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Title 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE
& MEDICAID SERVICES,
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES
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 | 412.1 | Scope of part. |
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| 412.2 | Basis of payment. |
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| 412.4 | Discharges and transfers. |
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| 412.6 | Cost reporting periods subject to the prospective payment systems. |
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| 412.8 | Publication of schedules for determining prospective payment rates. |
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| 412.10 | Changes in the DRG classification system. |
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| 412.20 | Hospital services subject to the prospective payment systems. |
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| 412.22 | Excluded hospitals and hospital units: General rules. |
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| 412.23 | Excluded hospitals: Classifications. |
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| 412.25 | Excluded hospital units: Common requirements. |
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| 412.27 | Excluded psychiatric units: Additional requirements. |
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| 412.29 | Excluded rehabilitation units: Additional requirements. |
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| 412.30 | Exclusion of new rehabilitation units and expansion of units already excluded. |
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| 412.40 | General requirements. |
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| 412.42 | Limitations on charges to beneficiaries. |
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| 412.44 | Medical review requirements: Admissions and quality review. |
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| 412.46 | Medical review requirements: Physician acknowledgement. |
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| 412.48 | Denial of payment as a result of admissions and quality review. |
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| 412.50 | Furnishing of inpatient hospital services directly or under arrangements. |
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| 412.52 | Reporting and recordkeeping requirements. |
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| 412.60 | DRG classification and weighting factors. |
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| 412.62 | Federal rates for inpatient operating costs for fiscal year 1984. |
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| 412.63 | Federal rates for inpatient operating costs for Federal fiscal years 1984 through 2004. |
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| 412.64 | Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years. |
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| 412.70 | General description. |
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| 412.71 | Determination of base-year inpatient operating costs. |
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| 412.72 | Modification of base-year costs. |
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| 412.73 | Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period. |
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| 412.75 | Determination of the hospital-specific rate for inpatient operating costs based on a Federal fiscal year 1987 base period. |
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| 412.77 | 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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| 412.78 | Recovery of excess transition period payment amounts resulting from unlawful claims. |
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| 412.80 | Outlier cases: General provisions. |
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| 412.82 | Payment for extended length-of-stay cases (day outliers). |
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| 412.84 | Payment for extraordinarily high-cost cases (cost outliers). |
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| 412.86 | Payment for extraordinarily high-cost day outliers. |
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| 412.87 | Additional payment for new medical services and technologies: General provisions. |
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| 412.88 | Additional payment for new medical service or technology. |
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| 412.90 | General rules. |
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| 412.92 | Special treatment: Sole community hospitals. |
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| 412.96 | Special treatment: Referral centers. |
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| 412.100 | Special treatment: Renal transplantation centers. |
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| 412.101 | Special treatment: Inpatient hospital payment adjustment for low-volume hospitals. |
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| 412.102 | Special treatment: Hospitals located in areas that are reclassified from urban to rural as a result of a geographic redesignation. |
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| 412.103 | Special treatment: Hospitals located in urban areas and that apply for reclassification as rural. |
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| 412.104 | Special treatment: Hospitals with high percentage of ESRD discharges. |
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| 412.105 | Special treatment: Hospitals that incur indirect costs for graduate medical education programs. |
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| 412.106 | Special treatment: Hospitals that serve a disproportionate share of low-income patients. |
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| 412.107 | Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999. |
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| 412.108 | Special treatment: Medicare-dependent, small rural hospitals. |
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| 412.109 | Special treatment: Essential access community hospitals (EACHs). |
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| 412.110 | Total Medicare payment. |
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| 412.112 | Payments determined on a per case basis. |
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| 412.113 | Other payments. |
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| 412.115 | Additional payments. |
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| 412.116 | Method of payment. |
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| 412.120 | Reductions to total payments. |
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| 412.125 | Effect of change of ownership on payments under the prospective payment systems. |
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| 412.130 | Retroactive adjustments for incorrectly excluded hospitals and units. |
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| 412.200 | General provisions. |
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| 412.204 | Payment to hospitals located in Puerto Rico. |
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| 412.208 | Puerto Rico rates for Federal fiscal year 1988. |
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| 412.210 | Puerto Rico rates for Federal fiscal years 1989 through 2003. |
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| 412.211 | Puerto Rico rates for Federal fiscal year 2004 and subsequent fiscal years. |
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| 412.212 | National rate. |
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| 412.220 | Special treatment of certain hospitals located in Puerto Rico. |
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| 412.230 | Criteria for an individual hospital seeking redesignation to another rural area or an urban area. |
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| 412.232 | Criteria for all hospitals in a rural county seeking urban redesignation. |
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| 412.234 | Criteria for all hospitals in an urban county seeking redesignation to another urban area. |
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| 412.235 | Criteria for all hospitals in a State seeking a statewide wage index redesignation. |
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| 412.246 | MGCRB members. |
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| 412.248 | Number of members needed for a decision or a hearing. |
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| 412.250 | Sources of MGCRB's authority. |
