{"abstract":"We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital costs to implement changes arising from our continuing experience with these systems. In addition, in the Addendum to this final rule, we are describing 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 are applicable to discharges occurring on or after October 1, 2003. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the IPPS that are paid on a cost basis subject to these limits. Among other changes that we are making are: changes to the classification of cases to the diagnosis-related groups (DRGS); changes to the long-term care (LTC)-DRGs and relative weights; the introduction of updated wage data used to compute the wage index; the approval of new technologies for add-on payments; changes to the policies governing postacute care transfers; payments to hospitals for the direct and indirect costs of graduate medical education; pass-through payments for nursing and allied health education programs; determination of hospital beds and patient days for payment adjustment purposes; and payments to critical access hospitals (CAHs).","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":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2003/08/01/03-19363.html","cfr_references":[{"chapter":null,"citation_url":null,"part":412,"title":42},{"chapter":null,"citation_url":null,"part":413,"title":42}],"citation":"68 FR 45346","comment_url":null,"comments_close_on":"2003-08-01","correction_of":null,"corrections":[],"dates":"The provisions of this final rule, except the provisions of Sec. 412.230(e)(2)(ii)(A) (because it grants an exemption) and Sec. 412.278(f)(2)(i), are effective on October 1, 2003. The provisions of Sec. 412.230(e)(2)(ii)(A) and Sec. 412.278(f)(2)(i) are effective on August 1, 2003. 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, 2003.","disposition_notes":null,"docket_ids":["CMS-1470-F"],"dockets":[],"document_number":"03-19363","effective_on":"2003-10-01","end_page":45672,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2003/08/01/03-19363.xml","html_url":"https://www.federalregister.gov/documents/2003/08/01/03-19363/medicare-program-changes-to-the-hospital-inpatient-prospective-payment-systems-and-fiscal-year-2004","images":{"ER01AU03.027":{"large":"https://img.federalregister.gov/ER01AU03.027/ER01AU03.027_large.png","medium":"https://img.federalregister.gov/ER01AU03.027/ER01AU03.027_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.027/ER01AU03.027_original_size.png"},"ER01AU03.038":{"large":"https://img.federalregister.gov/ER01AU03.038/ER01AU03.038_large.png","medium":"https://img.federalregister.gov/ER01AU03.038/ER01AU03.038_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.038/ER01AU03.038_original_size.png"},"ER01AU03.017":{"large":"https://img.federalregister.gov/ER01AU03.017/ER01AU03.017_large.png","medium":"https://img.federalregister.gov/ER01AU03.017/ER01AU03.017_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.017/ER01AU03.017_original_size.png"},"ER01AU03.028":{"large":"https://img.federalregister.gov/ER01AU03.028/ER01AU03.028_large.png","medium":"https://img.federalregister.gov/ER01AU03.028/ER01AU03.028_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.028/ER01AU03.028_original_size.png"},"ER01AU03.039":{"large":"https://img.federalregister.gov/ER01AU03.039/ER01AU03.039_large.png","medium":"https://img.federalregister.gov/ER01AU03.039/ER01AU03.039_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.039/ER01AU03.039_original_size.png"},"ER01AU03.018":{"large":"https://img.federalregister.gov/ER01AU03.018/ER01AU03.018_large.png","medium":"https://img.federalregister.gov/ER01AU03.018/ER01AU03.018_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.018/ER01AU03.018_original_size.png"},"ER01AU03.029":{"large":"https://img.federalregister.gov/ER01AU03.029/ER01AU03.029_large.png","medium":"https://img.federalregister.gov/ER01AU03.029/ER01AU03.029_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.029/ER01AU03.029_original_size.png"},"ER01AU03.019":{"large":"https://img.federalregister.gov/ER01AU03.019/ER01AU03.019_large.png","medium":"https://img.federalregister.gov/ER01AU03.019/ER01AU03.019_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