[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2004]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR412.101]

[Page 448]
 
                         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
--Table of Contents
 
Subpart G_Special Treatment of Certain Facilities Under the Prospective 
              Payment System for Inpatient Operating Costs
 
Sec. 412.101  Special treatment: Inpatient hospital payment adjustment 
for low-volume hospitals.

    (a) General considerations.
    (1) CMS provides an additional payment to a qualifying hospital for 
the higher incremental costs associated with a low volume of discharges. 
The amount of any additional payment for a qualifying hospital is 
calculated in accordance with paragraph (b) of this section.
    (2) In order to qualify for this adjustment, a hospital must have 
less than 200 discharges during the fiscal year, as reflected in its 
cost report specified in paragraph (a)(3) of this section, and be 
located more than 25 road miles from the nearest subsection (d) 
hospital.
    (3) The fiscal intermediary makes the determination of the discharge 
count for purposes of determining a hospital's qualification for the 
adjustment based on the hospital's most recent submitted cost report.
    (4) In order to qualify for the adjustment, a hospital must provide 
its fiscal intermediary with sufficient evidence that it meets the 
distance requirement specified under paragraph (a)(2) of this section. 
The fiscal intermediary will base its determination of whether the 
distance requirement is satisfied upon the evidence presented by the 
hospital and other relevant evidence, such as maps, mapping software, 
and inquiries to State and local police, transportation officials, or 
other government officials.
    (b) Determination of the adjustment amount. The low-volume 
adjustment for hospitals that qualify under paragraph (a) of this 
section is 25 percent for each Medicare discharge.
    (c) Eligibility of new hospitals for the adjustment. A new hospital 
will be eligible for a low-volume adjustment under this section once it 
has submitted a cost report for a cost reporting period that indicates 
that it meets the number of discharge requirements during the fiscal 
year and has provided its fiscal intermediary with sufficient evidence 
that it meets the distance requirement, as specified under paragraph 
(a)(2) of this section.

[69 FR 49244, Aug. 11, 2004]