{"abstract":"We are revising the Medicare hospital inpatient prospective payment system for operating costs to: implement applicable statutory requirements, including a number of provisions of the Medicare, Medicaid, and State Children's Health Insurance Program Balanced Budget Refinement Act of 1999 (Pub. L. 106-113); and implement changes arising from our continuing experience with the system. In addition, in the Addendum to this final rule, we describe changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes apply to discharges occurring on or after October 1, 2000. We also set forth rate-of-increase limits and make changes to our policy for hospitals and hospital units excluded from the prospective payment systems. We are making changes to the policies governing payments to hospitals for the direct costs of graduate medical education, sole community hospitals and critical access hospitals. We are adding a new condition of participation on organ, tissue, and eye procurement for critical access hospitals that parallels the condition of participation that we previously published for all other Medicare-participating hospitals. Lastly, we are finalizing a January 20, 2000 interim final rule with comment period (65 FR 3136) that sets forth the criteria to be used in calculating the Medicare disproportionate share adjustment in reference to Medicaid expansion waiver patient days under section 1115 of the Social Security Act.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Health Care Financing Administration","name":"Health Care Finance Administration","id":559,"url":"https://www.federalregister.gov/agencies/health-care-finance-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/559","parent_id":221,"slug":"health-care-finance-administration"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2000/08/01/00-19108.html","cfr_references":[{"chapter":null,"citation_url":null,"part":410,"title":42},{"chapter":null,"citation_url":null,"part":412,"title":42},{"chapter":null,"citation_url":null,"part":413,"title":42},{"chapter":null,"citation_url":null,"part":485,"title":42}],"citation":"65 FR 47054","comment_url":null,"comments_close_on":"2000-08-01","correction_of":null,"corrections":[],"dates":"The provisions of this final rule are effective October 1, 2000. This rule is a major rule as defined in 5 U.S.C. 804(2). Pursuant to 5 U.S.C. 801(a)(1)(A), we are submitting a report to Congress on this rule on August 1, 2000.","disposition_notes":null,"docket_ids":["HCFA-1118-F"],"dockets":[],"document_number":"00-19108","effective_on":"2000-10-01","end_page":47211,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2000/08/01/00-19108.xml","html_url":"https://www.federalregister.gov/documents/2000/08/01/00-19108/medicare-program-changes-to-the-hospital-inpatient-prospective-payment-systems-and-fiscal-year-2001","images":{"ER01AU00.020":{"original_size":"https://img.federalregister.gov/ER01AU00.020/ER01AU00.020_original_size.gif"},"ER01AU00.010":{"original_size":"https://img.federalregister.gov/ER01AU00.010/ER01AU00.010_original_size.gif"},"ER01AU00.002":{"original_size":"https://img.federalregister.gov/ER01AU00.002/ER01AU00.002_original_size.gif"},"ER01AU00.013":{"original_size":"https://img.federalregister.gov/ER01AU00.013/ER01AU00.013_original_size.gif"},"ER01AU00.003":{"original_size":"https://img.federalregister.gov/ER01AU00.003/ER01AU00.003_original_size.gif"},"ER01AU00.014":{"original_size":"https://img.federalregister.gov/ER01AU00.014/ER01AU00.014_original_size.gif"},"ER01AU00.000":{"original_size":"https://img.federalregister.gov/ER01AU00.000/ER01AU00.000_original_size.gif"},"ER01AU00.011":{"original_size":"https://img.federalregister.gov/ER01AU00.011/ER01AU00.011_original_size.gif"},"ER01AU00.001":{"original_size":"https://img.federalregister.gov/ER01AU00.001/ER01AU00.001_original_size.gif"},"ER01AU00.012":{"original_size":"https://img.federalregister.gov/ER01AU00.012/ER01AU00.012_original_size.gif"},"ER01AU00.006":{"original_size":"https://img.federalregister.gov/ER01AU00.006/ER01AU00.006_original_size.gif"},"ER01AU00.017":{"original_size":"https://img.federalregister.gov/ER01AU00.017