.019/ER01AU03.019_original_size.png"},"ER01AU03.023":{"large":"https://img.federalregister.gov/ER01AU03.023/ER01AU03.023_large.png","medium":"https://img.federalregister.gov/ER01AU03.023/ER01AU03.023_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.023/ER01AU03.023_original_size.png"},"ER01AU03.034":{"large":"https://img.federalregister.gov/ER01AU03.034/ER01AU03.034_large.png","medium":"https://img.federalregister.gov/ER01AU03.034/ER01AU03.034_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.034/ER01AU03.034_original_size.png"},"ER01AU03.024":{"large":"https://img.federalregister.gov/ER01AU03.024/ER01AU03.024_large.png","medium":"https://img.federalregister.gov/ER01AU03.024/ER01AU03.024_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.024/ER01AU03.024_original_size.png"},"ER01AU03.035":{"large":"https://img.federalregister.gov/ER01AU03.035/ER01AU03.035_large.png","medium":"https://img.federalregister.gov/ER01AU03.035/ER01AU03.035_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.035/ER01AU03.035_original_size.png"},"ER01AU03.025":{"large":"https://img.federalregister.gov/ER01AU03.025/ER01AU03.025_large.png","medium":"https://img.federalregister.gov/ER01AU03.025/ER01AU03.025_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.025/ER01AU03.025_original_size.png"},"ER01AU03.036":{"large":"https://img.federalregister.gov/ER01AU03.036/ER01AU03.036_large.png","medium":"https://img.federalregister.gov/ER01AU03.036/ER01AU03.036_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.036/ER01AU03.036_original_size.png"},"ER01AU03.026":{"large":"https://img.federalregister.gov/ER01AU03.026/ER01AU03.026_large.png","medium":"https://img.federalregister.gov/ER01AU03.026/ER01AU03.026_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.026/ER01AU03.026_original_size.png"},"ER01AU03.037":{"large":"https://img.federalregister.gov/ER01AU03.037/ER01AU03.037_large.png","medium":"https://img.federalregister.gov/ER01AU03.037/ER01AU03.037_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.037/ER01AU03.037_original_size.png"},"ER01AU03.030":{"large":"https://img.federalregister.gov/ER01AU03.030/ER01AU03.030_large.png","medium":"https://img.federalregister.gov/ER01AU03.030/ER01AU03.030_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.030/ER01AU03.030_original_size.png"},"ER01AU03.020":{"large":"https://img.federalregister.gov/ER01AU03.020/ER01AU03.020_large.png","medium":"https://img.federalregister.gov/ER01AU03.020/ER01AU03.020_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.020/ER01AU03.020_original_size.png"},"ER01AU03.031":{"large":"https://img.federalregister.gov/ER01AU03.031/ER01AU03.031_large.png","medium":"https://img.federalregister.gov/ER01AU03.031/ER01AU03.031_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.031/ER01AU03.031_original_size.png"},"ER01AU03.021":{"large":"https://img.federalregister.gov/ER01AU03.021/ER01AU03.021_large.png","medium":"https://img.federalregister.gov/ER01AU03.021/ER01AU03.021_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.021/ER01AU03.021_original_size.png"},"ER01AU03.032":{"large":"https://img.federalregister.gov/ER01AU03.032/ER01AU03.032_large.png","medium":"https://img.federalregister.gov/ER01AU03.032/ER01AU03.032_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.032/ER01AU03.032_original_size.png"},"ER01AU03.022":{"large":"https://img.federalregister.gov/ER01AU03.022/ER01AU03.022_large.png","medium":"https://img.federalregister.gov/ER01AU03.022/ER01AU03.022_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.022/ER01AU03.022_original_size.png"},"ER01AU03.033":{"large":"https://img.federalregister.gov/ER01AU03.033/ER01AU03.033_large.png","medium":"https://img.federalregister.gov/ER01AU03.033/ER01AU03.033_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.033/ER01AU03.033_original_size.png"},"ER01AU03.040":{"large":"https://img.federalregister.gov/ER01AU03.040/ER01AU03.040_large.png","medium":"https://img.federalregister.gov/ER01AU03.040/ER01AU03.040_medium.png","original_size":"https://img.federalregister.gov/ER01AU03.040/ER01AU03.040_original_size.png"}},"images_metadata":{"ER01AU03.027":{"large":{"identifier":"ER01AU03.027","content_type":"image/png","size":109449,"width":