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Electronic Code of Federal Regulations

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e-CFR Data is current as of October 23, 2014

Title 42Chapter IVSubchapter BPart 413


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B—MEDICARE PROGRAM

PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES

rule

Subpart A—INTRODUCTION AND GENERAL RULES

§413.1
Introduction.
§413.5
Cost reimbursement: General.
§413.9
Cost related to patient care.
§413.13
Amount of payment if customary charges for services furnished are less than reasonable costs.
§413.17
Cost to related organizations.
rule

Subpart B—ACCOUNTING RECORDS AND REPORTS

§413.20
Financial data and reports.
§413.24
Adequate cost data and cost finding.
rule

Subpart C—LIMITS ON COST REIMBURSEMENT

§413.30
Limitations on payable costs.
§413.35
Limitations on coverage of costs: Charges to beneficiaries if cost limits are applied to services.
§413.40
Ceiling on the rate of increase in hospital inpatient costs.
rule

Subpart D—APPORTIONMENT

§413.50
Apportionment of allowable costs.
§413.53
Determination of cost of services to beneficiaries.
§413.56
[Reserved]
rule

Subpart E—PAYMENTS TO PROVIDERS

§413.60
Payments to providers: General.
§413.64
Payments to providers: Specific rules.
§413.65
Requirements for a determination that a facility or an organization has provider-based status.
§413.70
Payment for services of a CAH.
§413.74
Payment to a foreign hospital.
rule

Subpart F—SPECIFIC CATEGORIES OF COSTS

§413.75
Direct GME payments: General requirements.
§413.76
Direct GME payments: Calculation of payments for GME costs.
§413.77
Direct GME payments: Determination of per resident amounts.
§413.78
Direct GME payments: Determination of the total number of FTE residents.
§413.79
Direct GME payments: Determination of the weighted number of FTE residents.
§413.80
Direct GME payments: Determination of weighting factors for foreign medical graduates.
§413.81
Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts.
§413.82
Direct GME payments: Special rules for States that formerly had a waiver from Medicare reimbursement principles.
§413.83
Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate.
§413.85
Cost of approved nursing and allied health education activities.
§413.87
Payments for Medicare+Choice nursing and allied health education programs.
§413.88
Incentive payments under plans for voluntary reduction in number of medical residents.
§413.89
Bad debts, charity, and courtesy allowances.
§413.90
Research costs.
§413.92
Costs of surety bonds.
§413.94
Value of services of nonpaid workers.
§413.98
Purchase discounts and allowances, and refunds of expenses.
§413.100
Special treatment of certain accrued costs.
§413.102
Compensation of owners.
§413.106
Reasonable cost of physical and other therapy services furnished under arrangements.
§413.114
Payment for posthospital SNF care furnished by a swing-bed hospital.
§413.118
Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis.
§413.122
Payment for hospital outpatient radiology services and other diagnostic procedures.
§413.123
Payment for screening mammography performed by hospitals on an outpatient basis.
§413.124
Reduction to hospital outpatient operating costs.
§413.125
Payment for home health agency services.
rule

Subpart G—CAPITAL-RELATED COSTS

§413.130
Introduction to capital-related costs.
§413.134
Depreciation: Allowance for depreciation based on asset costs.
§413.139
Depreciation: Optional allowance for depreciation based on a percentage of operating costs.
§413.144
Depreciation: Allowance for depreciation on fully depreciated or partially depreciated assets.
§413.149
Depreciation: Allowance for depreciation on assets financed with Federal or public funds.
§413.153
Interest expense.
§413.157
Return on equity capital of proprietary providers.
rule

Subpart H—PAYMENT FOR END-STAGE RENAL DISEASE (ESRD) SERVICES AND ORGAN PROCUREMENT COSTS

§413.170
Scope.
§413.171
Definitions.
§413.172
Principles of prospective payment.
§413.174
Prospective rates for hospital-based and independent ESRD facilities.
§413.176
Amount of payments.
§413.177
Quality incentive program payment.
§413.178
[Reserved]
§413.180
Procedures for requesting exceptions to payment rates.
§413.182
Criteria for approval of exception requests.
§413.184
Payment exception: Pediatric patient mix.
§413.186
Payment exception: Self-dialysis training costs in pediatric facilities.
§413.194
Appeals.
§413.195
Limitation on Review.
§413.196
Notification of changes in rate-setting methodologies and payment rates.
§413.198
Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.
§413.200
Payment of independent organ procurement organizations and histocompatibility laboratories.
§413.202
Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
§413.203
Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
§413.210
Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.
§413.215
Basis of payment.
§413.217
Items and services included in the ESRD prospective payment system.
§413.220
Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011.
§413.230
Determining the per treatment payment amount.
§413.231
Adjustment for wages.
§413.232
Low-volume adjustment.
§413.235
Patient-level adjustments.
§413.237
Outliers.
§413.239
Transition period.
§413.241
Pharmacy arrangements.
rule

Subpart I—PROSPECTIVELY DETERMINED PAYMENT RATES FOR LOW-VOLUME SKILLED NURSING FACILITIES, FOR COST REPORTING PERIODS BEGINNING PRIOR TO JULY 1, 1998

§413.300
Basis and scope.
§413.302
Definitions.
§413.304
Eligibility for prospectively determined payment rates.
§413.308
Rules governing election of prospectively determined payment rates.
§413.310
Basis of payment.
§413.312
Methodology for calculating rates.
§413.314
Determining payment amounts: Routine per diem rate.
§413.316
Determining payment amounts: Ancillary services.
§413.320
Publication of prospectively determined payment rates or amounts.
§413.321
Simplified cost report for SNFs.
rule

Subpart J—PROSPECTIVE PAYMENT FOR SKILLED NURSING FACILITIES

§413.330
Basis and scope.
§413.333
Definitions.
§413.335
Basis of payment.
§413.337
Methodology for calculating the prospective payment rates.
§413.340
Transition period.
§413.343
Resident assessment data.
§413.345
Publication of Federal prospective payment rates.
§413.348
Limitation on review.
§413.350
Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A services.
§413.355
Additional payment: QIO photocopy and mailing costs.


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