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| 412.252 | Applications. |
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| 412.254 | Proceedings before MGCRB. |
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| 412.256 | Application requirements. |
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| 412.258 | Parties to MGCRB proceeding. |
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| 412.260 | Time and place of the oral hearing. |
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| 412.262 | Disqualification of an MGCRB member. |
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| 412.264 | Evidence and comments in MGCRB proceeding. |
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| 412.266 | Availability of wage data. |
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| 412.268 | Subpoenas. |
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| 412.270 | Witnesses. |
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| 412.272 | Record of proceedings before the MGCRB. |
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| 412.273 | Withdrawing an application, terminating an approved 3-year reclassification, or canceling a previous withdrawal or termination. |
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| 412.274 | Scope and effect of an MGCRB decision. |
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| 412.276 | Timing of MGCRB decision and its appeal. |
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| 412.278 | Administrator's review. |
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| 412.280 | Representation. |
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| 412.300 | Scope of subpart and definition. |
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| 412.302 | Introduction to capital costs. |
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| 412.304 | Implementation of the capital prospective payment system. |
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| 412.308 | Determining and updating the Federal rate. |
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| 412.312 | Payment based on the Federal rate. |
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| 412.316 | Geographic adjustment factors. |
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| 412.320 | Disproportionate share adjustment factor. |
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| 412.322 | Indirect medical education adjustment factor. |
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| 412.324 | General description. |
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| 412.328 | Determining and updating the hospital-specific rate. |
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| 412.331 | Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution. |
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| 412.332 | Payment based on the hospital-specific rate. |
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| 412.336 | Transition period payment methodologies. |
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| 412.340 | Fully prospective payment methodology. |
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| 412.344 | Hold-harmless payment methodology. |
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| 412.348 | Exception payments. |
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| 412.352 | Budget neutrality adjustment. |
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| 412.370 | General provisions for hospitals located in Puerto Rico. |
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| 412.374 | Payments to hospitals located in Puerto Rico. |
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| 412.400 | Basis and scope of subpart. |
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| 412.402 | Definitions. |
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| 412.404 | Conditions for payment under the prospective payment system for inpatient hospital services of psychiatric facilities. |
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| 412.422 | Basis of payment. |
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| 412.424 | Methodology for calculating the Federal per diem payment amount. |
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| 412.426 | Transition period. |
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| 412.428 | Publication of Updates to the inpatient psychiatric facility prospective payment system. |
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| 412.432 | Method of payment under the inpatient psychiatric facility prospective payment system. |
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| 412.500 | Basis and scope of subpart. |
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| 412.503 | Definitions. |
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| 412.505 | Conditions for payment under the prospective payment system for long-term care hospitals. |
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| 412.507 | Limitation on charges to beneficiaries. |
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| 412.508 | Medical review requirements. |
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| 412.509 | Furnishing of inpatient hospital services directly or under arrangement. |
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| 412.511 | Reporting and recordkeeping requirements. |
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| 412.513 | Patient classification system. |
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| 412.515 | LTC-DRG weighting factors. |
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| 412.517 | Revision of LTC-DRG group classifications and weighting factors. |
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| 412.521 | Basis of payment. |
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| 412.523 | Methodology for calculating the Federal prospective payment rates. |
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| 412.525 | Adjustments to the Federal prospective payment. |
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| 412.529 | Special payment provision for short-stay outliers. |
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| 412.531 | Special payment provisions when an interruption of a stay occurs in a long-term care hospital. |
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| 412.532 | Special payment provisions for patients who are transferred to onsite providers and readmitted to a long-term care hospital. |
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| 412.533 | Transition payments. |
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| 412.534 | Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. |
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| 412.535 | Publication of the Federal prospective payment rates. |
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| 412.541 | Method of payment under the long-term care hospital prospective payment system. |
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| 412.600 | Basis and scope of subpart. |
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| 412.602 | Definitions. |
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| 412.604 | Conditions for payment under the prospective payment system for inpatient rehabilitation facilities. |
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| 412.606 | Patient assessments. |
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| 412.608 | Patients' rights regarding the collection of patient assessment data. |
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| 412.610 | Assessment schedule. |
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| 412.612 | Coordination of the collection of patient assessment data. |
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| 412.614 | Transmission of patient assessment data. |
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| 412.616 | Release of information collected using the patient assessment instrument. |
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| 412.618 | Assessment process for interrupted stays. |
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| 412.620 | Patient classification system. |
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| 412.622 | Basis of payment. |
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| 412.624 | Methodology for calculating the Federal prospective payment rates. |
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| 412.626 | Transition period. |
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| 412.628 | Publication of the Federal prospective payment rates. |
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| 412.630 | Limitation on review. |
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| 412.632 | Method of payment under the inpatient rehabilitation facility prospective payment system. |
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