Home/CFR/Title 42/Part 413
FEDERAL · 42 CFR

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

123 sections · Title 42: Public Health

§ 413.1Introduction.
§ 413.5Cost reimbursement: General.
§ 413.9Cost related to patient care.
§ 413.13Amount of payment if customary charges for services furnished are less than reasonable costs.
§ 413.17Cost to related organizations.
§ 413.20Financial data and reports.
§ 413.24Adequate cost data and cost finding.
§ 413.30Limitations on payable costs.
§ 413.35Limitations on coverage of costs: Charges to beneficiaries if cost limits are applied to services.
§ 413.40Ceiling on the rate of increase in hospital inpatient costs.
§ 413.50Apportionment of allowable costs.
§ 413.53Determination of cost of services to beneficiaries.
§ 413.56§ 413.56 [Reserved]
§ 413.60Payments to providers: General.
§ 413.64Payments to providers: Specific rules.
§ 413.65Requirements for a determination that a facility or an organization has provider-based status.
§ 413.70Payment for services of a CAH.
§ 413.74Payment to a foreign hospital.
§ 413.75Direct GME payments: General requirements.
§ 413.76Direct GME payments: Calculation of payments for GME costs.
§ 413.77Direct GME payments: Determination of per resident amounts.
§ 413.78Direct GME payments: Determination of the total number of FTE residents.
§ 413.79Direct GME payments: Determination of the weighted number of FTE residents.
§ 413.80Direct GME payments: Determination of weighting factors for foreign medical graduates.
§ 413.81Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts.
§ 413.82Direct GME payments: Special rules for States that formerly had a waiver from Medicare reimbursement principles.
§ 413.83Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate.
§ 413.85Cost of approved nursing and allied health education activities.
§ 413.87Payments for Medicare + Choice nursing and allied health education programs.
§ 413.88Incentive payments under plans for voluntary reduction in number of medical residents.
§ 413.89Bad debts, charity, and courtesy allowances.
§ 413.90Research costs.
§ 413.92Costs of surety bonds.
§ 413.94Value of services of nonpaid workers.
§ 413.98Purchase discounts and allowances, and refunds of expenses.
§ 413.99Qualified and Non-Qualified Deferred Compensation Plans.
§ 413.100Special treatment of certain accrued costs.
§ 413.102Compensation of owners.
§ 413.106Reasonable cost of physical and other therapy services furnished under arrangements.
§ 413.114Payment for posthospital SNF care furnished by a swing-bed hospital.
§ 413.118Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis.
§ 413.122Payment for hospital outpatient radiology services and other diagnostic procedures.
§ 413.123Payment for screening mammography performed by hospitals on an outpatient basis.
§ 413.124Reduction to hospital outpatient operating costs.
§ 413.125Payment for home health agency services.
§ 413.130Introduction to capital-related costs.
§ 413.134Depreciation: Allowance for depreciation based on asset costs.
§ 413.139Depreciation: Optional allowance for depreciation based on a percentage of operating costs.
§ 413.144Depreciation: Allowance for depreciation on fully depreciated or partially depreciated assets.
§ 413.149Depreciation: Allowance for depreciation on assets financed with Federal or public funds.
§ 413.153Interest expense.
§ 413.157Return on equity capital of proprietary providers.
§ 413.170Scope.
§ 413.171Definitions.
§ 413.172Principles of prospective payment.
§ 413.174Prospective rates for hospital-based and independent ESRD facilities.
§ 413.176Amount of payments.
§ 413.177Quality incentive program payment.
§ 413.178ESRD quality incentive program.
§ 413.180Procedures for requesting exceptions to payment rates.
§ 413.182Criteria for approval of exception requests.
§ 413.184Payment exception: Pediatric patient mix.
§ 413.186Payment exception: Self-dialysis training costs in pediatric facilities.
§ 413.194Appeals.
§ 413.195Limitation on Review.
§ 413.196Notification of changes in rate-setting methodologies and payment rates.
§ 413.198Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.
§ 413.200§ 413.200 [Reserved]
§ 413.202Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
§ 413.203Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
§ 413.210Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.
§ 413.215Basis of payment.
§ 413.217Items and services included in the ESRD prospective payment system.
§ 413.220Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011.
§ 413.230Determining the per treatment payment amount.
§ 413.231Adjustment for wages.
§ 413.232Low-volume adjustment.
§ 413.233Additional facility-level adjustments.
§ 413.234Drug designation process.
§ 413.235Patient-level adjustments.
§ 413.236Transitional add-on payment adjustment for new and innovative equipment and supplies.
§ 413.237Outliers.
§ 413.239Transition period.
§ 413.241Pharmacy arrangements.
§ 413.300Basis and scope.
§ 413.302Definitions.
§ 413.304Eligibility for prospectively determined payment rates.
§ 413.308Rules governing election of prospectively determined payment rates.
§ 413.310Basis of payment.
§ 413.312Methodology for calculating rates.
§ 413.314Determining payment amounts: Routine per diem rate.
§ 413.316Determining payment amounts: Ancillary services.
§ 413.320Publication of prospectively determined payment rates or amounts.
§ 413.321Simplified cost report for SNFs.
§ 413.330Basis and scope.
§ 413.333Definitions.
§ 413.335Basis of payment.
§ 413.337Methodology for calculating the prospective payment rates.
§ 413.338Skilled nursing facility value-based purchasing program.
§ 413.340Transition period.
§ 413.343Resident assessment data.
§ 413.345Publication of Federal prospective payment rates.
§ 413.348Limitation on review.
§ 413.350Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A services.
§ 413.355Additional payment: QIO reimbursement for cost of sending records electronically or by photocopy and mailing.
§ 413.360Requirements under the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).
§ 413.370Scope.
§ 413.371Definition.
§ 413.372AKI dialysis payment rate.
§ 413.373Other adjustments to the AKI dialysis payment rate.
§ 413.374Renal dialysis services included in the AKI dialysis payment rate.
§ 413.375Notification of changes in rate-setting methodologies and payment rates.
§ 413.400Definitions.
§ 413.402Organ acquisition costs.
§ 413.404Standard acquisition charge.
§ 413.406Acquisition of pancreata for islet cell transplant.
§ 413.408§ 413.408 [Reserved]
§ 413.410§ 413.410 [Reserved]
§ 413.412Intent to transplant, intent for research, counting en bloc, and unusable organs.
§ 413.414Medicare secondary payer and organ acquisition costs.
§ 413.416Organ acquisition charges for kidney-paired exchanges.
§ 413.418Amounts billed to organ procurement organizations for hospital services provided to deceased donors and included as organ acquisition costs.
§ 413.420Payment to independent organ procurement organizations and histocompatibility laboratories for kidney acquisition costs.