The 2023 Florida Statutes (including Special Session C)
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. . . . § 413.30(e). . . . . § 413.30(e)(1). . . . “violate[d] the applicable cost limit statu[t]e, 42 U.S.C. § 1395yy(c), and regulation, 42 C.F.R. § 413.30 . . . the patients treated and are necessary in the efficient delivery of needed health care.” 42 C.F.R. § 413.30 . . . (f)(1) (1996) (currently promulgated with non-material alterations at 42 C.F.R. § 413.30(e)(1)); see . . .
. . . . § 413.30(e). . . . . § 413.30(e)(1). . . . “violate[d] the applicable cost limit statu[t]e, 42 U.S.C. § 1395yy(c), and regulation, 42 C.F.R. § 413.30 . . . the patients treated and are necessary in the efficient delivery of needed health care.” 42 C.F.R. § 413.30 . . . (f)(1) (1996) (currently promulgated with non-material alterations at 42 C.F.R. § 413.30(e)(1)); see . . .
. . . Code § 413.30. . . .
. . . . § 413.30. . . . . § 413.30] may be granted to a new SNF,” 42 C.F.R. § 413.30(d), and a provider who receives such an . . . circumstances specified, separately identified by the SNF ..., and verified by the intermediary.” 42 C.F.R. § 413.30 . . . the patients treated and are necessary in the efficient delivery of needed health care.” 42 C.F.R. § 413.30 . . . conflicts with the applicable cost limit statute, 42 U.S.C. § 1395yy(c), and regulation, 42 C.F.R. § 413.30 . . .
. . . ADF’s petition reflects 413.30 hours worked, and Becket’s requests 894.750 hours worked. . . .
. . . . § 413.30(a)(1) (1978). . . . Id. § 413.30(a)(3). . . .
. . . . § 413.30(a)(1) (1978). . . . Id. § 413.30(a)(3). . . .
. . . . § 413.30. The caps are referred to as “routine cost limits” (RCLs). . . . under Medicare, under present and previous ownership, for less than three full years.” 42 C.F.R. § 413.30 . . . (e) (1997) (now codified at 42 C.F.R. § 413.30(d)). . . . certified under Medicare, under present and previous ownership, for less than three full years. 42 C.F.R. § 413.30 . . . Elizabeth’s, 396 F.3d at 1233 (citing 42 C.F.R. § 413.30(e) (1997)). . . .
. . . . § 413.30(d) (regulating skilled nursing facilities), are unavailing. See Pis.’ Mot. for Summ. . . .
. . . . § 413.30, includes provisions for exceptions. . . . Id.; 42 C.F.R. § 413.30(e). . . . Under § 413.30(c), a provider must make an RCL exception request “within 180 days of the date on the . . . Furthermore, the Secretary reasonably interpreted § 413.30(c) in light of her reopening regulations. . . . Accordingly, having found that the Secretary’s issue-specific interpretation of 42 C.F.R. § 413.30(c) . . .
. . . that “ERISA” does not contain the same definitions of “pension plan,” as do CAS 412.30(a)(13) and CAS 413.30 . . . CAS 412.30(a)(20), 48 C.F.R. § 9904.412-30(a) (20) (2010); CAS 413.30(a)(12), 48 C.F.R. § 9904.413-30 . . . costs fall within the express terms of the definition of pension costs under CAS 412.30(a)(20) and CAS 413.30 . . . CAS 412.30(a)(20), 48 C.F.R. § 9904.412-30(a)(20); CAS 413.30(a)(12), 48 C.F.R. § 9904.413~30(a)(12) . . . CAS 412.30(a)(20), 48 C.F.R. § 9904.412-30(a)(20); CAS 413.30(a)(12), 48 C.F.R. § 9904.413-30(a)(12) . . .
. . . CAS 413.30(a)(3), 4 C.F.R. § 413.30(a)(3) (1977), defines actuarial gains and losses as “[t]he effect . . .
. . . . § 413.30(b)(1). . . .
. . . . § 413.30. . . .
. . . CAS 413.30(a)(20), 48 C.F.R. § 9904.413.30-(a)(20) (1995). . . .
. . . . § 413.30(a)(ll) (1986). The term "closing” is not defined. . . .
. . . . § 413.30. . . .
. . . . § 413.30. . . .
