42 CFR Part 413
PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS
- PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter B—Medicare Program
- 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.
- Subpart B—Accounting Records and Reports
- § 413.20 Financial data and reports.
- § 413.24 Adequate cost data and cost finding.
- 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.
- Subpart D—Apportionment
- § 413.50 Apportionment of allowable costs.
- § 413.53 Determination of cost of services to beneficiaries.
- § 413.56 [Reserved]
- 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.
- 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.
- § 413.84 xxx
- § 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.
- § 413.99 Qualified and Non-Qualified Deferred Compensation Plans.
- § 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.
- 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.
- Subpart H—Payment for End-Stage Renal Disease (ESRD) Services
- § 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 ESRD quality incentive program.
- § 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 [Reserved]
- § 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.
- § 413.233 Additional facility-level adjustments.
- § 413.234 Drug designation process.
- § 413.235 Patient-level adjustments.
- § 413.236 Transitional add-on payment adjustment for new and innovative equipment and supplies.
- § 413.237 Outliers.
- § 413.239 Transition period.
- § 413.241 Pharmacy arrangements.
- 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.
- 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.
- § 413.338 Skilled nursing facility value-based purchasing program.
- § 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 reimbursement for cost of sending records electronically or by photocopy and mailing.
- § 413.360 Requirements under the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).
- Subpart K—Payment for Acute Kidney Injury (AKI) Dialysis
- § 413.370 Scope.
- § 413.371 Definition.
- § 413.372 AKI dialysis payment rate.
- § 413.373 Other adjustments to the AKI dialysis payment rate.
- § 413.374 Renal dialysis services included in the AKI dialysis payment rate.
- § 413.375 Notification of changes in rate-setting methodologies and payment rates.
- Subpart L—Payment of Organ Acquisition Costs for Transplant Hospitals. Organ Procurement Organizations, and Histocompatibility Laboratories
- § 413.400 Definitions.
- § 413.402 Organ acquisition costs.
- § 413.404 Standard acquisition charge.
- § 413.406 Acquisition of pancreata for islet cell transplant.
- § 413.408 [Reserved]
- § 413.410 [Reserved]
- § 413.412 Intent to transplant, intent for research, counting en bloc, and unusable organs.
- § 413.414 Medicare secondary payer and organ acquisition costs.
- § 413.416 Organ acquisition charges for kidney-paired exchanges.
- § 413.418 Amounts billed to organ procurement organizations for hospital services provided to deceased donors and included as organ acquisition costs.
- § 413.420 Payment to independent organ procurement organizations and histocompatibility laboratories for kidney acquisition costs.
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