Code of Federal Regulations (alpha)

CFR /  Title 42  /  Part 412: Prospective Payment Systems For Inpatient Hospital Services

Section No. Description
Section 412.1 Basis of payment
Section 412.2 Admissions
Section 412.3 Discharges and transfers
Section 412.4 Cost reporting periods subject to the prospective payment systems
Section 412.6 Publication of schedules for determining prospective payment rates
Section 412.8 Changes in the DRG classification system
Section 412.10 Hospital services subject to the prospective payment systems
Section 412.20 Excluded hospitals and hospital units: General rules
Section 412.22 Excluded hospitals: Classifications
Section 412.23 Excluded hospital units: Common requirements
Section 412.25 Excluded psychiatric units: Additional requirements
Section 412.27 Classification criteria for payment under the inpatient rehabilitation facility prospective payment system
Section 412.29 General requirements
Section 412.40 Limitations on charges to beneficiaries
Section 412.42 Medical review requirements: Admissions and quality review
Section 412.44 Medical review requirements
Section 412.46 Denial of payment as a result of admissions and quality review
Section 412.48 Furnishing of inpatient hospital services directly or
Section 412.50 Reporting and recordkeeping requirements
Section 412.52 DRG classification and weighting factors
Section 412.60 Federal rates for inpatient operating costs for fiscal year 1984
Section 412.62 Federal rates for inpatient operating costs for Federal fiscal years 1984 through 2004
Section 412.63 Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years
Section 412.64 General description
Section 412.70 Determination of base-year inpatient operating costs
Section 412.71 Modification of base-year costs
Section 412.72 Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period
Section 412.73 Determination of the hospital-specific rate for inpatient operating costs based on a Federal fiscal year 1987 base period
Section 412.75 Recovery of excess transition period payment amounts resulting from unlawful claims
Section 412.76 Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal
Section 412.77 Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fisca
Section 412.78 Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent, small rural hospitals based
Section 412.79 Outlier cases: General provisions
Section 412.80 Payment for extended length-of-stay cases (day outliers)
Section 412.82 Payment for extraordinarily high-cost cases (cost outliers)
Section 412.84 Payment for extraordinarily high-cost day outliers
Section 412.86 Additional payment for new medical services and technologies: General provisions
Section 412.87 Additional payment for new medical service or technology
Section 412.88 Payment adjustment for certain replaced devices
Section 412.89 General rules
Section 412.90 Special treatment: Sole community hospitals
Section 412.92 Special treatment: Referral centers
Section 412.96 Special treatment: Renal transplantation centers
Section 412.100 Special treatment: Inpatient hospital payment adjustment for low-volume hospitals
Section 412.101 Special treatment: Hospitals located in areas that are changing from urban to rural as a result of a geographic
Section 412.102 Special treatment: Hospitals located in urban areas and that apply for reclassification as rural
Section 412.103 Special treatment: Hospitals with high percentage of ESRD discharges
Section 412.104 Special treatment: Hospitals that incur indirect costs for graduate medical education programs
Section 412.105 Special treatment: Hospitals that serve a disproportionate share of low-income patients
Section 412.106 Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999
Section 412.107 Special treatment: Medicare-dependent, small rural hospitals
Section 412.108 Special treatment: Essential access community hospitals (EACHs)
Section 412.109 Total Medicare payment
Section 412.110 Payments determined on a per case basis
Section 412.112 Other payments
Section 412.113 Additional payments
Section 412.115 Method of payment
Section 412.116 Reductions to total payments
Section 412.120 Effect of change of ownership on payments under the prospective payment systems
Section 412.125 Retroactive adjustments for incorrectly excluded hospitals and units
Section 412.130 Participation, data submission, and validation requirements under the Hospital Inpatient Quality Reporting (IQR)
Section 412.140 Basis and scope of subpart
Section 412.150 Definitions for the Hospital Readmissions Reduction Program
Section 412.152 Payment adjustments under the Hospital Readmissions Reduction Program
Section 412.154 Definitions for the Hospital Value-Based Purchasing (VBP) Program
Section 412.160 Applicability of the Hospital Value-Based Purchasing (VBP) Program
Section 412.161 Process for reducing the base operating DRG payment amount and applying the value-based incentive payment amount adjustment
Section 412.162 Process for making hospital-specific performance information under the Hospital Value-Based Purchasing (VBP) Program
Section 412.163 Measure selection under the Hospital Value-Based
Section 412.164 Performance scoring under the Hospital Value-Based Purchasing (VBP) Program
Section 412.165 Appeal under the Hospital Value-Based Purchasing (VBP) Program
Section 412.167 Payment adjustments under the Hospital-Acquired Condition Reduction Program
Section 412.172 General provisions
Section 412.200 Payment to hospitals located in Puerto Rico
Section 412.204 Puerto Rico rates for Federal fiscal year 1988
Section 412.208 Puerto Rico rates for Federal fiscal years 1989 through 2003
Section 412.210 Puerto Rico rates for Federal fiscal year 2004 and subsequent fiscal years
Section 412.211 National rate
Section 412.212 Special treatment of certain hospitals located in Puerto Rico
Section 412.220 Criteria for an individual hospital seeking redesignation to another rural area or an urban area
