Title 42

PART 413 SUBPART H

Subpart H - Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs Source:62 FR 43668, Aug. 15, 1997, unless otherwise noted.

• 42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww.
• Source: 51 FR 34793, Sept. 30, 1986, unless otherwise noted.

42:2.0.1.2.14.8.61.1	SECTION 413.170	413.170 Scope.
42:2.0.1.2.14.8.61.2	SECTION 413.171	413.171 Definitions.
42:2.0.1.2.14.8.61.3	SECTION 413.172	413.172 Principles of prospective payment.
42:2.0.1.2.14.8.61.4	SECTION 413.174	413.174 Prospective rates for hospital-based and independent ESRD facilities.
42:2.0.1.2.14.8.61.5	SECTION 413.176	413.176 Amount of payments.
42:2.0.1.2.14.8.61.6	SECTION 413.177	413.177 Quality incentive program payment.
42:2.0.1.2.14.8.61.7	SECTION 413.178	413.178 ESRD quality incentive program.
42:2.0.1.2.14.8.61.8	SECTION 413.180	413.180 Procedures for requesting exceptions to payment rates.
42:2.0.1.2.14.8.61.9	SECTION 413.182	413.182 Criteria for approval of exception requests.
42:2.0.1.2.14.8.61.10	SECTION 413.184	413.184 Payment exception: Pediatric patient mix.
42:2.0.1.2.14.8.61.11	SECTION 413.186	413.186 Payment exception: Self-dialysis training costs in pediatric facilities.
42:2.0.1.2.14.8.61.12	SECTION 413.194	413.194 Appeals.
42:2.0.1.2.14.8.61.13	SECTION 413.195	413.195 Limitation on Review.
42:2.0.1.2.14.8.61.14	SECTION 413.196	413.196 Notification of changes in rate-setting methodologies and payment rates.
42:2.0.1.2.14.8.61.15	SECTION 413.198	413.198 Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.
42:2.0.1.2.14.8.61.16	SECTION 413.200	413.200 Payment of independent organ procurement organizations and histocompatibility laboratories.
42:2.0.1.2.14.8.61.17	SECTION 413.202	413.202 Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
42:2.0.1.2.14.8.61.18	SECTION 413.203	413.203 Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
42:2.0.1.2.14.8.61.19	SECTION 413.210	413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.
42:2.0.1.2.14.8.61.20	SECTION 413.215	413.215 Basis of payment.
42:2.0.1.2.14.8.61.21	SECTION 413.217	413.217 Items and services included in the ESRD prospective payment system.
42:2.0.1.2.14.8.61.22	SECTION 413.220	413.220 Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011.
42:2.0.1.2.14.8.61.23	SECTION 413.230	413.230 Determining the per treatment payment amount.
42:2.0.1.2.14.8.61.24	SECTION 413.231	413.231 Adjustment for wages.
42:2.0.1.2.14.8.61.25	SECTION 413.232	413.232 Low-volume adjustment.
42:2.0.1.2.14.8.61.26	SECTION 413.233	413.233 Rural facility adjustment.
42:2.0.1.2.14.8.61.27	SECTION 413.234.	413.234. Drug designation process.
42:2.0.1.2.14.8.61.28	SECTION 413.235	413.235 Patient-level adjustments.
42:2.0.1.2.14.8.61.29	SECTION 413.236	413.236 Transitional add-on payment adjustment for new and innovative equipment and supplies.
42:2.0.1.2.14.8.61.30	SECTION 413.237	413.237 Outliers.
42:2.0.1.2.14.8.61.31	SECTION 413.239	413.239 Transition period.
42:2.0.1.2.14.8.61.32	SECTION 413.241	413.241 Pharmacy arrangements.

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