Program instructions are day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. They are used by CMS program components, contractors, and State survey agencies to administer CMS programs. For many others, they are a good source of technical and professional information about the Medicare and Medicaid programs.
Section of the Law |
File Name
|
Subject |
Effective Date |
Change
Request Number(s) |
Date Released |
302 |
R35OTN
(192 kb)
R54CP
(475 kb)
R55CP
(361 kb)
R110CP
(241 kb)
R119CP
(183 kb) |
Payment for Durable Medicare Equipment; Competitive Acquisition of Certain Items and Services |
01/01/2004 |
3020
3022
3025
3078
3161 |
12/24/2003
12/24/2003
12/24/2003
02/27/2004
03/15/2004 |
303 |
R54CP
(475 kb)
R55CP
(361 kb)
R110CP
(241 kb)
R119CP
(183 kb)
R269CP
(65 kb)
R248CP
(141 kb) |
Payment for Drugs and Biologicals |
01/01/2004 |
3022
3025
3078
3161
3231
3232 |
12/24/2003
12/24/2003
02/27/2004
03/15/2004
08/03/2004
07/23/2004 |
303 |
R110OTN
(29 kb) |
Payment for Drugs and Biologicals |
01/01/2004 |
3418 |
08/27/2004 |
304 |
R54CP
(475 kb)
R55CP
(361 kb)
R47OTN
(91 kb)
R75CP
(99 kb)
R110CP
(241 kb)
R119CP
(183 kb)
|
Extension of application of payment reform for covered outpatient drugs and biologicals to other physician services |
01/01/2004 |
3022
3025
3043
3105
3078
3161 |
12/24/2003
12/24/2003
01/23/2004
01/30/2004
02/27/2004
03/15/2004 |
305 |
R54CP
(475 kb)
R55CP
(361 kb)
R75CP
(99 kb)
R110CP
(241 kb)
R119CP
(183 kb) |
Payment for inhalation drugs |
01/01/2004 |
3022
3025
3105
3078
3161 |
12/24/2003
12/24/2003
01/30/2004
02/27/2004
03/15/2004 |
401 |
R16OTN
(106 kb)
R64OTN
(298 kb) |
Equalizing urban and rural standardized payment amounts under the medicare inpatient hospital prospective payment system |
10/01/2003 |
2971
3158 |
10/31/2003
03/26/2004 |
402 |
R64OTN
(298 kb) |
Beginning in FY 2004, the formula currently used to calculate the DSH adjustment... |
04/05/2004 |
3158 |
03/26/2004 |
405 |
R63CP
(303 kb)
R68CP
(270 kb)
R103CP
(272 kb)
|
Improvements to Critical Access Hospital Program: Revision of Bed Limitation for Hospitals |
01/01/2004 |
3051
3052
3114 |
01/16/2004
01/16/2004
02/20/2004 |
405 |
R285CP
(62 kb) |
Improvements to Critical Access Hospital Program: Revision of Bed Limitation for Hospitals |
01/01/2004 |
3228 |
08/27/2004 |
405 |
R276CP
(114 kb) |
Improvements to Critical Access Hospital Program: Revision of Bed Limitation for Hospitals |
01/01/2004 |
3399 |
08/13/2004 |
408 |
R15BP
(93 kb)
R205CP
(174 kb) |
Recognition of Attending Nurse Practitioners as Attending Physicians to Serve Hospice Patients |
10/04/2004 |
3226 |
06/15/2004 |
411 |
R30OTN
(244 kb) |
2-Year Extension of Hold Harmless Provisions for Small Rural Hospitals and Sole Community Hospitals Under the Prospective Payment System for Hospital Outpatient Department Services |
01/01/2004 |
3015 |
12/19/2003 |
412 |
R28OTN
(252 kb) |
Establishment of Floor on Work Geographic Adjustment |
01/01/2004 |
3009 |
12/12/2003 |
414 |
R88CP
(507 kb)
R220CP
(302 kb) |
Payment for Rural and Urban Ambulance Services |
07/05/2004
07/06/2004 |
3099 |
02/06/2004
Re-issued 06/25/2004 |
416 |
R100CP (257 kb) |
Treatment of Certain Diagnostic Laboratory Tests Furnished to Hospital Outpatients in Certain Areas |
07/06/2004 |
3130 |
02/13/2004
|
421 |
R59OTN (166 kb) |
Increase payments to home health agencies for sevices provide in a rural area by 5 percent for one year, beginning April 1, 2004 |
04/01/2004 |
3085 |
02/20/2004 |
422 |
R77OTN
(81 kb) |
Redistribution of Unused Resident Positions |
06/04/2004 |
3247 |
04/30/2004 |
502 |
R61OTN
(200 kb) |
Raised the IME adjustment between April 1, 2004 and October 1, 2004 to 5.98%... |
04/01/2004 |
3071 |
03/12/2004 |
504 |
R64OTN
(298 kb) |
The PPS rate for hospitals in Puerto Rico... |
04/05/2004 |
3158 |
03/26/2004 |
507 |
R62OTN
(140 kb) |
Clarifications to Certain Exceptions to Medicare Limits on Physician Referrals |
