42 CFR 413 - PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES
- SUBPART A — Introduction and General Rules (§§ 413.1 - 413.17)
- SUBPART B — Accounting Records and Reports (§§ 413.20 - 413.24)
- SUBPART C — Limits on Cost Reimbursement (§§ 413.30 - 413.40)
- SUBPART D — Apportionment (§§ 413.50 - 413.56)
- SUBPART E — Payments to Providers (§§ 413.60 - 413.74)
- SUBPART F — Specific Categories of Costs (§§ 413.75 - 413.125)
- SUBPART G — Capital-Related Costs (§§ 413.130 - 413.157)
- SUBPART H — Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs (§§ 413.170 - 413.241)
- SUBPART I — Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998 (§§ 413.300 - 413.321)
- SUBPART J — Prospective Payment for Skilled Nursing Facilities (§§ 413.330 - 413.355)
Title 42 published on 2011-10-01
The following are only the Rules published in the Federal Register after the published date of Title 42.
For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-26505 RIN 0938-AR12 CMS-1588-CN3 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule; correction. Effective Date: October 26, 2012. 42 CFR Parts 412, 413, 424, and 476 This document corrects technical errors that appeared in the final rule that appeared in the August 31, 2012 Federal Register entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers.”
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-25975 RIN -0938-AQ84 CMS-0044-CN2 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule; correction. Effective Date: This document is effective on November 12, 2012, except that the correction to instruction 8.NN (77 FR 54149) is effective October 23, 2012. 42 CFR Parts 412, 413, and 495 This document corrects technical errors and typographical errors in the final rule entitled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2” which appeared in the September 4, 2012 issue of the Federal Register .
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-24307 RIN 0938-AR12 CMS-1588-CN2 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule; correction. Effective Date: October 1, 2012. 42 CFR Parts 412, 413, 424, and 476 This document corrects technical errors in the final rule that appeared in the August 31, 2012 Federal Register entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers.”
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-21050 RIN 0938-AQ84 CMS-0044-F DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule. Effective dates: This final rule is effective on November 5, 2012, with the exception of the definition of “meaningful EHR user” in § 495.4 and the provisions in § 495.6(f), § 495.6(g), § 495.8, § 495.102(c), and part 495 subpart D, which are effective September 4, 2012. Applicability dates: Sections 495.302, 495.304, and 495.306 are applicable beginning payment year 2013. 42 CFR Parts 412, 413, and 495 This final rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. In addition, it specifies payment adjustments under Medicare for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology (CEHRT) and other program participation requirements. This final rule revises certain Stage 1 criteria, as finalized in the July 28, 2010 final rule, as well as criteria that apply regardless of Stage.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-19079 RIN 0938-AR12 CMS-1588-F DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule. Effective date: This final rule is effective on October 1, 2012. 42 CFR Parts 412, 413, 424, and 476 We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-2220 RIN 0938-AQ24 CMS-1518-CN4 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Correction of final rule. Effective Date: This document is effective January 31, 2012. Applicability Date: The corrections noted in this document and posted on the CMS Web site are applicable to hospital payments and discharges on or after October 1, 2011. 42 CFR Parts 412, 413, and 476 This document corrects technical errors that occurred in the Addendum of the final rule entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates” which appeared in the August 18, 2011 Federal Register .
This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.
This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].
It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly. More limitations on accuracy are described at the GPO site.
§ 1395 - Prohibition against any Federal interference
§ 1395d - Scope of benefits
§ 1395f - Conditions of and limitations on payment for services
§ 1395g - Payments to providers of services
42 USC § -
§ 1395x - Definitions
§ 1395rr - End stage renal disease program
§ 1395tt - Hospital providers of extended care services
§ 1395ww - Payments to hospitals for inpatient hospital services
113 Stat. 1501A-332
Title 42 published on 2011-10-01
The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR 413 after this date.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-26903 RIN 0938-AR13 CMS-1352-F DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule. Effective Date: These regulations are effective on January 1, 2013. Applicability Date: The regulations setting forth the reductions in Medicare bad debt pursuant to section 3201 of the Middle Class Tax Extension and Job Creation Act of 2012 (Pub. L. 112-96) are applicable for cost reporting periods beginning October 1, 2012. 42 CFR Parts 413 and 417 This final rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2013. This rule also sets forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2015 and beyond. In addition, this rule implements changes to bad debt reimbursement for all Medicare providers, suppliers, and other entities eligible to receive Medicare payment for bad debt and removes the cap on bad debt reimbursement to ESRD facilities. (See the Table of Contents for a listing of the specific issues addressed in this final rule.)
