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Code of Federal Regulations (Last Updated: October 10, 2024) |
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Title 42 - Public Health |
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Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter B—Medicare Program |
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 |
| § 413.1 - Introduction. |
| § 413.5 - Cost reimbursement: General. |
| § 413.9 - Cost related to patient care. |
| § 413.13 - Amount of payment if customary charges for services furnished are less than reasonable costs. |
| § 413.17 - Cost to related organizations. |
| Subpart B - Accounting Records and Reports |
| § 413.20 - Financial data and reports. |
| § 413.24 - Adequate cost data and cost finding. |
| Subpart C - Limits on Cost Reimbursement |
| § 413.30 - Limitations on payable costs. |
| § 413.35 - Limitations on coverage of costs: Charges to beneficiaries if cost limits are applied to services. |
| § 413.40 - Ceiling on the rate of increase in hospital inpatient costs. |
| Subpart D - Apportionment |
| § 413.50 - Apportionment of allowable costs. |
| § 413.53 - Determination of cost of services to beneficiaries. |
| § 413.56 - [Reserved] |
| Subpart E - Payments to Providers |
| § 413.60 - Payments to providers: General. |
| § 413.64 - Payments to providers: Specific rules. |
| § 413.65 - Requirements for a determination that a facility or an organization has provider-based status. |
| § 413.70 - Payment for services of a CAH. |
| § 413.74 - Payment to a foreign hospital. |
| 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. |
| § 413.86 - Direct graduate medical education payments. |
| § 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. |
| § 413.188 - Payment exception: Extraordinary circumstances. |
| § 413.190 - Payment exception: Self-dialysis training costs. |
| § 413.192 - Payment exception: Frequency of dialysis. |
| § 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. |
| § 413.200 - [Reserved] |
| § 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 - Rural facility adjustment. |
| § 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 |
| § 413.370 - Scope. |
| § 413.371 - Definition. |
| § 413.372 - AKI dialysis payment rate. |
| § 413.373 - Other adjustments to the AKI dialysis payment rate |
| § 413.374 - Renal dialysis services included in the AKI dialysis payment rate |
| § 413.375 - Notification of changes in rate-setting methodologies and payment rates. |
| 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. |
| § 413.408 - [Reserved] |
| § 413.410 - [Reserved] |
| § 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. |