[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: 42CFR412.88]



[Page 504]

 

                         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. 412.88  Additional payment for new medical service or technology.



    (a) For discharges involving new medical services or technologies 

that meet the criteria specified in Sec. 412.87, Medicare payment will 

be:

    (1) One of the following:

    (i) The full DRG payment (including adjustments for indirect medical 

education and disproportionate share but excluding outlier payments);

    (ii) The payment determined under Sec. 412.4(f) for transfer cases;

    (iii) The payment determined under Sec. 412.92(d) for sole 

community hospitals; or

    (iv) The payment determined under Sec. 412.108(c) for Medicare-

dependent hospitals; plus

    (2) If the costs of the discharge (determined by applying cost-to-

charge ratios as described in Sec. 412.84(h)) exceed the full DRG 

payment, an additional amount equal to the lesser of--

    (i) 50 percent of the costs of the new medical service or 

technology; or

    (ii) 50 percent of the amount by which the costs of the case exceed 

the standard DRG payment.

    (b) Unless a discharge case qualifies for outlier payment under 

Sec. 412.84, Medicare will not pay any additional amount beyond the DRG 

payment plus 50 percent of the estimated costs of the new medical 

service or technology.



[66 FR 46924, Sept. 7, 2001, as amended at 67 FR 50111, Aug. 1, 2002; 69 

FR 49244, Aug. 11, 2004]