04/02/2004 |
3036 |
03/19/2004
|
508 |
R32OTN
(728 kb)
R64OTN
(298 kb)
R65OTN
(223 kb) |
Time Appeals Process for Hospital Wage Index Classification |
01/01/2004 |
3007
3158
3084 |
12/18/2003
03/26/2004
03/26/2004 |
511 |
R160CP
(81 kb) |
Payment for Covered Skilled Nursing Facility Services |
10/04/2004 |
3291 |
04/30/2004 |
601 |
R28OTN
(252 kb)
R34OTN
(250 kb)
R38OTN
(576 kb) |
Revision of Updates for Physicians’ services |
01/01/2004 |
3009
3028
3040 |
12/12/2003
12/24/2003
01/02/2004 |
602 |
R28OTN
(252 kb) |
Treatment of Physicians’ Services Furnished in Alaska |
01/01/2004 |
3009 |
12/12/2003 |
603 |
R4BP
(314 kb) |
Inclusion of podiatrists, dentists, and optometrists under private contracting authority |
01/01/2004 |
3016 |
01/02/2004 |
621(a) |
R112CP
(263 kb)
R113CP
(192 kb) |
Requires use of Medicaid definitions for drugs |
04/01/2004 |
3144
3145 |
02/27/2004 |
623(b) |
R7BP
(139 kb)
R101CP
(258 kb)
|
The composite rate will be increased by 1.6% for services provided on or after January 1, 2005: The prohibition of dialysis facility exceptions to the composite rate (BIPA 422) is made inapplicable to pediatric facilities (those with 50% of patients under age 18). |
03/01/2004 |
3119 |
02/20/2004 |
624 |
R42CP
(348 kb)
R40OTN
(521 kb) |
2-year moratorium on therapy caps; provisions relating to reports |
Upon enactment |
3005
3045 |
12/08/2003
Provider Ed article released on 01/06/2004 |
626(a) |
R51OTN (174 kb) |
For FY 2004, beginning April 1, reduces the update to CPI minus 3 percentage points |
04/01/2004 |
3082 |
02/05/2004 |
628 |
R20OTN
(221 kb)
R31OTN
(168 kb) |
Payment for clinical diagnostic laboratory tests |
01/01/2004 |
2959
3013 |
11/07/2003
12/19/2003 |
629 |
R3GI
(319 kb) |
The Part B Medicare deductible remains $100 through 2004... |
01/03/2005 |
3121 |
03/12/2004 |
630 |
R241CP
(210 kb) |
5-Year Authorization of Reimbursement for All Medicare Part B Services Furnished by Certain Indian Hospitals and Clinics |
01/03/2005 |
3288 |
07/23/2004 |
642 |
R6BP
(264 kb)
R74CP
(253 kb) |
Extension of coverage of intravenous immune globulin |
04/01/2004 |
3059
3060 |
01/23/2004 |
701 |
R59OTN
(166 kb) |
Home health prospective payment system (PPS) update |
04/01/2004 |
3085 |
02/20/2004 |
702 |
R3DEMO
(107 kb) |
Establishes a 2-year demonstration to test an expanded homebound definition... |
10/04/2004 |
3269 |
05/07/2004 |
711 |
R61OTN
(265 kb) |
Reinstates the freeze on further updates to hospitals with per resident amounts above 140 percent of the national average |
04/01/2004 |
3071 |
03/12/2004 |
712 |
R61OTN
(265 kb) |
Exception to initial residency period for geriatric residency or fellowship programs |
01/01/2004 |
3071 |
03/12/2004 |
713 |
R61OTN
(265 kb) |
Treatment of volunteer supervision |
01/01/2004 |
3071 |
03/12/2004 |
721 |
R256CP
(29 kb) |
Voluntary Chronic Care Improvement Under Traditional Fee-For-Service |
01/03/2005 |
3410 |
07/30/2004 |
733 |
R18NCD
(25 kb) |
Payment for Pancreatic Islet Cell Investigational Transplants for Medicare Beneficiaries in Clinical Trials |
10/04/2004 |
3385 |
07/30/2004 |
911 |
R97OTN
(66 kb) |
Consolidation and flexibility in contracting |
01/03/2005 |
3362 |
07/23/2004 |
921 |
R113OTN
(389 kb) |
Implementation of §921 of the MMA—Provider Customer Service Program |
01/03/2005 |
3376 |
09/10/2004 |
935 |
R54FM
(72 kb) |
Recovery of Overpayments |
10/25/2004 |
3441 |
09/24/2004 |
940 |
R96OTN
(57 kb) |
Revisions to Appeals Timeframes and Amounts |
10/01/2004 |
3354 |
07/23/2004 |
943 |
R11MSP
(303 kb) |
Treatment of Hospitals for Certain Services Under Medicare Secondary Payer (MSP) Provisions |
Effective 12/08/2003. Implement 30 days after date of issuance. |
3064 |
03/29/2004 |
952 |
R111CP
(225 kb) |
Allows physicians to reassign payment for Medicare covered services to entities... |
03/12/2004 |
3083 |
02/27/2004 |