Hospital Low Volume Adjustment

Criteria for Low-volume Payment Adjustment
For fiscal years 2019 through 2022, a hospital must have fewer than 3,800 total discharges and be located more than 15 road miles from the nearest subsection (d) hospital. For fiscal years 2019 through 2022, the add-on payment is calculated using a continuous linear sliding scale ranging from 25 percent for low-volume hospitals with 500 or fewer discharges to 0 percent for low-volume hospitals with greater than 3,800 discharges. For fiscal year 2023 and subsequent fiscal years, the qualifying criteria and payment adjustment revert to the preexisting requirements.

Continuing Qualifying Hospitals
A hospital that is seeking to continue to qualify to receive the low-volume hospital payment adjustment for fiscal year 2019 should submit to its Medicare Administrative Contractor (MAC) a written request to continue to receive the low-volume payment adjustment. This request would be based on the hospital meeting the mileage and discharge criteria applicable for fiscal year 2019. This written verification should be a brief letter stating that the hospital continues to meet the low-volume hospital distance criterion as noted in the previously submitted low-volume hospital request for fiscal year 2018.

Newly Qualifying Hospitals
A hospital seeking to initially qualify to receive the low-volume hospital payment adjustment based on the mileage and discharge criteria applicable for fiscal year 2019 must submit a request to the MAC. For mileage, the request should address that the hospital is more than 15 road miles from another subsection (d) hospital. For discharges, the request should address that hospital had fewer than 3,800 total discharges. The total discharges would be based on the most recently submitted Medicare cost report. To support the mileage, please include the results of a web-based mapping tool.

Please send requests to JMREIMBURSEMENT@palmettogba.com.