. . . . § 413.30(e). B. Factual and Procedural Background St. . . . See 42 C.F.R. § 413.30(e). 1. . . . The issue of whether section 413.30(e) is ambiguous has yet to be addressed by the Eighth Circuit. . . . Thompson, 353 F.3d 661, 665 (9th Cir.2003) (holding that section 413.30(e) is inherently ambiguous); . . . Gertrude does not qualify as a new provider under section 413.30(e). 4. . . .
. . . . § 413.30(c). . . . The Defendant’s Interpretation of 42 C.F.R. § 413.30 is Entitled to Substantial Deference In support . . .
. . . . § 413.30(f)(1) (1986). . . . During the periods in question, the atypical cost exception was covered by 42 C.F.R. § 413.30(f). . . . . § 413.30(e). .The cost limits for SNFs are determined based on the mean per diem costs of “peer groups . . .
. . . See CAS 413.30(a)(1), 42 Fed.Reg. at 37,196 (defining “actuarial assumption” as a “prediction of future . . .
. . . . § 413.30(a)-(b) (1996).. . . . Id. § 413.30(d). . . . the fiscal intermediary for a new provider exemption, which tolls the 180 day period, see 42 C.F.R. § 413.30 . . . See id. § 413.30(d). The provider may then appeal the agency’s decision to the Board. . . . See 42 C.F.R. § 413.30(d). . . .
. . . . § 413.30(e). (See id. ¶ 30.) . . . Carney Hospital Transitional Care Unit is dissatisfied with this decision, as provided at 42 C.F.R. § 413.30 . . . The new provider exemption appears at 42 C.F.R. § 413.30(d) in the current regulations. . . . .
. . . CAS 413.30(a)(4) (emphasis added). . . . CAS 413.30(a)(2) (emphasis added). . . . CAS 413.30(a)(1) (emphasis added). . . . CAS 413.30(a)(l 1). . . . . CAS 413.30(a)(4) (emphasis added). . . . .
. . . . § 413.30(a)(11). . . . As the Government explained during oral argument:. 413.30(a)(19) says segment means one of two or more . . .
. . . award of subrogation damages for this employee is $8,331.21, rather than $7,917.91, a difference of $413.30 . . .
. . . . § 413.30. See also Good Samaritan Hosp. v. . . . In 42 C.F.R. 413.30(e)(1996), the Secretary created an exemption from RCLs for new providers of SNF services . . . Thompson, 251 F.3d 1141, 1149 (7th Cir.2001); 42 C.F.R. 413.30(e). . . . On February 23, 1994, Twin Rivers formally requested a new provider exemption under 42 C.F.R. § 413.30 . . . Management, Inc.’s requested new provider exemption under 42 C.F.R. § 413.30(e)(1996) for its 1993 and . . .
. . . . § 413.30(e) (1997). Complaint (“Compl.”) ¶¶ 1, 5. . . . certain cost limits under 42 U.S.C. §§ 1395c, 1395d, 1395i, 1395x(b), (i), 1395yy(a) and 42 C.F.R. § 413.30 . . . reporting period beginning at least two years after the provider accepts its first patient.” 42 C.F.R. § 413.30 . . . stated herein, this exhibit would not provide support for the Administrator’s decision. .42 C.F.R. § 413.30 . . .
. . . . § 413.30(a) (1998). . . . Id. § 413.30(c). . . . . § 413.30(f). . . . Id. § 413.30(c). . . . ’s request to HCFA. 42 C.F.R. § 413.30(c). . . .
. . . . § 413.30(e) (1997) (now codified at 42 C.F.R. § 413.30(d)). . . . certified under Medicare, under present and previous ownership, for less than three full years. 42 C.F.R. § 413.30 . . . previous ownership” as a SNF or equivalent,- it could not qualify as a “new” provider under 42 C.F.R. § 413.30 . . . See 42 C.F.R. § 413.30(e) (1997). . . .
. . . . § 413.30(e). . . . Under 42 C.F.R. § 413.30: Exemptions from the limits imposed under this section may be granted to a new . . . In addition, even if a provider does not qualify as a new provider under the express terms of § 413.30 . . . In contrast, the Sixth and Fourth Circuits have held that § 413.30 is not ambiguous. . . . The new provider exception is now codified at 42 C.F.R. § 413.30(d). . . . .
