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Home Page > Executive Branch > Code of Federal Regulations > Electronic Code of Federal Regulations
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 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES
Subpart A--INTRODUCTION AND GENERAL RULES
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| Cost reimbursement: General. |
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| Cost related to patient care. |
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| Amount of payment if customary charges for services furnished are less than reasonable costs. |
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| Cost to related organizations. |
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Subpart B--ACCOUNTING RECORDS AND REPORTS
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| Financial data and reports. |
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| Adequate cost data and cost finding. |
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Subpart C--LIMITS ON COST REIMBURSEMENT
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| Limitations on payable costs. |
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| Limitations on coverage of costs: Charges to beneficiaries if cost limits are applied to services. |
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| Ceiling on the rate of increase in hospital inpatient costs. |
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Subpart D--APPORTIONMENT
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| Apportionment of allowable costs. |
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| Determination of cost of services to beneficiaries. |
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Subpart E--PAYMENTS TO PROVIDERS
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| Payments to providers: General. |
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| Payments to providers: Specific rules. |
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| Requirements for a determination that a facility or an organization has provider-based status. |
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| Payment for services of a CAH. |
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| Payment to a foreign hospital. |
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Subpart F--SPECIFIC CATEGORIES OF COSTS
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| Direct GME payments: General requirements. |
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| Direct GME payments: Calculation of payments for GME costs. |
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| Direct GME payments: Determination of per resident amounts. |
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| Direct GME payments: Determination of the total number of FTE residents. |
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| Direct GME payments: Determination of the weighted number of FTE residents. |
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| Direct GME payments: Determination of weighting factors for foreign medical graduates. |
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| Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts. |
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| Direct GME payments: Special rules for States that formerly had a waiver from Medicare reimbursement principles. |
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| Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate. |
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| Cost of approved nursing and allied health education activities. |
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| Payments for Medicare+Choice nursing and allied health education programs. |
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| Incentive payments under plans for voluntary reduction in number of medical residents. |
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| Bad debts, charity, and courtesy allowances. |
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| Value of services of nonpaid workers. |
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| Purchase discounts and allowances, and refunds of expenses. |
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| Special treatment of certain accrued costs. |
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| Reasonable cost of physical and other therapy services furnished under arrangements. |
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| Payment for posthospital SNF care furnished by a swing-bed hospital. |
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| Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis. |
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| Payment for hospital outpatient radiology services and other diagnostic procedures. |
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| Payment for screening mammography performed by hospitals on an outpatient basis. |
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| Reduction to hospital outpatient operating costs. |
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| Payment for home health agency services. |
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Subpart G--CAPITAL-RELATED COSTS
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| Introduction to capital-related costs. |
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| Depreciation: Allowance for depreciation based on asset costs. |
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| Depreciation: Optional allowance for depreciation based on a percentage of operating costs. |
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| Depreciation: Allowance for depreciation on fully depreciated or partially depreciated assets. |
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| Depreciation: Allowance for depreciation on assets financed with Federal or public funds. |
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| Return on equity capital of proprietary providers. |
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Subpart H--PAYMENT FOR END-STAGE RENAL DISEASE (ESRD) SERVICES AND ORGAN PROCUREMENT COSTS
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| Principles of prospective payment. |
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| Prospective rates for hospital-based and independent ESRD facilities. |
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| Procedures for requesting exceptions to payment rates. |
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| Criteria for approval of exception requests. |
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| Payment exception: Pediatric patient mix. |
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| Payment exception: Self-dialysis training costs in pediatric facilities. |
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| Notification of changes in rate-setting methodologies and payment rates. |
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| Recordkeeping and cost reporting requirements for outpatient maintenance dialysis. |
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| Payment of independent organ procurement organizations and histocompatibility laboratories. |
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| Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. |
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| Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries. |
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Subpart I--PROSPECTIVELY DETERMINED PAYMENT RATES FOR LOW-VOLUME SKILLED NURSING FACILITIES, FOR COST REPORTING PERIODS BEGINNING PRIOR TO JULY 1, 1998
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| Eligibility for prospectively determined payment rates. |
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| Rules governing election of prospectively determined payment rates. |
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| Methodology for calculating rates. |
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| Determining payment amounts: Routine per diem rate. |
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| Determining payment amounts: Ancillary services. |
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| Publication of prospectively determined payment rates or amounts. |
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| Simplified cost report for SNFs. |
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Subpart J--PROSPECTIVE PAYMENT FOR SKILLED NURSING FACILITIES
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| Methodology for calculating the prospective payment rates. |
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| Resident assessment data. |
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| Publication of Federal prospective payment rates. |
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| Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A services. |
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| Additional payment: QIO photocopy and mailing costs. |
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