Fed Regist. 1984 Jul 3;49(129):27422-63.
We are proposing to amend the Medicare regulations published as interim final rules on September 1, 1983 (48 FR 39752) and final rules on January 3, 1984 (49 FR 234). Those regulations implement section 1886 of the Social Security Act, which changes the method of payment for inpatient hospital services from a cost-based, retrospective reimbursement system to a prospective payment system based on diagnosis. Generally, our proposed changes would be effective with discharges occurring on or after October 1, 1984, or with hospital cost reporting periods beginning on or after October 1, 1984. In addition, in the addendum to this proposed rule, we are proposing changes in the methods, amounts, and factors necessary to determine prospective payment rates for medicare inpatient hospital services applicable to discharges occurring on or after October 1, 1984, in the case of the Federal portion of the payment and effective with hospital cost reporting periods beginning on or after October 1, 1984, in the case of the hospital-specific portion. These changes would be applicable in the second year of the three-year transition period for the prospective payment system. Congress has passed a bill (H.R. 4170, known as the "Deficit Reduction Act of 1984") which, if approved by the President, will affect the proposed rates and rules included in this notice. We will make adjustments as necessary in the final rule to accommodate changes required by this legislation.
我们提议修订1983年9月1日作为暂行最终规则发布的医疗保险法规（《联邦法规汇编》第48卷，第39752页）以及1984年1月3日的最终规则（《联邦法规汇编》第49卷，第234页）。这些法规实施了《社会保障法》第1886条，该条将住院医院服务的支付方式从基于成本的追溯报销系统改为基于诊断的前瞻性支付系统。一般来说，我们提议的变更将于1984年10月1日或之后发生的出院情况生效，或者于1984年10月1日或之后开始的医院成本报告期生效。此外，在本提议规则的附录中，我们提议对确定适用于1984年10月1日或之后出院情况的医疗保险住院医院服务前瞻性支付费率所需的方法、金额和因素进行变更（就支付的联邦部分而言），以及对适用于1984年10月1日或之后开始的医院成本报告期的特定医院部分进行变更（就该部分而言）。这些变更将适用于前瞻性支付系统三年过渡期的第二年。国会已通过一项法案（众议院第4170号法案，即“1984年赤字削减法案”），如果该法案获得总统批准，将影响本通知中包含的提议费率和规则。我们将在最终规则中进行必要的调整，以适应该立法要求的变更。
