CMS Updates Transmittal to MACs Regarding New RHC Upper Payment Limits


On May 4th, the Centers for Medicare and Medicaid Services (CMS) updated Change Request 12185, which is the main document from CMS implementing the new RHC Upper Payment Limits from the Consolidated Appropriations Act of 2021.

As many of you are aware, the Consolidated Appropriations Act of 2021 contained a drafting error regarding the grandfathering date which NARHC worked swiftly to correct. On April 14th, President Biden signed the grandfathering fix into law, simultaneously fixing the grandfathering date and creating a mechanism for entities that had submitted an application to become an RHC by the end of 2020 to also be considered grandfathered.

However, because payment limits technically took effect on April 1, 2021, CMS had to issue guidance implementing the law on the books at the time. As a result, the initial Change Request 12185 did not include the updated grandfathering date, and until now, was all the instruction the MACs had in regards to the new upper payment limits.

As a result, MACs were applying $100 upper payment limits to RHCs that opened in 2020 not yet reflecting the grandfathering fix President Biden signed into law. Now, however, the guidance does reflect the April 14th statutory fix and the MACs have the instruction they need to properly pay those RHCs that were established in 2020.

We suspect that an updated MLN Matters Article will also be posted soon. The full change request can be read HERE


Nathan Baugh
Director of Government Affairs