/ER01AU00.017_original_size.gif"},"ER01AU00.007":{"original_size":"https://img.federalregister.gov/ER01AU00.007/ER01AU00.007_original_size.gif"},"ER01AU00.018":{"original_size":"https://img.federalregister.gov/ER01AU00.018/ER01AU00.018_original_size.gif"},"ER01AU00.004":{"original_size":"https://img.federalregister.gov/ER01AU00.004/ER01AU00.004_original_size.gif"},"ER01AU00.015":{"original_size":"https://img.federalregister.gov/ER01AU00.015/ER01AU00.015_original_size.gif"},"ER01AU00.005":{"original_size":"https://img.federalregister.gov/ER01AU00.005/ER01AU00.005_original_size.gif"},"ER01AU00.016":{"original_size":"https://img.federalregister.gov/ER01AU00.016/ER01AU00.016_original_size.gif"},"ER01AU00.008":{"original_size":"https://img.federalregister.gov/ER01AU00.008/ER01AU00.008_original_size.gif"},"ER01AU00.019":{"original_size":"https://img.federalregister.gov/ER01AU00.019/ER01AU00.019_original_size.gif"},"ER01AU00.009":{"original_size":"https://img.federalregister.gov/ER01AU00.009/ER01AU00.009_original_size.gif"}},"images_metadata":{"ER01AU00.020":{"original_size":{"identifier":"ER01AU00.020","content_type":"image/gif","size":136869,"width":1952,"sha":"96c81754a1f55e7838373a186d6b8abf","url":"https://img.federalregister.gov/ER01AU00.020/ER01AU00.020_original_size.gif","height":2668}},"ER01AU00.010":{"original_size":{"identifier":"ER01AU00.010","content_type":"image/gif","size":163246,"width":1943,"sha":"fbfc4c5f8fbfeb16231ef609a45bab58","url":"https://img.federalregister.gov/ER01AU00.010/ER01AU00.010_original_size.gif","height":2668}},"ER01AU00.002":{"original_size":{"identifier":"ER01AU00.002","content_type":"image/gif","size":164835,"width":1948,"sha":"e21509069a2e4651a2873b3f4a093c1f","url":"https://img.federalregister.gov/ER01AU00.002/ER01AU00.002_original_size.gif","height":2671}},"ER01AU00.013":{"original_size":{"identifier":"ER01AU00.013","content_type":"image/gif","size":162473,"width":1957,"sha":"8dafee509c6db85860ddb80af78f002c","url":"https://img.federalregister.gov/ER01AU00.013/ER01AU00.013_original_size.gif","height":2664}},"ER01AU00.003":{"original_size":{"identifier":"ER01AU00.003","content_type":"image/gif","size":160461,"width":1953,"sha":"3d88d142e273dcab3b4caefc0b78d743","url":"https://img.federalregister.gov/ER01AU00.003/ER01AU00.003_original_size.gif","height":2670}},"ER01AU00.014":{"original_size":{"identifier":"ER01AU00.014","content_type":"image/gif","size":163287,"width":1950,"sha":"66b9cd79ff6c80ed779bfe29ddf60193","url":"https://img.federalregister.gov/ER01AU00.014/ER01AU00.014_original_size.gif","height":2664}},"ER01AU00.000":{"original_size":{"identifier":"ER01AU00.000","content_type":"image/gif","size":158647,"width":1952,"sha":"33a2b869dfef1c04f65bdf2f393059c3","url":"https://img.federalregister.gov/ER01AU00.000/ER01AU00.000_original_size.gif","height":2666}},"ER01AU00.011":{"original_size":{"identifier":"ER01AU00.011","content_type":"image/gif","size":163335,"width":1952,"sha":"d6d35657f2121d7acb4d1f48222d6303","url":"https://img.federalregister.gov/ER01AU00.011/ER01AU00.011_original_size.gif","height":2668}},"ER01AU00.001":{"original_size":{"identifier":"ER01AU00.001","content_type":"image/gif","size":164494,"widt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12:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2000-08-01/pdf/00-19108.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2000-08-01","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2000/08/01/00-19108.txt","regulation_id_number_info":{"0938-AK09":null},"regulation_id_numbers":["0938-AK09"],"regulations_dot_gov_info":{},"regulations_dot_gov_url":null,"significant":null,"signing_date":null,"start_page":47054,"subtype":null,"title":"Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2001 Rates","toc_doc":"Hospital inpatient prospective payment systems and 2001 FY rates","toc_subject":"Medicare:","topics":["Administrative practice and procedure","Grant programs-health","Health facilities","Health professions","Kidney diseases","Laboratories","Medicaid","Medicare","Puerto Rico","Reporting and recordkeeping requirements","Rural 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