[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR412.101]



[Page 511]

 

                         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]



[[Page 512]]