New Medical Services and New Technologies

Application Information for FY 2022

The deadline to submit (and for CMS to receive) an application for FY 2022 new technology add-on payments was Friday October 16, 2020.
 

Information for New Technology Town Hall Meeting for FY 2022

The FY 2022 New Technology Town Hall Meeting to discuss FY 2022 applications for add-on payments for new medical services and technologies under the hospital inpatient prospective payment system (IPPS) was held virtually December 15-16, 2020. Links for recordings of the Town Hall meeting are located in the Related Links section below.


Background

Sections 1886(d)(5)(K) and (L) of the Act establish a process of identifying and ensuring adequate payment for new medical services and technologies (sometimes collectively referred to in this section as “new technologies”) under the IPPS. Section 1886(d)(5)(K)(vi) of the Act specifies that a medical service or technology will be considered new if it meets criteria established by the Secretary after notice and opportunity for public comment. Section 1886(d)(5)(K)(ii)(I) of the Act specifies that a new medical service or technology may be considered for new technology add-on payment if, based on the estimated costs incurred with respect to discharges involving such service or technology, the DRG prospective payment rate otherwise applicable to such discharges under this subsection is inadequate. We note that, beginning with discharges occurring in FY 2008, CMS transitioned from CMS-DRGs to MS-DRGs. The regulations at 42 CFR 412.87 implement these provisions and § 412.87(b) specifies three criteria for a new medical service or technology to receive the additional payment:

(1) the medical service or technology must be new;

(2) the medical service or technology must be costly such that the DRG rate otherwise applicable to discharges involving the medical service or technology is determined to be inadequate; and

(3) the service or technology must demonstrate a substantial clinical improvement over existing services or technologies.

In addition, certain transformative new devices, Qualified Infectious Disease Products (QIDP) and Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD) may qualify under an alternative inpatient new technology add-on payment pathway, as set forth in the regulations at § 412.87(c) and (d).

 

Page Last Modified:
01/22/2021 10:47 AM