Determining Payment Limits for Specified Provider-Based

70.2.2.2 – Determining Payment Limits for Specified Provider-Based RHCs that did not have an AIR Established for RHC Services Furnished in 2020 (Rev. 11803; Issued: 01-26-23; Effective: 01-01-23; Implementation: 02-27-23) Beginning April 1, 2021, specified provider-based RHCs that did not have a per visit payment amount (that is, AIR) established for services furnished in 2020, the payment limit per visit shall be at an amount equal to the greater of: 1. the per visit payment amount applicable to the provider-based RHC for services furnished in 2021; or 2. the national statutory payment limit for RHCs (see section 70.2.1 of this chapter). For subsequent years, the provider-based RHCs payment limit per visit shall be set at an amount equal to the greater of: 1. the payment limit per visit established for the previous year, increased by the percentage increase in MEI applicable to primary care services furnished as of the first day of such subsequent year; or 2. the national statutory payment limit for RHCs (see section 70.2.1 of this chapter). Note: For purposes of establishing the payment limit effective April 1, 2021 for specified provider-based RHCs defined in section 1833(f)(3)(A)(i)(II) of the Act (that is, those that did not have an AIR established for services furnished in 2020), the MACs shall use the cost report ending in 2021 that reports costs for 12 consecutive months. If the RHC does not have a 12-consecutive month cost report ending in 2021, the MACs shall use the next most-recent final settled cost report that reports cost for 12- consecutive months. MACs should not combine cost report data to equal a 12-consecutive month cost report.