER16AU19.110/ER16AU19.110_large.png","original_size":"https://img.federalregister.gov/ER16AU19.110/ER16AU19.110_original_size.png"},"ER16AU19.231":{"large":"https://img.federalregister.gov/ER16AU19.231/ER16AU19.231_large.png","original_size":"https://img.federalregister.gov/ER16AU19.231/ER16AU19.231_original_size.png"},"ER16AU19.113":{"large":"https://img.federalregister.gov/ER16AU19.113/ER16AU19.113_large.png","original_size":"https://img.federalregister.gov/ER16AU19.113/ER16AU19.113_original_size.png"},"ER16AU19.234":{"large":"https://img.federalregister.gov/ER16AU19.234/ER16AU19.234_large.png","original_size":"https://img.federalregister.gov/ER16AU19.234/ER16AU19.234_original_size.png"},"ER16AU19.112":{"large":"https://img.federalregister.gov/ER16AU19.112/ER16AU19.112_large.png","original_size":"https://img.federalregister.gov/ER16AU19.112/ER16AU19.112_original_size.png"},"ER16AU19.233":{"large":"https://img.federalregister.gov/ER16AU19.233/ER16AU19.233_large.png","original_size":"https://img.federalregister.gov/ER16AU19.233/ER16AU19.233_original_size.png"},"ER16AU19.119":{"large":"https://img.federalregister.gov/ER16AU19.119/ER16AU19.119_large.png","original_size":"https://img.federalregister.gov/ER16AU19.119/ER16AU19.119_original_size.png"},"ER16AU19.118":{"large":"https://img.federalregister.gov/ER16AU19.118/ER16AU19.118_large.png","original_size":"https://img.federalregister.gov/ER16AU19.118/ER16AU19.118_original_size.png"},"ER16AU19.239":{"large":"https://img.federalregister.gov/ER16AU19.239/ER16AU19.239_large.png","original_size":"https://img.federalregister.gov/ER16AU19.239/ER16AU19.239_original_size.png"},"ER16AU19.230":{"large":"https://img.federalregister.gov/ER16AU19.230/ER16AU19.230_large.png","original_size":"https://img.federalregister.gov/ER16AU19.230/ER16AU19.230_original_size.png"},"ER16AU19.005":{"large":"https://img.federalregister.gov/ER16AU19.005/ER16AU19.005_large.png","original_size":"https://img.federalregister.gov/ER16AU19.005/ER16AU19.005_original_size.png"},"ER16AU19.126":{"large":"https://img.federalregister.gov/ER16AU19.126/ER16AU19.126_large.png","original_size":"https://img.federalregister.gov/ER16AU19.126/ER16AU19.126_original_size.png"},"ER16AU19.004":{"large":"https://img.federalregister.gov/ER16AU19.004/ER16AU19.004_large.png","original_size":"https://img.federalregister.gov/ER16AU19.004/ER16AU19.004_original_size.png"},"ER16AU19.125":{"large":"https://img.federalregister.gov/ER16AU19.125/ER16AU19.125_large.png","original_size":"https://img.federalregister.gov/ER16AU19.125/E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