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-26505 RIN 0938-AR12 CMS-1588-CN3 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule; correction. Effective Date: October 26, 2012. 42 CFR Parts 412, 413, 424, and 476 This document corrects technical errors that appeared in the final rule that appeared in the August 31, 2012 Federal Register entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers.”
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-25975 RIN -0938-AQ84 CMS-0044-CN2 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule; correction. Effective Date: This document is effective on November 12, 2012, except that the correction to instruction 8.NN (77 FR 54149) is effective October 23, 2012. 42 CFR Parts 412, 413, and 495 This document corrects technical errors and typographical errors in the final rule entitled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2” which appeared in the September 4, 2012 issue of the Federal Register .
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-24307 RIN 0938-AR12 CMS-1588-CN2 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule; correction. Effective Date: October 1, 2012. 42 CFR Parts 412, 413, 424, and 476 This document corrects technical errors in the final rule that appeared in the August 31, 2012 Federal Register entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers.”
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-21050 RIN 0938-AQ84 CMS-0044-F DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule. Effective dates: This final rule is effective on November 5, 2012, with the exception of the definition of “meaningful EHR user” in § 495.4 and the provisions in § 495.6(f), § 495.6(g), § 495.8, § 495.102(c), and part 495 subpart D, which are effective September 4, 2012. Applicability dates: Sections 495.302, 495.304, and 495.306 are applicable beginning payment year 2013. 42 CFR Parts 412, 413, and 495 This final rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. In addition, it specifies payment adjustments under Medicare for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology (CEHRT) and other program participation requirements. This final rule revises certain Stage 1 criteria, as finalized in the July 28, 2010 final rule, as well as criteria that apply regardless of Stage.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-19079 RIN 0938-AR12 CMS-1588-F DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Final rule. Effective date: This final rule is effective on October 1, 2012. 42 CFR Parts 412, 413, 424, and 476 We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-16566 RIN 0938-AR13 CMS-1352-P DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Proposed rule. To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. E.S.T. on August 31, 2012. 42 CFR Parts 413 and 417 This rule proposes to update and make revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2013. This rule also proposes to set forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2015 and beyond. This proposed rule will implement changes to bad debt reimbursement for all Medicare providers, suppliers, and other entities eligible to receive bad debt. (See the Table of Contents for a listing of the specific issues addressed in this proposed rule.)
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-14159 RIN 0938-AR12 CMS-1588-CN DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Proposed rule, correction. 42 CFR Parts 412, 413, 424, 476, and 489 This document corrects technical and typographical errors in the proposed rule that appeared in the May 11, 2012 Federal Register entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers.”
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-9985 RIN 0938-AR12 CMS-1588-P DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Proposed rule. Comment Period: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. EDT on June 25, 2012. 42 CFR Parts 412, 413, 424, 476, and 489 We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes would be applicable to discharges occurring on or after October 1, 2012. We also are proposing to update the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits would be effective for cost reporting periods beginning on or after October 1, 2012. We are proposing to update the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. These proposed changes would be applicable to discharges occurring on or after October 1, 2012. In addition, we are proposing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are proposing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are proposing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are proposing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-9331 RIN 0938-AQ84 CMS-0044-CN DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Proposed rule; correction. 42 CFR Parts 412, 413, and 495 This document corrects technical errors and typographical errors in the proposed rule entitled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2” which appeared in the March 7, 2012, Federal Register .
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-4443 RIN 0938-AQ84 CMS-0044-P DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Proposed rule. To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on May 7, 2012. 42 CFR Parts 412, 413, and 495 This proposed rule would specify the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. In addition, it would specify payment adjustments under Medicare for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology and other program participation requirements. This proposed rule would also revise certain Stage 1 criteria, as well as criteria that apply regardless of Stage, as finalized in the final rule titled Medicare and Medicaid Programs; Electronic Health Record Incentive Program published on July 28, 2010 in the Federal Register . The provisions included in the Medicaid section of this proposed rule (which relate to calculations of patient volume and hospital eligibility) would take effect shortly after finalization of this rule, not subject to the proposed 1 year delay for Stage 2 of meaningful use of certified EHR technology. Changes to Stage 1 of meaningful use would take effect for 2013, but most would be optional until 2014.
GPO FDSys XML | Text type regulations.gov FR Doc. 2012-2220 RIN 0938-AQ24 CMS-1518-CN4 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services Correction of final rule. Effective Date: This document is effective January 31, 2012. Applicability Date: The corrections noted in this document and posted on the CMS Web site are applicable to hospital payments and discharges on or after October 1, 2011. 42 CFR Parts 412, 413, and 476 This document corrects technical errors that occurred in the Addendum of the final rule entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates” which appeared in the August 18, 2011 Federal Register .