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. § 412.71

Determination of base-year inpatient operating costs

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(a) Base-year costs. (1) For each hospital, the intermediary will estimate the hospital's Medicare Part A allowable inpatient operating costs, as described in § 412.2(c), for the 12-month or longer cost reporting period ending on or after September 30, 1982 and before September 30, 1983.

(2) If the hospital's last cost reporting period ending before September 30, 1983 is for less than 12 months, the base period will be the hospital's most recent 12-month or longer cost reporting period ending before such short reporting period, with an appropriate adjustment for inflation. (The rules applicable to new hospitals are set forth in § 412.74.)

(b) Modifications to base-year costs. Prior to determining the hospital-specific rate, the intermediary will adjust the hospital's estimated base-year inpatient operating costs, as necessary, to include malpractice insurance costs in accordance with § 413.53(a)(1)(i) of this chapter, and exclude the following:

(1) Medical education costs as described in § 413.85 of this chapter.

(2) Capital-related costs as described in § 413.130 of this chapter.

(3) Kidney acquisition costs incurred by hospitals with approved kidney transplant programs as described in § 412.100. Kidney acquisition costs in the base year are determined by multiplying the hospital's average kidney acquisition cost per kidney times the number of kidney transplants covered by Medicare Part A during the base period.

(4) Higher costs that were incurred for purposes of increasing base-year costs.

(5) One-time nonrecurring higher costs or revenue offsets that have the effect of distorting base-year costs as an appropriate basis for computing the hospital-specific rate.

(6) Higher costs that result from changes in hospital accounting principles initiated in the base year.

(7) The costs of qualified nonphysician anesthetists' services, as described in § 412.113(c).

(c) Hospital's request for adjustment of base-year inpatient operating costs. (1) Before the date it becomes subject to the prospective payment system for inpatient operating costs, a hospital may request the intermediary to further adjust its estimated base-period costs to take into account the following:

(i) Services paid for under Medicare Part B during the hospital's base year that will be paid for under prospective payments. The base-year costs may be increased to include estimated payments for certain services previously billed as physicians' services before the effective date of § 415.102(a) of this chapter, and estimated payments for nonphysicians' services that were not furnished either directly or under arrangements before October 1, 1983 (the effective date of § 405.310(m) of this chapter), but may not include the costs of anesthetists' services for which a physician employer continues to bill under § 405.553(b)(4) of this chapter.

(ii) The payment of FICA taxes during cost reporting periods subject to the prospective payment system, if the hospital had not paid such taxes for all its employees during its base period and will be required to participate effective January 1, 1984.

(2) If a hospital requests that its base-period costs be adjusted under paragraph (c)(1) of this section, it must timely provide the intermediary with sufficient documentation to justify the adjustment, and adequate data to compute the adjusted costs. The intermediary decides whether to use part or all of the data on the basis of audit, survey and other information available.

(d) Intermediary's determination. The intermediary uses the best data available at the time in estimating each hospital's base-year costs and the modifications to those costs authorized by paragraphs (b) and (c) of this section. The intermediary's estimate of base-year costs and modifications thereto is final and may not be changed after the first day of the first cost reporting period beginning on or after October 1, 1983, except as provided in § 412.72.

