C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › 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 H—Payment for End-Stage Renal Disease (ESRD) Ser…

42 C.F.R. § 413.182

Criteria for approval of exception requests

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(a) CMS may approve exceptions to a pediatric ESRD facility's prospective payment rate if the pediatric ESRD facility did not have an approved exception rate as of October 1, 2002.

(b) The pediatric ESRD facility must demonstrate, by convincing objective evidence, that its total per treatment costs are reasonable and allowable under the relevant cost reimbursement principles of part 413 and that its per treatment costs in excess of its payment rate are directly attributable to any of the following criteria:

(1) Pediatric patient mix, as specified in § 413.184.

(2) Self-dialysis training costs in pediatric facilities, as specified in § 413.186.

[70 FR 70331, Nov. 21, 2005]
Notes of Decisions
Cited in 5 cases, 2005–2009 · leading case: Loma Linda Univ. Med. Ctr. v. Leavitt (D.D.C. 2009).
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Loma Linda Univ. Med. Ctr. v. Leavitt (D.D.C. 2009). · cites it 2× “; see also 42 C.F.R. §§ 413.182 , 413.180 (2000). Providers seeking such a “payment rate exception” must submit to CMS materials specified in the implementing regulations, and at the request of CMS, which are necessary for CMS to “adjudicate each type of exception.”
Aroostook Med. Ctr. v. Leavitt, 365 F. Supp. 2d 51 (D. Me. 2005). “42 C.F.R. 413.182. To qualify for an exception as an isolated essential facility, AMC must meet three criteria: (1) The facility must be the only supplier of dialysis in its geographical area; (2) The facility’s patients must be unable to obtain dialysis services elsewhere…”
St. Joseph Hosp. v. Leavitt, 334 F. App'x 57 (9th Cir. 2008). “To qualify for an exception to its prospective payment rate based on “[ajtypical service intensity,” see 42 C.F.R. §§ 413.182 (a), 413.184(a) (2001), St.”
St. Joseph Hosp. v. Leavitt, 334 F. App'x 57 (9th Cir. 2008). “To qualify for an exception to its prospective payment rate based on “[ajtypical service intensity,” see 42 C.F.R. §§ 413.182 (a), 413.184(a) (2001), St.”
St. Joseph Hosp. v. Leavitt, 280 F. App'x 587 (9th Cir. 2008). “To qualify for an exception to its prospective payment rate on the ground that it provided atypically intense services, see 42 C.F.R. §§ 413.182 (a), 413.184(a) (2001), St.”
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