C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 412—PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES › Subpart E—Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating Costs

42 C.F.R. § 412.70

General description

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For discharges occurring on or after April 1, 1988, and before October 1, 1996, payments to a hospital are based on the greater of the national average standardized amount or the sum of 85 percent of the national average standardized amount and 15 percent of the average standardized amount for the region in which the hospital is located.

[57 FR 39822, Sept. 1, 1992, as amended at 58 FR 46338, Sept. 1, 1993]
Notes of Decisions
Cited in 5 cases, 1986–1994 · leading case: Springdale Mem'l Hosp. Ass'n, Inc. v. Otis R. Bowen, M.D., Sec'y of Health & Human Servs., 818 F.2d 1377 (8th Cir. 1987).
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Springdale Mem'l Hosp. Ass'n, Inc. v. Otis R. Bowen, M.D., Sec'y of Health & Human Servs., 818 F.2d 1377 (8th Cir. 1987). “A “hospital’s target amount” — termed the “hospital-specific rate” in the Secretary’s regulations, 42 C.F.R. §§ 412.70 (a), 412.73 (1986) — is based primarily on the hospital’s own average cost of treating a Medicare patient during the hospital’s base year, its cost year ending…”
Washington Hosp. Ctr. v. Bowen, 795 F.2d 139 (D.C. Cir. 1986). · cites it 2× “” 42 C.F.R. §§ 412.70 -.74. Over the course of the transition period, the proportion of the per-discharge payment which is based on the hospital’s costs decreases from 75% to 25% while the proportion based on DRG amounts increases accordingly.”
Hosp. San Rafael, Inc. v. Sullivan, 784 F. Supp. 927 (D.P.R. 1991). “See 42 C.F.R. §§ 412.70 (a)(3) and 412.80-412.”
Good Samaritan Hosp. v. Shalala, 873 F. Supp. 1083 (S.D. Ohio 1994). “474 [subpart E, redesignated 42 C.F.R. 412.70, et. seq.] (1984). The rule was later qualified to read, “Except as provided in 413.”
Episcopal Hosp. v. Bowen, 657 F. Supp. 12 (E.D. Pa. 1986). “§ 1395ww(d)(l)(A)(i)-(ii); 42 C.F.R. § 412.70 (1985). The “target amount” is the amount of a particular hospital’s allowable inpatient operating costs per discharged patient for an historic cost reporting year (known as the “base year”), updated by an inflation factor.”
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