. . . . § 413.30(e) provides for an exemption from the SNF routine service cost limits for new providers. . . . Although the term “provider” is not defined in § 413.30(e), its meaning is made clear by referencing . . . In this case, ACMC represents the “provider of inpatient services” contemplated by § 413.30(e). . . . However, we conclude that the language of section 413.30(e) has a plain meaning. . . . Accordingly, we hold that ACMC is entitled to “new provider” status pursuant to section 413.30(e). . . .
. . . . § 413.30(e) (1996). We hold that 42 C.F.R. § 413.30(e) is ambiguous. . . . We hold that the plain language of 42 C.F.R. § 413.30(e) does not clearly address whether Summitview’ . . . Ohio 2002), in support of its argument that 42 C.F.R. § 413.30(e) is unambiguous. . . . Here, Providence’s attempt to cast 42 C.F.R. § 413.30(e) as unambiguous must fail. . . . The new provider exemption can now be found at 42 C.F.R. § 413.30(d). . . . .
. . . . § 413.30 et seq. B. . . .
. . . . § 413.30(a)(11). . . . , plants, or other subdivisions of an organization reporting directly to a home office.” 4 C.F.R. § 413.30 . . .
. . . . § 413.30(a)(ll). . . . , plants, or other subdivisions of an organization reporting directly to a home office.” 4 C.F.R. § 413.30 . . .
. . . . § 413.30(a)(1) (“This section implements section 1861(v)(l)(A) [codified at 42 U.S.C. § 1395x(v)] of . . . . § 413.30. . . .
. . . . § 413.30 (1996), sets forth general rules to establish “reasonable” limits for provider costs, as well . . . The district court concluded that PRM § 2534.5 was “an unreasonable interpretation of 42 C.F.R. § 413.30 . . . we must give to PRM § 2534.5, which the Secretary characterizes as the agency’s interpretation of § 413.30 . . . Luke’s is entitled to reimbursement is established by the plain language of § 413.30(f), which permits . . . See 42 U.S.C. 1395x(v)(l)(A); see also 42 C.F.R. § 413.30(f)(1) (1996). . . .
. . . . § 413.30(e)(2) (1994). . . . At issue here is an exemption for “new providers” of skilled nursing services. 42 C.F.R. § 413.30(e)( . . . turn now to the Secretary’s construction and application' of the new provider exemption, 42 C.F.R. § 413.30 . . . This case hinges on the meaning of the phrase “previous ownership,” and section 413.30(e)(2) neither . . . operated as the [same] type of provider (or the equivalent)” for the prescribed period. 42 C.F.R. § 413.30 . . .
. . . . § 413.30(e) (1996). . . . See 42 C.F.R. § 413.30(e). . . . Section 413.30(e) does not define “provider,” but the structure and wording of the regulation suggest . . . is now found, in slightly revised form, at section 413.30(d) (2001). . . . The references in this opinion to section 413.30 are to the 1996 version of the regulation. . . . . . § 413.30(e)(1996). Therefore, I respectfully dissent. I. . . . ownership” of the certificates in determining the length of time a provider has “operated.” 42 C.F.R. § 413.30 . . . The Secretary has fulfilled his obligation through regulation, 42 C.F.R. § 413.30(e), and has sought . . . Secretary’s interpretation that MGH is not entitled to the “new provider” exemption set forth in § 413.30 . . .
. . . . § 413.30(e) (“the new provider rule”). . . . certified for Medicare, under present and previous ownership, for less than three full years. 42 C.F.R. § 413.30 . . . Pro. 25(d). .During the relevant time period, the new provider rule appeared at 42 C.F.R. § 413.30(e) . . . It has since been moved, after certain amendments not relevant here, to 42 C.F.R. § 413.30(d). . . .
. . . . § 413.30(e) provides exemptions for new SNFs that have “operated as the type of SNF (or the equivalent . . . See 42 C.F.R. § 413.30(e). This regulation has been redesignated as 42 C.F.R. § 413.30(d). . . . on behalf of the Secretary of Health and Human services regarding Medicare payments. . 42 C.F.R. § 413.30 . . . (e). . 42 C.F.R. §§ 413.30(a)(1) and (2) allows Medicare to establish limits on SNF costs recognized . . . Airport Impact, 192 F.3d at 203. . 42 C.F.R. § 413.30(e). . . . .
