Payments to providers of services
Determination of amount
Conditions
Payments under assignment or power of attorney
Accrual of interest on balance of excess or deficit not paid
Periodic interim payments
The Secretary shall provide payment under this part for inpatient hospital services furnished by a subsection (d) hospital (as defined in section 1395ww(d)(1)(B) of this title, and including a distinct psychiatric or rehabilitation unit of such a hospital) and a subsection (d) Puerto Rico hospital (as defined in section 1395ww(d)(9)(A) of this title) on a periodic interim payment basis (rather than on the basis of bills actually submitted) in the following cases:
Upon the request of a hospital which is paid through an agency or organization with an agreement with the Secretary under section 1395h of this title, if the agency or organization, for three consecutive calendar months, fails to meet the requirements of subsection (c)(2) of such section and if the hospital meets the requirements (in effect as of
In the case of a hospital that—
has a disproportionate share adjustment percentage (as established in clause (iv) of such section) of at least 5.1 percent (as computed for purposes of establishing the average standardized amounts for discharges occurring during fiscal year 1987), and
requests payment on such basis,
but only if the hospital was being paid for inpatient hospital services on such a periodic interim payment basis as of
In the case of a hospital that—
is located in a rural area,
has 100 or fewer beds, and
requests payment on such basis,
but only if the hospital was being paid for inpatient hospital services on such a periodic interim payment basis as of
The Secretary shall provide (or continue to provide) for payment on a periodic interim payment basis (under the standards established under section 405.454(j) of title 42, Code of Federal Regulations, as in effect on
inpatient hospital services of a hospital that is not a subsection (d) hospital (as defined in section 1395ww(d)(1)(B) of this title);
a hospital which is receiving payment under a State hospital reimbursement system under section 1395f(b)(3) or 1395ww(c) of this title, if payment on a periodic interim payment basis is an integral part of such reimbursement system;
extended care services;
hospice care; and
inpatient critical access hospital services;
if the provider of such services elects to receive, and qualifies for, such payments.
Subject to subsection (f), in the case of a subsection (d) hospital or a subsection (d) Puerto Rico hospital (as defined for purposes of section 1395ww of this title) which has significant cash flow problems resulting from operations of its intermediary or from unusual circumstances of the hospital’s operation, the Secretary may make available appropriate accelerated payments.
A hospital created by the merger or consolidation of 2 or more hospitals or hospital campuses shall be eligible to receive periodic interim payment on the basis described in paragraph (1)(B) if—
at least one of the hospitals or campuses received periodic interim payment on such basis prior to the merger or consolidation; and
the merging or consolidating hospitals or campuses would each meet the requirement of paragraph (1)(B)(i) if such hospitals or campuses were treated as independent hospitals for purposes of this subchapter.
Expansion of accelerated payment program during COVID–19 public health emergency
During the emergency period described in section 1320b–5(g)(1)(B) of this title, the Secretary shall expand the program under subsection (e)(3) pursuant to paragraph (2).
In expanding the program under subsection (e)(3), the following shall apply:
In addition to the hospitals described in subsection (e)(3), the following hospitals shall be eligible to participate in the program:
Hospitals described in clause (iii) of section 1395ww(d)(1)(B) of this title.
Hospitals described in clause (v) of such section.
Critical access hospitals (as defined in section 1395x(mm)(1) of this title).
Subject to appropriate safeguards against fraud, waste, and abuse, upon a request of a hospital described in clause (i), the Secretary shall (or, with respect to requests submitted to the Secretary after
Upon the request of the hospital, the Secretary may do any of the following:
Make accelerated payments on a periodic or lump sum basis.
Increase the amount of payment that would otherwise be made to hospitals under the program up to 100 percent (or, in the case of critical access hospitals, up to 125 percent).
Extend the period that accelerated payments cover so that it covers up to a 6-month period.
In the case of a payment made under the terms of the program under subsection (e)(3), including such program as expanded pursuant to this subsection, on or after
provide 1 year before payments for items and services furnished by the hospital are offset to recoup payments under such program;
provide that any such offset be an amount equal to—
during the first 11 months in which any such offsets are made with respect to payment for items and services furnished by the hospital, 25 percent of the amount of such payment for such items and services; and
during the succeeding 6 months, 50 percent of the amount of such payment for such items and services; and
allow 29 months from the date of the first payment under such program to such provider before requiring that the outstanding balance be paid in full.
Nothing in this subsection shall preclude the Secretary from carrying out the provisions described in clauses (i), (ii), and (iii) of paragraph (2)(B) and clauses (i) and (ii) of paragraph (2)(C) under the program under subsection (e)(3) after the period for which this subsection applies.
