Medicare Prospective Payment Rates Act

Summary

Medicare Prospective Payment Rates Act - Amends title XVIII (Medicare) of the Social Security Act to provide that payments for inpatient hospital services shall be made on a prospective basis, except for psychiatric, long term, or children's hospitals. Bases payments to hospitals not paid on the prospective basis on target amounts. Sets forth a method for determining prospective Medicare payments which shall be based upon the national standard rate per discharge for the diagnosis related group to which that discharge belongs. Permits a Health Maintenance Organization (HMO) or a Competitive Medical Plan (CMP) receiving payments on a risk basis to choose to be reimbursed either on a reasonable cost basis or on a prospective basis for inpatient hospital services furnished to HMO or CMP enrollees. Provides that any reimbursement will be deducted from Medicare payments to an HMO or CMP. States that this Act shall not affect the authority of the Secretary of Health and Human Services to develop, carry out, or continue experiments and demonstration projects. Sets forth conforming amendments and effective dates.

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1 official file

• Introduced in Senate

  summary · EN · 23 February 1983

  Open at official source

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