[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: 42CFR412.86]



[Page 503]

 

                         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 F_Payment for Outlier Cases and Special Treatment Payment for 

                             New Technology

 

Sec. 412.86  Payment for extraordinarily high-cost day outliers.



    For discharges occurring before October 1, 1997, if a discharge that 

qualifies for an additional payment under the provisions of Sec. 412.82 

has charges adjusted to costs that exceed the cost outlier threshold 

criteria for an extraordinarily high-cost case as set forth in Sec. 

412.80(a)(1)(ii), the additional payment made for the discharge is the 

greater of--

    (a) The applicable per diem payment computed under Sec. 412.82 (c) 

or (d); or

    (b) The payment that would be made under Sec. 412.84 (i) or (j) if 

the case had not met the day outlier criteria threshold set forth in 

Sec. 412.80(a)(1)(i).



[53 FR 38529, Sept. 30, 1988, as amended at 62 FR 46028, Aug. 29, 1997]



          Additional Special Payment for Certain New Technology