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 I—Prospectively Determined Payment Rates for Low…

42 C.F.R. § 413.300

Basis and scope

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(a) Basis. This subpart implements section 1888(d) of the Act, which provides for optional prospectively determined payment rates for qualified SNFs.

(b) Scope. This subpart sets forth the eligibility criteria an SNF must meet to qualify, the process governing election of prospectively determined payment rates, and the basis and methodology for determining prospectively determined payment rates.

Notes of Decisions
Cited in 1 case, 2012–2012 · leading case: Select Specialty Hosp. - Denver, Inc. v. Sebelius, 848 F. Supp. 2d 13 (D.D.C. 2012).
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Select Specialty Hosp. - Denver, Inc. v. Sebelius, 848 F. Supp. 2d 13 (D.D.C. 2012). “§ 1395yy(e); 42 C.F.R. § 413.300 et seq. However, certain other Medicare payments continued to be retrospectively determined and reimbursed on a reasonable cost basis, including the unpaid deductible and coinsurance obligations of Medicare beneficiaries — or “bad debts” — at…”
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