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e-CFR Data is current as of February 4, 2010
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B--MEDICARE PROGRAM
PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES
Subpart A--GENERAL PROVISIONS
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| Discharges and transfers. |
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| Cost reporting periods subject to the prospective payment systems. |
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| Publication of schedules for determining prospective payment rates. |
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| Changes in the DRG classification system. |
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Subpart B--HOSPITAL SERVICES SUBJECT TO AND EXCLUDED FROM THE PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT OPERATING COSTS AND INPATIENT CAPITAL-RELATED COSTS
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| Hospital services subject to the prospective payment systems. |
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| Excluded hospitals and hospital units: General rules. |
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| Excluded hospitals: Classifications. |
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| Excluded hospital units: Common requirements. |
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| Excluded psychiatric units: Additional requirements. |
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| Excluded rehabilitation units: Additional requirements. |
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| Exclusion of new rehabilitation units and expansion of units already excluded. |
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Subpart C--CONDITIONS FOR PAYMENT UNDER THE PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT OPERATING COSTS AND INPATIENT CAPITAL-RELATED COSTS
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| Limitations on charges to beneficiaries. |
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| Medical review requirements: Admissions and quality review. |
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| Medical review requirements: Physician acknowledgement. |
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| Denial of payment as a result of admissions and quality review. |
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| Furnishing of inpatient hospital services directly or under arrangements. |
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| Reporting and recordkeeping requirements. |
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Subpart D--BASIC METHODOLOGY FOR DETERMINING PROSPECTIVE PAYMENT FEDERAL RATES FOR INPATIENT OPERATING COSTS
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| DRG classification and weighting factors. |
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| Federal rates for inpatient operating costs for fiscal year 1984. |
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| Federal rates for inpatient operating costs for Federal fiscal years 1984 through 2004. |
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| Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years. |
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Subpart E--DETERMINATION OF TRANSITION PERIOD PAYMENT RATES FOR THE PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT OPERATING COSTS
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| Determination of base-year inpatient operating costs. |
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| Modification of base-year costs. |
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| Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period. |
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| Determination of the hospital-specific rate for inpatient operating costs based on a Federal fiscal year 1987 base period. |
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| Recovery of excess transition period payment amounts resulting from unlawful claims. |
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| Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 1996 base period. |
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| Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 2006 base period. |
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| Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent, small rural hospitals based on a Federal fiscal year 2002 base period. |
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Subpart F--PAYMENTS FOR OUTLIER CASES, SPECIAL TREATMENT PAYMENT FOR NEW TECHNOLOGY, AND PAYMENT ADJUSTMENT FOR CERTAIN REPLACED DEVICES
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| Outlier cases: General provisions. |
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| Payment for extended length-of-stay cases (day outliers). |
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| Payment for extraordinarily high-cost cases (cost outliers). |
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| Payment for extraordinarily high-cost day outliers. |
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| Additional payment for new medical services and technologies: General provisions. |
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| Additional payment for new medical service or technology. |
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| Payment adjustment for certain replaced devices. |
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Subpart G--SPECIAL TREATMENT OF CERTAIN FACILITIES UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT OPERATING COSTS
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| Special treatment: Sole community hospitals. |
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| Special treatment: Referral centers. |
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| Special treatment: Renal transplantation centers. |
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| Special treatment: Inpatient hospital payment adjustment for low-volume hospitals. |
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| Special treatment: Hospitals located in areas that are reclassified from urban to rural as a result of a geographic redesignation. |
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| Special treatment: Hospitals located in urban areas and that apply for reclassification as rural. |
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| Special treatment: Hospitals with high percentage of ESRD discharges. |
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| Special treatment: Hospitals that incur indirect costs for graduate medical education programs. |
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| Special treatment: Hospitals that serve a disproportionate share of low-income patients. |
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| Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999. |
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| Special treatment: Medicare-dependent, small rural hospitals. |
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| Special treatment: Essential access community hospitals (EACHs). |
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Subpart H--PAYMENTS TO HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEMS
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| Payments determined on a per case basis. |
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| Reductions to total payments. |
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| Effect of change of ownership on payments under the prospective payment systems. |
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| Retroactive adjustments for incorrectly excluded hospitals and units. |
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Subparts I-J--[RESERVED]
Subpart K--PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT OPERATING COSTS FOR HOSPITALS LOCATED IN PUERTO RICO
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| Payment to hospitals located in Puerto Rico. |
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| Puerto Rico rates for Federal fiscal year 1988. |
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| Puerto Rico rates for Federal fiscal years 1989 through 2003. |
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| Puerto Rico rates for Federal fiscal year 2004 and subsequent fiscal years. |