. . . Pursuant to 42 C.F.R. § 413.30(f)(1), St. . . . See 42 C.F.R. § 413.30(f). . . . See 42 C.F.R. § 413.30(f)(1). . . . Is PRM § 2531.5 an unreasonable interpretation of 12 C.F.R. § 413.30? . . . See 42 C.F.R. § 413.30(f)(l)(ii). . . .
. . . . § 413.30(a)(ll) (1986). The term “closing” is not defined. . . . usually identified with responsibility for profit and/or producing a product or service.” 4 C.F.R. § 413.30 . . . CAS 413.30(a)(20) provides as follows: Segment closing means that a segment has (i) been sold or ownership . . . sale, which occurred after the 1995 CAS 413 became effective, is a segment closing as provided in CAS 413.30 . . . The amended CAS 413.30(a)(20) provides in relevant part: “Segment closing means that a segment has (i . . .
. . . . § 413.30(e)(1996). Section 413.30(e) provides: Exemptions. . . . are “new” so as to deem a SNF a new provider that makes the word “provider” ambiguous as used in § 413.30 . . . at a different result, Plaintiff argues that the test as to whether an exemption is granted under § 413.30 . . . Section 413.30(e), however, nowhere speaks of assets being operated or not operated. . . . exceptions” to the routine cost limits for two of the cost years in question pursuant to 42 C.F.R. § 413.30 . . .
. . . . § 413.30(e) exempted “new providers” from the RCLs for a period of up to two years. . . . Secretary’s Interpretation 42 C.F.R. § 413.30(e) contains an exemption to the Medicare RCLs for a “new . . . The Secretary claims that the current interpretation of 42 C.F.R. § 413.30(e) is not new, but does not . . . Having found that Seminole Rock deference is warranted, we next determine whether 42 C.F.R. § 413.30( . . . Paragon also has a few policy arguments as to why the Secretary’s construction of 42 C.F.R. § 413.30( . . .
. . . . § 413.30 (emphasis added). . . .
. . . . § 413.30(a)(1), (e)-(h). . . . . § 413.30(e). . . . See 42 C.F.R. § 413.30(c). . . .
. . . . § 413.30 (1993) (emphasis added). See also 42 C.F.R. § 413.30 (1992) (same text). . . .
. . . . § 413.30(f), the Health Care Financing Administration granted upward adjustments to HB-SNFs that demonstrated . . . See 42 C.F.R. § 413.30(f). In the years 1984-1990, St. . . . See 42 C.F.R. § 413.30(f). . . . rule adds a fifth, unwaivable requirement to the four reimbursement criteria set out in 42 C.F.R. § 413.30 . . . The PRM rule cannot be construed as an “interpretation” of 42 C.F.R. § 413.30 The majority concludes . . . . § 413.30), and a PRM provision (PRM § 2534.5) interpreting the regulation. 1. 42 U.S.C. § 1395yy: The . . . Id. at § 413.30(a). The regulation provides as follows: % H* (a)(2) General principle. . . . Neither Congress in 42 U.S.C. § 1395yy nor the Secretary in 42 C.F.R. § 413.30 mandated that a HB-SNF . . . should only be adjusted upward “to the extent the costs are reasonable.” 42 C.F.R. § 413.30(f). . . . extent to which costs for atypical services are “reasonable.” 42 C.F.R. § 413.30(f). . . .
. . . . § 413.30. . . . on a per beneficiary, per admission, per discharge, per diem, per visit, or other basis. 42 C.F.R. § 413.30 . . .
. . . See also 42 C.F.R. 413.30 (1992) (same text). . . . The PRRB determined that thesd market rates did not constitute “cost limits” under 42 C.F.R. 413.30. . . . The HCFA found that the market rates did not constitute cost limits under 42 C.F.R. 413.30. . . . See 42 C.F.R. 413.30(f). . . . See 42 C.F.R. 413.30(f). . . .
. . . when a provider may request a TEFRA limit adjustment after a reopening, that its interpretation of § 413.30 . . .
. . . . § 413.30(f), for determining the amount of the exception from the routine cost limits imposed by the . . . the patients treated and are necessary in the efficient delivery of needed health care. 42 C.F.R. § 413.30 . . . may make adjustments in the limits ... to the extent the Secretary deems appropriate); 42 C.F.R. § 413.30 . . . implementing regulation provides that the “actual cost of items or services” may be reimbursed. 42 C.F.R. § 413.30 . . .