Notwithstanding any other provision of law, the Secretary may implement the provisions of this subsection by program instruction or otherwise.
Source
(Aug. 14, 1935, ch. 531, title XVIII, § 1815, as added Pub. L. 89–97, title I, § 102(a),Notes
Editorial Notes
Amendments
Statutory Notes and Related Subsidiaries
Effective Date of 2011 Amendment
Effective Date of 2003 Amendment
Effective Date of 1997 Amendment
Effective Date of 1989 Amendment
Effective Date of 1986 Amendment
Effective Date of 1982 Amendment
Effective Date of 1977 Amendment
Effective Date of 1975 Amendment
Application to Other Part A Providers
In general.—
In the case of a payment made under the terms of an applicable program (as defined in clause (ii)), on or after the date of the enactment of the CARES Act (Public Law 116–136) [
Applicable program defined.—
In this clause, the term ‘applicable program’ means—
the programs under sections 413.64(g), 412.541(f), 412.632(e), 412.116(f), 413.350(d), or 418.307 of title 42, Code of Federal Regulations (or any successor regulations); and
any other comparable program under part A of title XVIII of the Social Security Act [42 U.S.C. 1395c et seq.], as determined by the Secretary.
Applicable provider.—
In this clause, the term ‘applicable provider’ means a provider of services that is eligible for payment under an applicable program.”
Publication of Data
Data during covid–19 emergency.—
Initial publication.—
Not later than 2 weeks after the date of the enactment of this section [
The total amount of such payments made under each applicable payment program (as defined in paragraph (3)(A)), including a specification of the percentage of such payments so made from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the percentage of such payments so made from the Federal Supplementary Insurance Trust Fund established under section 1841 of such Act (42 U.S.C. 1395t) under each such program.
The amount of specified payments made under each such program by type of provider of services or supplier receiving such payments.
The Centers for Medicare & Medicaid Services certification number or other appropriate number of, and the amount of such payments received by, each provider of services and supplier receiving such payments.
Interim publication.—
Every 2 weeks thereafter during the emergency period, if any specified payments are made that were not included in a preceding publication of data under this paragraph, the Secretary shall post on the website described in subparagraph (A) data containing the information described in clauses (i), (ii), and (iii) of such subparagraph with respect to such specified payments.
Additional publications.—
Not later than 15 months after the date of the enactment of the CARES Act (Public Law 116–136) [
The total amount of all specified payments not recouped or repaid under each applicable payment program.
The amount of payments made under each such program and not recouped or repaid by type of provider of services or supplier.
The total amount of specified payments that have been recouped or repaid under each such program, including a specification of the percentage of such payments so recouped or repaid that have been deposited into the Federal Hospital Insurance Trust Fund and the percentage of such payments so recouped or repaid that have been deposited into the Federal Supplementary Insurance Trust Fund under each such program.
The dollar amount of interest that has been collected with respect to all specified payments under each such program.
Definitions.—
In this subsection:
Applicable payment program.—
The term ‘applicable payment program’ means—
the program under subsection (e)(3) of section 1815 of the Social Security Act (42 U.S.C. 1395g), including such program as expanded under subsection (f) of such section;
an applicable program (as defined in subsection (a)(1)(C)(ii) of this section [set out as a note above]); and
the program described in section 421.214 of title 42, Code of Federal Regulations (or any successor regulation).
Emergency period.—
The term ‘emergency period’ means the emergency period described in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)).
Provider of services and supplier.—
The terms ‘provider of services’ and ‘supplier’ have the meaning given such terms in subsections (u) and (d), respectively, of section 1861 of such Act (42 U.S.C. 1395x).
Secretary.—
The term ‘Secretary’ means the Secretary of Health and Human Services.
Specified payments.—
The term ‘specified payments’ means payments made under an applicable payment program on or after the date of the enactment of the CARES Act (Public Law 116–136) during the emergency period.”
Development of Alternative Timing Methods of Periodic Interim Payments
Transition
“Upon the request of a hospital which—
as of
requests continuation of payment on such basis, and
is paid through an agency or organization with an agreement under section 1816 of such Act [42 U.S.C. 1395h],
the Secretary of Health and Human Services shall continue payment on such a basis until not earlier than the end of the first period of three consecutive calendar months (beginning no earlier than April 1987) during all of which the agency or organization has met the requirements of section 1816(c)(2) of such Act (relating to prompt payment of claims).”
Delay in Periodic Interim Payments
with respect to the last 21 days for which such payments would otherwise be made during fiscal year 1983, such payments shall be deferred until fiscal year 1984; and
with respect to the last 21 days for which such payments would otherwise be made during fiscal year 1984, such payments shall be deferred until fiscal year 1985.”