Last Modified: 8/5/2024
Location: FL, PR, USVI
Business: Part A
The temporary changes to the low-volume hospital payment adjustment originally provided by the Affordable Care Act, and extended by subsequent legislation, which expanded the definition of a low-volume hospital and modified the methodology for determining the payment adjustment for hospitals meeting that definition, will expire December 31, 2024. Therefore, we will utilize the following criteria to determine hospitals’ eligibility for the FY 2025 LVPA for the split periods:
Payment period (from/to): |
Mileage criterion: |
Payment period (from/to): |
Mileage |
October 1, 2024–December 31, 2024 |
Hospital must be located more than 15 road miles from the nearest subsection (d) hospital. |
Hospital must have fewer than 3,800 total discharges, which includes Medicare and non-Medicare discharges. |
Hospital request must be received by the MAC no later than September 1, 2024. |
January 1, 2025–September 30, 2025 |
Hospital must be located more than 25 road miles from the nearest subsection (d) hospital. |
Hospital must have fewer than 200 total discharges, which includes Medicare and non-Medicare discharges. |
Hospital request must be received by the MAC no later than December 1, 2024. |
Federal Register, Vol. 89, No. 86, Thursday, May 2, 2024, Pages 36208–36212
The payment adjustment for each period will be determined according to 42 CFR 412.101(c).
Hospitals can choose to submit a single written request for low-volume hospital status for both the portion of FY 2025 beginning on October 1, 2024, and ending December 31, 2024, and the portion of FY 2025 beginning on January 1, 2025, through September 30, 2025, then we must receive your request no later than September 1, 2024. Alternatively, Hospitals may choose to submit separate written requests, one for the portion of FY 2025 beginning on October 1, 2024, and ending on December 31, 2024 (by September 1, 2024, deadline), and another for the portion of FY 2025 beginning on January 1, 2025, through September 30, 2025 (by the December 1, 2024, deadline).
When sending your request, please include a verification statement that your facility continues to meet the mileage criterion for the payment period requested. Additionally, please submit a copy of your facility’s most recently filed cost report Worksheet S-3 Part 1 to document total discharges. If a hospital request for low-volume hospital status for FY 2025 is received after the September 1, 2024, or December 1, 2024, deadline, and if the MAC determines the hospital meets the criteria to qualify as a low-volume hospital for the specified period, then the MAC will apply the applicable low-volume hospital payment adjustment effective prospectively within 30 days of the date of the MAC’s low-volume hospital status determination.
You may also send a physical hard copy to:
PARD Reimbursement
First Coast Service Options, Inc.
2020 Technology Parkway, Suite 100
Mechanicsburg, PA 17050
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