. . . . § 413.30, and provides that reimbursable provider costs under Medicare may not exceed the costs recognized . . .
. . . . § 413.30(a)(2), (c)-(f) (describing procedure for deriving the RCL). . . . the services are furnished, the size of the hospital, and the type of patients treated. 42 C.F.R. § 413.30 . . .
. . . . § 413.30. . . . See 42 C.F.R. §§ 413.30(c) & (f). Blue Cross denied the hospital’s request on January 10, 1991. . . .
. . . . § 413.30 (1993). . . .
. . . See 42 CFR § 413.30 (1993). . . . .
. . . . § 413.30(f), a provider may request an exception from the imposition of routine cost limits (“RCL”) . . . within 180 days of the issuance of the NPR. 42 C.F.R. 413.30(c), (f). . . . then makes a recommendation to HCFA as to whether to grant the request for an exception. 42 C.F.R. § 413.30 . . . See 42 U.S.C. § 1395oo (a); 42 C.F.R. §§ 405.1835, 413.30(c). . . . Board review may be extended until HCFA completes its review of the exception request. 42 C.F.R. § 413.30 . . .
. . . . § 413.30(e), (f). Memorial does not appeal the denial of its request for an exemption. . . . .
. . . A provider classified as a rural hospital can apply for reclassification as an urban one. 42 CFR § 413.30 . . . is the sole hospital in a community, a new provider, or a rural hospital with fewer than 50 beds. § 413.30 . . . circumstances beyond the provider’s control, unusual labor costs, or essential community services. § 413.30 . . . See id., at 188; 42 CFR § 413.30(e)(1) (1992). . . .
. . . ’s sale of several wholly-owned subsidiaries legally amounted to segment closings pursuant to 4 CFR 413.30 . . .
. . . . § 413.30(e), (f). Memorial does not appeal the denial of its request for an exemption. . Mt. . . .
. . . . § 413.30. The Court will reference the regulation herein to section 405.460. . . . .
. . . . § 413.30 (1990). . . . . § 413.30(b) (1990). . . . See id. § 413.30(e), (f) (1990). These cost schedules are updated yearly. . . .
. . . . § 413.30(a)(ll). . . .
. . . . § 413.30(e)(1) (1989)). . . . See 42 C.F.R. § 413.30(e)(1) (1989). . . .
. . . . § 413.30(a)(ll), which provides as follows: (11) Segment. . . .
. . . . § 413.30(a)(1) (1989). . . . applicable cost limits and providing a procedure for requesting such exceptions and exemptions. 42 C.F.R. §§ 413.30 . . . the patients treated and are necessary in the efficient delivery of needed health care. 42 C.F.R. § 413.30 . . . request an exception from the fiscal intermediary within 180 days after the NPR was issued. 42 C.F.R. § 413.30 . . .
. . . Section 413.30(e)(1), (2), and (3). . . . .
. . . in the Code of Federal Regulations, and 42 C.F.R. section 405.460 is now numbered 42 C.F.R. section 413.30 . . .
. . . . § 413.30(f). . . . The Secretary has established limits on reasonable costs. 42 C.F.R. § 413.30. . . . . § 413.30(f), the limits so established may be adjusted upward under specific circumstances, for example . . . Id. at § 413.30(f)(1). . . .
. . . . § 413.30. . . . The regulation pertinent to this case, 42 C.F.R. § 405.460, now is designated as 42 C.F.R. § 413.30. . . .
. . . . § 413.30(a)(2) (1986). . . . for the purposes of the cost limits may apply for reclassification as an urban hospital. 42 C.F.R. § 413.30 . . . Id. § 413.30(e). . . . Id. § 413.30(f). . . . basis, that requirement is satisfied by the so-called “exceptions process” established in 42 C.F.R. § 413.30 . . .
. . . . § 413.30(f)(7). . . .
. . . . § 405.460 (1985), redesignated as 42 C.F.R. 413.30 (51 Fed.Reg. 34,790, 34,800-2 (September 30, 1986 . . . furnished by “providers similarly classified.” 42 C.F.R. § 405.460 (1985), redesignated as 42 C.F.R. § 413.30 . . .
. . . . § 413.30 (1986); Beth Israel Hosp. v. . . .
. . . Albert Branwell 330.50 Stanley Brayan 76.80 Federico Chin 316.50 Ellis Frederick 1215.30 Edwin Edwards 413.30 . . .