[50 FR 12741, Mar. 29, 1985, as amended at 51 FR 34793, Sept. 30, 1986; 52 FR 33057, Sept. 1, 1987; 57 FR 33897, July 31, 1992; 57 FR 39822, Sept. 1, 1992; 59 FR 45398, Sept. 1, 1994; 60 FR 63188, Dec. 8, 1995; 86 FR 73510, Dec. 27, 2021]
Notes of Decisions
Cited in 17 cases, 1985–2004 · leading case: Huntington Hosp. v. Shalala, 130 F. Supp. 2d 376 (E.D.N.Y 2001).
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Huntington Hosp. v. Shalala, 130 F. Supp. 2d 376 (E.D.N.Y 2001). · cites it 18× “As per 42 C.F.R. § 412.71 (a), Empire used the plaintiffs’ respective cost reporting periods that ended after September 30, 1982, and before September 30, 1983, to calculate the HSP portion of the plaintiffs’ blended rate.”
Mercy Catholic Med. Ctr. v. Tommy G. Thompson, Sec'y of Health & Human Servs., 380 F.3d 142 (3rd Cir. 2004). “See 42 C.F.R. §§ 412.71 , 412.73. For most hospitals the prospective payment system base year was FY 1983.”
Greenville Hosp. Sys. v. Heckler, 642 F. Supp. 15 (D.S.C. 1985). · cites it 3× “42 CFR § 412.71 . Statement of Facts Greenville Hospital System operates several hospitals, including Greenville Hospital Center (“GHC”) and Greenville General Hospital (“GGH”).”
Good Samaritan Hosp. Reg'l Med. Ctr. v. Shalala, 894 F. Supp. 683 (S.D.N.Y. 1995). · cites it 3× “at § 1395ww(b)(3)(A)(i); 42 C.F.R. § 412.71 (a)(1) (1994). Over the Transition Period, commencing on January 1, 1984 and ending on February 21, 1988, the reimbursement amount was based increasingly on PPS, until, finally, the HSP component was completely phased out.”
Sunshine Health Sys., Inc. v. Bowen, 809 F.2d 1390 (9th Cir. 1987). · cites it 7× “The district court held that 42 C.F.R. § 412.71 (a)(2) (1985) is inconsistent with 42 U.”
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). “The Secretary agrees that the determination of the hospital’s target amount is final to the extent it "may not be changed after the first day of the first cost reporting period * * 42 C.F.R. § 412.71 (d). But we still must ask whether this is the "final determination” that…”
Washington Hosp. Ctr. v. Bowen, 795 F.2d 139 (D.C. Cir. 1986). · cites it 2× “11, they do not represent a "reversal" in the Secretary’s interpretation of § 1395oo (a). . Subsection (d) of § 1395ww sets out methods for calculating PPS payments and refers to subsection (b) for an explanation of how to calculate a hospital’s target amount.”
Georgetown Univ. Hosp. v. Bowen, 698 F. Supp. 290 (D.D.C. 1988). “42 C.F.R. § 412.71 (d). These regulations also provide that the intermediary’s determinations are “final and may not be changed after the first day” of the hospital’s first PPS year except in the limited circumstances set forth in 42 C.”
Sunshine Health Sys., Inc. v. Bowen, 809 F.2d 1390 (9th Cir. 1987). “" III Validity of 42 C.F.R. 412.71(a)(2) 42 42 C.F.R. Sec. 412.”
Doctors Gen. Hosp., Inc. v. Heckler, 613 F. Supp. 1036 (S.D. Fla. 1985). “12,753 (1985)(to be codified at 42 CFR § 412.71 (d)). With the exception of PRRB review, jurisdiction under § 1395oo, then, the intermediary’s target amount determination has been interpreted by the Secretary as “final” for most administrative purposes.”
Sacred Heart Med. Ctr. v. Sullivan, 958 F.2d 537 (3rd Cir. 1992). “” 16 Accordingly, the HCFA has promulgated regulations in the exercise of the power delegated to it by the Secretary; these regulations are codified at 42 C.F.R. §§ 412.71 and 412.72. Section 412.”
Huntington Hosp. v. Thompson, 319 F.3d 74 (2d Cir. 2003). · cites it 3× “” 42 C.F.R. § 412.71 (a)(2001) (originally numbered 42 C.”
Show all 17 citing cases →
— 42 C.F.R. § 412.71(a) — 4 cases
Huntington Hosp. v. Thompson, 319 F.3d 74 (2d Cir. 2003). “” 42 C.F.R. § 412.71 (a)(2001) (originally numbered 42 C.”
Huntington Hosp. v. Thompson, 306 F.3d 1240 (2d Cir. 2002).
Huntington Hosp. v. Tommy Thompson, 319 F.3d 74 (2d Cir. 2003).
Huntington Hosp. v. Tommy Thompson, 306 F.3d 1240 (2d Cir. 2002).
— 42 C.F.R. § 412.71(a)(2) — 2 cases
Sunshine Health Sys., Inc. v. Bowen, 809 F.2d 1390 (9th Cir. 1987). “" III Validity of 42 C.F.R. 412.71(a)(2) 42 42 C.F.R. Sec. 412.”
Sunshine Health Sys., Inc. v. Bowen, 809 F.2d 1390 (9th Cir. 1987). “The district court held that 42 C.F.R. § 412.71 (a)(2) (1985) is inconsistent with 42 U.”
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