CMS Pub. 100-04, ch. 4, § 250

For cost reporting periods beginning before October 1, 2000, a CAH will be paid for

outpatient services under the method in §250.1. The BIPA legislation on payment for

professional services at 115 percent of what would otherwise be paid under the fee

schedule is effective for services furnished on or after July 1, 2001. This provision was

implemented with respect to cost reporting periods starting on or after October 1, 2001.

For cost reporting period beginning on or after October 1, 2001, the CAH will be paid

under the method in item 1 below unless it elects to be paid under the method in §250.1

of this manual.

If a CAH elects payment under the elective method (cost-based facility payment plus fee

schedule for professional services) for a cost reporting period, that election is effective

for the entire cost reporting period to which it applies. If the CAH wishes to make a new

election or change a previous election, that election should be made in writing, made on

an annual basis and delivered to the appropriate A/B MAC (A), at least 30 days in

advance of the beginning of the affected cost reporting period.

All outpatient CAH services, other than pneumococcal pneumonia vaccines, influenza

vaccines, administration of the vaccines, screening mammograms, and clinical diagnostic

laboratory tests are subject to Part B deductible and coinsurance. Regardless of the

payment method applicable for a period, payment for outpatient CAH services is not

subject to the following payment principles:

• Lesser of cost or charges,

• Reasonable compensation equivalent (RCE) limits,

• Any type of reduction to operating or capital costs under 42 CFR 413.124 or

413.30(j)(7), or

• Blended payment rates for ASC-type, radiology, and other diagnostic services.

See §250.4 below regarding payment for screening mammography services.