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| Special treatment of certain hospitals located in Puerto Rico. |
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Subpart L--THE MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD
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| Criteria for an individual hospital seeking redesignation to another rural area or an urban area. |
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| Criteria for all hospitals in a rural county seeking urban redesignation. |
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| Criteria for all hospitals in an urban county seeking redesignation to another urban area. |
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| Criteria for all hospitals in a State seeking a statewide wage index redesignation. |
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| Number of members needed for a decision or a hearing. |
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| Sources of MGCRB's authority. |
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| Proceedings before MGCRB. |
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| Application requirements. |
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| Parties to MGCRB proceeding. |
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| Time and place of the oral hearing. |
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| Disqualification of an MGCRB member. |
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| Evidence and comments in MGCRB proceeding. |
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| Availability of wage data. |
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| Record of proceedings before the MGCRB. |
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| Withdrawing an application, terminating an approved 3-year reclassification, or canceling a previous withdrawal or termination. |
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| Scope and effect of an MGCRB decision. |
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| Timing of MGCRB decision and its appeal. |
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Subpart M--PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT HOSPITAL CAPITAL COSTS
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| Scope of subpart and definition. |
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| Introduction to capital costs. |
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| Implementation of the capital prospective payment system. |
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| Determining and updating the Federal rate. |
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| Payment based on the Federal rate. |
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| Geographic adjustment factors. |
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| Disproportionate share adjustment factor. |
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| Indirect medical education adjustment factor. |
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| Determining and updating the hospital-specific rate. |
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| Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution. |
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| Payment based on the hospital-specific rate. |
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| Transition period payment methodologies. |
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| Fully prospective payment methodology. |
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| Hold-harmless payment methodology. |
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| Budget neutrality adjustment. |
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| General provisions for hospitals located in Puerto Rico. |
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| Payments to hospitals located in Puerto Rico. |
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Subpart N--PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT HOSPITAL SERVICES OF INPATIENT PSYCHIATRIC FACILITIES
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| Basis and scope of subpart. |
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| Conditions for payment under the prospective payment system for inpatient hospital services of psychiatric facilities. |
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| Methodology for calculating the Federal per diem payment amount. |
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| Publication of Updates to the inpatient psychiatric facility prospective payment system. |
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| Method of payment under the inpatient psychiatric facility prospective payment system. |
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Subpart O--PROSPECTIVE PAYMENT SYSTEM FOR LONG-TERM CARE HOSPITALS
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| Basis and scope of subpart. |
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| Conditions for payment under the prospective payment system for long-term care hospitals. |
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| Limitation on charges to beneficiaries. |
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| Medical review requirements. |
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| Furnishing of inpatient hospital services directly or under arrangement. |
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| Reporting and recordkeeping requirements. |
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| Patient classification system. |
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| LTC-DRG weighting factors. |
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| Revision of LTC-DRG group classifications and weighting factors. |
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| Methodology for calculating the Federal prospective payment rates. |
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| Adjustments to the Federal prospective payment. |
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| Special payment provision for short-stay outliers. |
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| Special payment provisions when an interruption of a stay occurs in a long-term care hospital. |
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| Special payment provisions for patients who are transferred to onsite providers and readmitted to a long-term care hospital. |
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| Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. |
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| Publication of the Federal prospective payment rates. |
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| Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellite of the long-term care hospital. |
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| Method of payment under the long-term care hospital prospective payment system. |
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Subpart P--PROSPECTIVE PAYMENT FOR INPATIENT REHABILITATION HOSPITALS AND REHABILITATION UNITS
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| Basis and scope of subpart. |
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| Conditions for payment under the prospective payment system for inpatient rehabilitation facilities. |
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| Patients' rights regarding the collection of patient assessment data. |
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| Coordination of the collection of patient assessment data. |
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| Transmission of patient assessment data. |
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| Release of information collected using the patient assessment instrument. |
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| Assessment process for interrupted stays. |
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| Patient classification system. |
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| Methodology for calculating the Federal prospective payment rates. |
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| Publication of the Federal prospective payment rates. |
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| Method of payment under the inpatient rehabilitation facility prospective payment system. |
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