§ 413.170 Scope
§ 413.171 Definitions
§ 413.172 Principles of prospective payment
§ 413.174 Prospective rates for hospital-based and independent ESRD facilities
§ 413.176 Amount of payments
§ 413.177 Quality incentive program payment
§ 413.178 ESRD quality incentive program
§ 413.180 Procedures for requesting exceptions to payment rates
§ 413.182 Criteria for approval of exception requests
§ 413.184 Payment exception: Pediatric patient mix
§ 413.186 Payment exception: Self-dialysis training costs in pediatric facilities
§ 413.194 Appeals
§ 413.195 Limitation on Review
§ 413.196 Notification of changes in rate-setting methodologies and payment rates
§ 413.198 Recordkeeping and cost reporting requirements for outpatient maintenance dialysis
§ 413.202 Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries
§ 413.203 Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries
§ 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system
§ 413.215 Basis of payment
§ 413.217 Items and services included in the ESRD prospective payment system
§ 413.220 Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011
§ 413.230 Determining the per treatment payment amount
§ 413.231 Adjustment for wages
§ 413.232 Low-volume adjustment
§ 413.233 Rural facility adjustment
§ 413.234 Drug designation process
§ 413.235 Patient-level adjustments
§ 413.236 Transitional add-on payment adjustment for new and innovative equipment and supplies
§ 413.237 Outliers
§ 413.239 Transition period
§ 413.241 Pharmacy arrangements

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B > Part 413 > Subpart H - Payment for End-Stage Renal Disease (Esrd) Services

  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Contract: A legal written agreement that becomes binding when signed.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • provider: means a hospital, rural emergency hospital, skilled nursing facility, home health agency, hospice, organ procurement organization, histocompatibility laboratory, rural health clinic, federally qualified health center, community mental health center, or end-stage renal disease facility. See 42 CFR 413.24
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • User fees: Fees charged to users of goods or services provided by the government. In levying or authorizing these fees, the legislature determines whether the revenue should go into the treasury or should be available to the agency providing the goods or services.