[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: 42CFR412.90]



[Page 504-505]

 

                         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. 412.90  General rules.





    (a) Sole community hospitals. CMS may adjust the prospective payment 

rates for inpatient operating costs determined under subpart D or E of 

this part if a hospital, by reason of factors such as isolated location, 

weather conditions, travel conditions, or absence of other hosptials, is 

the sole source of inpatient hospital services reasonably available in a 

geographic area to Medicare beneficiaries. If a hospital meets the 

criteria for such an exception under Sec. 412.92(a), its prospective 

payment rates for inpatient operating costs are determined under Sec. 

412.92(d).

    (b) Referral center. CMS may adjust the prospective payment rates 

for inpatient operating costs determined under subpart D or E of this 

part if a hospital acts as a referral center for patients transferred 

from other hospitals. Criteria for identifying such referral centers are 

set forth in Sec. 412.96.

    (c) [Reserved]

    (d) Kidney acquisition costs incurred by hospitals approved as renal 

transplantation centers. CMS pays for kidney acquisition costs incurred 

by renal transplanation centers on a reasonable cost basis. The criteria 

for this special payment provision are set forth in Sec. 412.100.

    (e) Hospitals located in areas that are reclassified from urban to 

rural. (1) CMS adjusts the rural Federal payment amounts for inpatient 

operating costs for hospitals located in geographic areas that are 

reclassified from urban to rural as defined in subpart D of this part. 

This adjustment is set forth in Sec. 412.102.

    (2) CMS establishes a procedure by which certain individual 

hospitals located in urban areas may apply for reclassification as 

rural. The criteria for reclassification are set forth in Sec. 412.103.

    (f) Hospitals that have a high percentage of ESRD beneficiary 

discharges. CMS makes an additional payment to a hospital if ten percent 

or more of its total Medicare discharges in a cost reporting period 

beginning on or after October 1, 1984 are ESRD beneficiary discharges. 

In determining ESRD discharges, discharges in DRG Nos. 302, 316, and 317 

are excluded. The criteria for this additional payment are set forth in 

Sec. 412.104.

    (g) Hosptials that incur indirect costs for graduate medical 

education programs. CMS makes an additional payment for inpatient 

operating costs to a hospital for indirect medical education costs 

attributable to an approved graduate medical education program. The 

criteria for this additional payment are set forth in Sec. 412.105.

    (h) Hospitals that serve a disproportionate share of low-income 

patients. For discharges occurring on or after May 1,



[[Page 505]]



1986, CMS makes an additional payment for inpatient operating costs to 

hospitals that serve a disproportionate share of low-income patients. 

The criteria for this additional payment are set forth in Sec. 412.106.

    (i) Hospitals that receive an additional update for FYs 1998 and 

1999. For FYs 1998 and 1999, CMS makes an upward adjustment to the 

standardized amounts for certain hospitals that do not receive indirect 

medical education or disproportionate share payments and are not 

Medicare- dependent, small rural hospitals. The criteria for identifying 

these hospitals are set forth in Sec. 412.107.

    (j) Medicare-dependent, small rural hospitals. For cost reporting 

periods beginning on or after April 1, 1990 and before October 1, 1994, 

or beginning on or after October 1, 1997 and before October 1, 2006, CMS 

adjusts the prospective payment rates for inpatient operating costs 

determined under subparts D and E of this part if a hospital is 

classified as a Medicare-dependent, small rural hospital.

    (k) Essential access community hospitals (EACHs). If a hospital was 

designated as an EACH by CMS as described in Sec. 412.109(a) and is 

located in a rural area as defined in Sec. 412.109(b), CMS determines 

the prospective payment rate for that hospital, as it does for sole 

community hospitals, under Sec. 412.92(d).



[57 FR 39823, Sept. 1, 1992, as amended at 58 FR 30669, May 26, 1993; 62 

FR 46028, Aug. 29, 1997; 64 FR 67051, Nov. 30, 1999; 65 FR 47047, Aug. 

1, 2000; 70 FR 47485, Aug. 12, 2005]