Part 413 — Principles of Reasonable Cost Reimbursement; Payment for End-Stage Renal Disease Services; Prospectively Determined Payment Rates for Skilled Nursing Facilities; Payment for Acute Kidney Injury Dialysis
Subpart A — Introduction and General Rules
Subpart B — Accounting Records and Reports
Subpart C — Limits on Cost Reimbursement
Subpart D — Apportionment
Subpart E — Payments to Providers
Subpart F — Specific Categories of Costs
- § 413.75— Direct GME payments: General requirements.
- § 413.76— Direct GME payments: Calculation of payments for GME costs.
- § 413.77— Direct GME payments: Determination of per resident amounts.
- § 413.78— Direct GME payments: Determination of the total number of FTE residents.
- § 413.79— Direct GME payments: Determination of the weighted number of FTE residents.
- § 413.80— Direct GME payments: Determination of weighting factors for foreign medical graduates.
- § 413.81— Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts.
- § 413.82— Direct GME payments: Special rules for States that formerly had a waiver from Medicare reimbursement principles.
- § 413.83— Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate.
- § 413.85— Cost of approved nursing and allied health education activities.
- § 413.87— Payments for Medicare + Choice nursing and allied health education programs.
- § 413.88— Incentive payments under plans for voluntary reduction in number of medical residents.
- § 413.89— Bad debts, charity, and courtesy allowances.
- § 413.90— Research costs.
- § 413.92— Costs of surety bonds.
- § 413.94— Value of services of nonpaid workers.
- § 413.98— Purchase discounts and allowances, and refunds of expenses.
- § 413.99— Qualified and Non-Qualified Deferred Compensation Plans.
- § 413.100— Special treatment of certain accrued costs.
- § 413.102— Compensation of owners.
- § 413.106— Reasonable cost of physical and other therapy services furnished under arrangements.
- § 413.114— Payment for posthospital SNF care furnished by a swing-bed hospital.
- § 413.118— Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis.
- § 413.122— Payment for hospital outpatient radiology services and other diagnostic procedures.
- § 413.123— Payment for screening mammography performed by hospitals on an outpatient basis.
- § 413.124— Reduction to hospital outpatient operating costs.
- § 413.125— Payment for home health agency services.
Subpart G — Capital-Related Costs
- § 413.130— Introduction to capital-related costs.
- § 413.134— Depreciation: Allowance for depreciation based on asset costs.
- § 413.139— Depreciation: Optional allowance for depreciation based on a percentage of operating costs.
- § 413.144— Depreciation: Allowance for depreciation on fully depreciated or partially depreciated assets.
- § 413.149— Depreciation: Allowance for depreciation on assets financed with Federal or public funds.
- § 413.153— Interest expense.
- § 413.157— Return on equity capital of proprietary providers.
Subpart H — Payment for End-Stage Renal Disease (ESRD) Services
- § 413.170— Scope.
- § 413.171— Definitions.
- § 413.172— Principles of prospective payment.
- § 413.174— Prospective rates for hospital-based and independent ESRD facilities.
- § 413.176— Amount of payments.
- § 413.177— Quality incentive program payment.
- § 413.178— ESRD quality incentive program.
- § 413.180— Procedures for requesting exceptions to payment rates.
- § 413.182— Criteria for approval of exception requests.
- § 413.184— Payment exception: Pediatric patient mix.
- § 413.186— Payment exception: Self-dialysis training costs in pediatric facilities.
- § 413.194— Appeals.
- § 413.195— Limitation on Review.
- § 413.196— Notification of changes in rate-setting methodologies and payment rates.
- § 413.198— Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.
- § 413.202— Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
- § 413.203— Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
- § 413.210— Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.
- § 413.215— Basis of payment.
- § 413.217— Items and services included in the ESRD prospective payment system.
- § 413.220— Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011.
- § 413.230— Determining the per treatment payment amount.
- § 413.231— Adjustment for wages.
- § 413.232— Low-volume adjustment.
- § 413.233— Additional facility-level adjustments.
- § 413.234— Drug designation process.
- § 413.235— Patient-level adjustments.
- § 413.236— Transitional add-on payment adjustment for new and innovative equipment and supplies.
- § 413.237— Outliers.
- § 413.239— Transition period.
- § 413.241— Pharmacy arrangements.
Subpart I — Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998
- § 413.300— Basis and scope.
- § 413.302— Definitions.
- § 413.304— Eligibility for prospectively determined payment rates.
- § 413.308— Rules governing election of prospectively determined payment rates.
- § 413.310— Basis of payment.
- § 413.312— Methodology for calculating rates.
- § 413.314— Determining payment amounts: Routine per diem rate.
- § 413.316— Determining payment amounts: Ancillary services.
- § 413.320— Publication of prospectively determined payment rates or amounts.
- § 413.321— Simplified cost report for SNFs.
Subpart J — Prospective Payment for Skilled Nursing Facilities
- § 413.330— Basis and scope.
- § 413.333— Definitions.
- § 413.335— Basis of payment.
- § 413.337— Methodology for calculating the prospective payment rates.
- § 413.338— Skilled nursing facility value-based purchasing program.
- § 413.340— Transition period.
- § 413.343— Resident assessment data.
- § 413.345— Publication of Federal prospective payment rates.
- § 413.348— Limitation on review.
- § 413.350— Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A services.
- § 413.355— Additional payment: QIO reimbursement for cost of sending records electronically or by photocopy and mailing.
- § 413.360— Requirements under the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).
Subpart K — Payment for Acute Kidney Injury (AKI) Dialysis
Subpart L — Payment of Organ Acquisition Costs for Transplant Hospitals. Organ Procurement Organizations, and Histocompatibility Laboratories
- § 413.400— Definitions.
- § 413.402— Organ acquisition costs.
- § 413.404— Standard acquisition charge.
- § 413.406— Acquisition of pancreata for islet cell transplant.
- § 413.412— Intent to transplant, intent for research, counting en bloc, and unusable organs.
- § 413.414— Medicare secondary payer and organ acquisition costs.
- § 413.416— Organ acquisition charges for kidney-paired exchanges.
- § 413.418— Amounts billed to organ procurement organizations for hospital services provided to deceased donors and included as organ acquisition costs.
- § 413.420— Payment to independent organ procurement organizations and histocompatibility laboratories for kidney acquisition costs.