[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: 42CFR412.104]



[Page 513]

 

                         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. 412.104  Special treatment: Hospitals with high percentage of ESRD 

discharges.



    (a) Criteria for classification. CMS provides an additional payment 

to a hospital for inpatient services provided to ESRD beneficiaries who 

receive a dialysis treatment during a hospital stay, if the hospital has 

established that ESRD beneficiary discharges, excluding discharges 

classified into DRG 302 (Kidney Transplant), DRG 316 (Renal Failure), or 

DRG 317 (Admit for Renal Dialysis), where the beneficiary received 

dialysis services during the inpatient stay, constitute 10 percent or 

more of its total Medicare discharges.

    (b) Additional payment. A hospital that meets the criteria of 

paragraph (a) of this section is paid an additional payment for each 

ESRD beneficiary discharge except those excluded under paragraph (a) of 

this section.

    (1) The payment is based on the estimated weekly cost of dialysis 

and the average length of stay of ESRD beneficiaries for the hospital.

    (2) The estimated weekly cost of dialysis is the average number of 

dialysis sessions furnished per week during the 12-month period that 

ended June 30, 1983 multiplied by the average cost of dialysis for the 

same period.

    (3) The average cost of dialysis includes only those costs 

determined to be directly related to the dialysis service. (These costs 

include salary, employee health and welfare, drugs, supplies, and 

laboratory services.)

    (4) The average cost of dialysis is reviewed and adjusted, if 

appropriate, at the time the composite rate reimbursement for outpatient 

dialysis is reviewed.

    (5) The payment to a hospital equals the average length of stay of 

ESRD beneficiaries in the hospital, expressed as a ratio to one week, 

times the estimated weekly cost of dialysis multiplied by the number of 

ESRD beneficiary discharges except for those excluded under paragraph 

(a) of this section. This payment is made only on the Federal portion of 

the payment rate.



[50 FR 12741, Mar. 29, 1985, as amended at 57 FR 39824, Sept. 1, 1992; 

69 FR 49244, Aug. 11, 2004]