Section 412.230 Criteria for all hospitals in a rural county seeking urban redesignation
Section 412.232 Criteria for all hospitals in an urban county seeking redesignation to another urban area
Section 412.234 Criteria for all hospitals in a State seeking a statewide wage index redesignation
Section 412.235 MGCRB members
Section 412.246 Number of members needed for a decision or a hearing
Section 412.248 Sources of MGCRB's authority
Section 412.250 Applications
Section 412.252 Proceedings before MGCRB
Section 412.254 Application requirements
Section 412.256 Parties to MGCRB proceeding
Section 412.258 Time and place of the oral hearing
Section 412.260 Disqualification of an MGCRB member
Section 412.262 Evidence and comments in MGCRB proceeding
Section 412.264 Availability of wage data
Section 412.266 Subpoenas
Section 412.268 Witnesses
Section 412.270 Record of proceedings before the MGCRB
Section 412.272 Withdrawing an application, terminating an approved 3-year reclassification, or canceling a previous withdrawal or termination
Section 412.273 Scope and effect of an MGCRB decision
Section 412.274 Timing of MGCRB decision and its appeal
Section 412.276 Administrator's review
Section 412.278 Representation
Section 412.280 Scope of subpart and definition
Section 412.300 Introduction to capital costs
Section 412.302 Implementation of the capital prospective payment system
Section 412.304 Determining and updating the Federal rate
Section 412.308 Payment based on the Federal rate
Section 412.312 Geographic adjustment factors
Section 412.316 Disproportionate share adjustment factor
Section 412.320 Indirect medical education adjustment factor
Section 412.322 General description
Section 412.324 Determining and updating the hospital-specific rate
Section 412.328 Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution
Section 412.331 Payment based on the hospital-specific rate
Section 412.332 Transition period payment methodologies
Section 412.336 Fully prospective payment methodology
Section 412.340 Hold-harmless payment methodology
Section 412.344 Exception payments
Section 412.348 Budget neutrality adjustment
Section 412.352 General provisions for hospitals located in Puerto Rico
Section 412.370 Payments to hospitals located in Puerto Rico
Section 412.374 Basis and scope of subpart
Section 412.400 Definitions
Section 412.402 Conditions for payment under the prospective payment system for inpatient hospital services of psychiatric facilities
Section 412.404 Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system
Section 412.405 Basis of payment
Section 412.422 Methodology for calculating the Federal per diem payment amount
Section 412.424 Transition period
Section 412.426 Publication of Updates to the inpatient psychiatric facility prospective payment system
Section 412.428 Method of payment under the inpatient psychiatric facility prospective payment system
Section 412.432 Reconsideration and appeals procedures of Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program decisions
Section 412.434 Basis and scope of subpart
Section 412.500 Definitions
Section 412.503 Conditions for payment under the prospective payment system for long-term care hospitals
Section 412.505 Limitation on charges to beneficiaries
Section 412.507 Medical review requirements
Section 412.508 Furnishing of inpatient hospital services directly or under arrangement
Section 412.509 Reporting and recordkeeping requirements
Section 412.511 Patient classification system
Section 412.513 LTC-DRG weighting factors
Section 412.515 Revision of LTC-DRG group classifications and weighting factors
Section 412.517 Basis of payment
Section 412.521 Application of site neutral payment rate
Section 412.522 Methodology for calculating the Federal prospective payment rates
Section 412.523 Adjustments to the Federal prospective payment
Section 412.525 Payment provisions for a ``subclause (II)'' long-term care hospital
Section 412.526 Special payment provision for short-stay outliers
Section 412.529 Special payment provisions when an interruption of a stay occurs in a long-term care hospital
Section 412.531 Transition payments
Section 412.533 Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals
Section 412.534 Publication of the Federal prospective payment rates
Section 412.535 Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare
Section 412.536 Method of payment for preadmission services under the long-term care hospital prospective payment system
Section 412.540 Method of payment under the long-term care hospital prospective payment system
Section 412.541 Participation, data submission, and other requirements under the Long-Term Care Hospital Quality Reporting (LTCHQR) Program
Section 412.560 Basis and scope of subpart
Section 412.600 Definitions
Section 412.602 Conditions for payment under the prospective payment system for inpatient rehabilitation facilities
Section 412.604 Patient assessments
Section 412.606 Patients' rights regarding the collection of patient assessment data
Section 412.608 Assessment schedule
Section 412.610 Coordination of the collection of patient assessment data
Section 412.612 Transmission of patient assessment data
Section 412.614 Release of information collected using the patient assessment instrument
Section 412.616 Assessment process for interrupted stays
Section 412.618 Patient classification system
Section 412.620 Basis of payment
Section 412.622 Methodology for calculating the Federal prospective payment rates
Section 412.624 Transition period
Section 412.626 Publication of the Federal prospective payment rates
Section 412.628 Limitation on review
Section 412.630 Method of payment under the inpatient rehabilitation facility prospective payment system
Section 412.632 Requirements under the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP)
Section 412.634 Introduction