1999 CFR Title 42, Volume 2

Title 42--Public Health CHAPTER IV--HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES
	412.1	Scope of part.
	412.2	Basis of payment.
	412.4	Discharges and transfers.
	412.6	Cost reporting periods subject to the prospective payment systems.
	412.8	Publication of schedules for determining prospective payment rates.
	412.10	Changes in the DRG classification system.
	412.20	Hospital services subject to the prospective payment systems.
	412.22	Excluded hospitals and hospital units: General rules.
	412.23	Excluded hospitals: Classifications.
	412.25	Excluded hospital units: Common requirements.
	412.27	Excluded psychiatric units: Additional requirements.
	412.29	Excluded rehabilitation units: Additional requirements.
	412.30	Exclusion of new rehabilitation units and expansion of units already excluded.
	412.40	General requirements.
	412.42	Limitations on charges to beneficiaries.
	412.44	Medical review requirements: Admissions and quality review.
	412.46	Medical review requirements: Physician acknowledgement.
	412.48	Denial of payment as a result of admissions and quality review.
	412.50	Furnishing of inpatient hospital services directly or under arrangements.
	412.52	Reporting and recordkeeping requirements.
	412.60	DRG classification and weighting factors.
	412.62	Federal rates for inpatient operating costs for fiscal year 1984.
	412.63	Federal rates for inpatient operating costs for fiscal years after Federal fiscal year 1984.
	412.70	General description.
	412.71	Determination of base-year inpatient operating costs.
	412.72	Modification of base-year costs.
	412.73	Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period.
	412.75	Determination of the hospital-specific rate for inpatient operating costs based on a Federal fiscal year 1987 base period.
	412.76	Recovery of excess transition period payment amounts resulting from unlawful claims.
	412.80	General provisions.
	412.82	Payment for extended length-of-stay cases (day outliers).
	412.84	Payment for extraordinarily high-cost cases (cost outliers).
	412.86	Payment for extraordinarily high-cost day outliers.
	412.90	General rules.
	412.92	Special treatment: Sole community hospitals.
	412.96	Special treatment: Referral centers.
	412.98	Special treatment: Christian Science Sanatoria.
	412.100	Special treatment: Renal transplantation centers.
	412.102	Special treatment: Hospitals reclassified as rural.
	412.104	Special treatment: Hospitals with high percentage of ESRD discharges.
	412.105	Special treatment: Hospitals that incur indirect costs for graduate medical education programs.
	412.106	Special treatment: Hospitals that serve a disproportionate share of low-income patients.
	412.107	Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999.
	412.108	Special treatment: Medicare-dependent, small rural hospitals.
	412.109	Special treatment: Essential access community hospitals (EACHs).
	412.110	Total Medicare payment.
	412.112	Payments determined on a per case basis.
	412.113	Other payments.
	412.115	Additional payments.
	412.116	Method of payment.
	412.120	Reductions to total payments.
	412.125	Effect of change of ownership on payments under the prospective payment systems.
	412.130	Retroactive adjustments for incorrectly excluded hospitals and units.
	412.200	General provisions.
	412.204	Payment to hospitals located in Puerto Rico.
	412.208	Puerto Rico rates for Federal fiscal year 1988.
	412.210	Puerto Rico rates for fiscal years after Federal fiscal year 1988.
	412.212	National rate.
	412.220	Special treatment of certain hospitals located in Puerto Rico.
	412.230	Criteria for an individual hospital seeking redesignation to another rural area or an urban area.
	412.232	Criteria for all hospitals in a rural county seeking urban redesignation.
	412.234	Criteria for all hospitals in an urban county seeking redesignation to another urban area.
	412.236	Alternative criteria for hospitals located in an NECMA.
	412.246	MGCRB members.
	412.248	Number of members needed for a decision or a hearing.
	412.250	Sources of MGCRB's authority.
	412.252	Applications.
	412.254	Proceedings before MGCRB.
	412.256	Application requirements.
	412.258	Parties to MGCRB proceeding.
	412.260	Time and place of the oral hearing.
	412.262	Disqualification of an MGCRB member.
	412.264	Evidence and comments in MGCRB proceeding.
	412.266	Availability of wage data.
	412.268	Subpoenas.
	412.270	Witnesses.
	412.272	Record of proceedings before the MGCRB.
	412.273	Withdrawing an application.
	412.274	Scope and effect of an MGCRB decision.
	412.276	Timing of MGCRB decision and its appeal.
	412.278	Administrator's review.
	412.280	Representation.
	412.300	Scope of subpart and definition.
	412.302	Introduction to capital costs.
	412.304	Implementation of the capital prospective payment system.
	412.308	Determining and updating the Federal rate.
	412.312	Payment based on the Federal rate.
	412.316	Geographic adjustment factors.
	412.320	Disproportionate share adjustment factor.
	412.322	Indirect medical education adjustment factor.
	412.324	General description.
	412.328	Determining and updating the hospital-specific rate.
	412.331	Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.
	412.332	Payment based on the hospital-specific rate.
	412.336	Transition period payment methodologies.
	412.340	Fully prospective payment methodology.
	412.344	Hold-harmless payment methodology.
	412.348	Exception payments.
	412.352	Budget neutrality adjustment.
	412.370	General provisions for hospitals located in Puerto Rico.
	412.374	Payments to hospitals located in Puerto Rico.