The Consolidated Appropriations Act of 2024 extended the temporary changes modifying the FFY 2025 qualifying criteria for the low volume hospital payment adjustments for FFY 2025. Under the modified criteria, the low volume hospital payment adjustments increases are applicable for hospitals that have less than 3,800 total discharges and are located more than 15 road miles from another hospital (excluding rural emergency, critical access, psychiatric, rehabilitation, long-term care, cancer, research, and children’s hospitals).
Beginning on January 1, 2025, and subsequent fiscal years, the low-volume hospital payment adjustment and qualifying criteria revert to the preexisting requirements – more than 25 road miles and less than 200 total discharges.
Action Points
For any provider who believes that they qualify for the low volume hospital payment adjustment for federal fiscal year 2025, they must notify their Medicare Administrative Contractor (MAC) of their desire to receive the adjustment and submit proof that the hospital meets the qualifying mileage requirement. The discharge criteria will be determined by CMS based on the hospital’s most recently submitted cost report. A provider response is due no later than September 1, 2024, to impact payments beginning October 1, 2024. Any requests made after this date will not impact payments for FFY 2025 services until the requests are processed, which could be delayed for up to 30 days with no retroactive adjustments.
For more information, please contact our Albany office at (229) 883-7878 or our Atlanta office at (404) 220-8494.
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