Manual Instructions

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.

Red text indicates information updated since we sent our last notification.

Links to a provision-by-provision summary are available by clicking on the section numbers provided below.

Links to the completed/published CMS publication are available by clicking on the document name provided in the "File Name" column below.

Completed Objectives

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

Spring Projections

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