823,"sha":"5db204678848d921483dcc722f16e05c","url":"https://img.federalregister.gov/ER01AU03.027/ER01AU03.027_large.png","height":1247},"medium":{"identifier":"ER01AU03.027","content_type":"image/png","size":48913,"width":471,"sha":"83e59af5096da328cfd76054c888927d","url":"https://img.federalregister.gov/ER01AU03.027/ER01AU03.027_medium.png","height":714},"original_size":{"identifier":"ER01AU03.027","content_type":"image/png","size":204854,"width":3557,"sha":"81c74cb1203989ba1afe079c571dc107","url":"https://img.federalregister.gov/ER01AU03.027/ER01AU03.027_original_size.png","height":5392}},"ER01AU03.038":{"large":{"identifier":"ER01AU03.038","content_type":"image/png","size":98413,"width":822,"sha":"60c41d27a8a0532dbbacaf69ca4f6aef","url":"https://img.federalregister.gov/ER01AU03.038/ER01AU03.038_large.png","height":1146},"medium":{"identifier":"ER01AU03.038","content_type":"image/png","size":48473,"width":512,"sha":"8195735ff8eeef99e4ba9a6f5db96b31","url":"https://img.federalregister.gov/ER01AU03.038/ER01AU03.038_medium.png","height":713},"original_size":{"identifier":"ER01AU03.038","content_type":"image/png","size":238480,"width":3864,"sha":"f3b16d64256059c7afc0e827485aabd5","url":"https://img.federalregister.gov/ER01AU03.038/ER01AU03.038_original_size.png","height":5385}},"ER01AU03.017":{"large":{"identifier":"ER01AU03.017","content_type":"image/png","size":105298,"width":823,"sha":"32fb64c66ae8fe0636bde3c3994f535f","url":"https://img.federalregister.gov/ER01AU03.017/ER01AU03.017_large.png","height":1185},"medium":{"identifier":"ER01AU03.017","content_type":"image/png","size":49061,"width":489,"sha":"0a1e6f1f179b02e5e4ab64ad3333fed5","url":"https://img.federalregister.gov/ER01AU03.017/ER01AU03.017_medium.png","height":704},"original_size":{"identifier":"ER01AU03.017","content_type":"image/png","size":232542,"width":3691,"sha":"1dbc3cdb95d56eabba56cbb4d163f7a6","url":"https://img.federalregister.gov/ER01AU03.017/ER01AU03.017_original_size.png","height":5313}},"ER01AU03.028":{"large":{"identifier":"ER01AU03.028","content_type":"image/png","size":108141,"width":823,"sha":"b678344702e77ce4dd584bca76335cbe","url":"https://img.federalregister.gov/ER01AU03.028/ER01AU03.028_large.png","height":1246},"medium":{"identifier":"ER01AU03.028","content_type":"image/png","size":48262,"width":472,"sha":"7c02d08a4967b941d449897221ecb310","url":"https://img.federalregister.gov/ER01AU03.028/ER01AU03.028_medium.png","height":715},"original_size":{"identifier":"ER01AU03.028","content_type":"image/png","size":201714,"width":3565,"sha":"49fde7804e38e12463d22cfad690f03f","url":"https://img.federalregister.gov/ER01AU03.028/ER01AU03.028_original_size.png","height":5398}},"ER01AU03.039":{"large":{"identifier":"ER01AU03.039","content_type":"image/png","size":94004,"width":823,"sha":"72c6edb8efa6186ca15646d199586ede","url":"https://img.federalregister.gov/ER01AU03.039/ER01AU03.039_large.png","height":1136},"medium":{"identifier":"ER01AU03.039","content_type":"image/png","size":48661,"width":517,"sha":"c5e359bedf9e0e13e1e13bf0ceb9ca21","url":"https://img.federalregister.gov/ER01AU03.039/ER01AU03.039_medium.png","height":713},"original_size":{"identifier":"ER01AU03.039","content_type":"image/png","size":191264,"width":3900,"sha":"9a2301dd3bcf2749aff76566fee8f873","url":"https://img.federalregister.gov/ER01AU03.039/ER01AU03.039_original_size.png","height":5382}},"ER01AU03.018":{"large":{"identifier":"ER01AU03.018","content_type":"image/png","size":103677,"width":823,"sha":"1c26c79a6c4a7968f780e22ecb2d3b7d","url":"https://img.federalregister.gov/ER01AU03.018/ER01AU03.018_large.png","height":1219},"medium":{"identifier":"ER01AU03.018","content_type":"image/png","size":48261,"width":480,"sha":"43094ec332f48bcdbd89ad8be7ece074","url":"https://img.federalregister.gov/ER01AU03.018/ER01AU03.018_medium.png","height":711},"original_size":{"identifier":"ER01AU03.018","content_type":"image/png","size":206401,"width":3628,"sha":"ba0ff62388ce48378369ea718eee931f","url":"https://img.federalregister.gov/ER01AU03.018/ER01AU03.018_original_size.png","height":5373}},"ER01AU03.029":{"large":{"identifier":"ER01AU03.029","content_type":"image/png","size":112602,"width":823,"sha":"49aa846f5973ba8cbe063a260a57a78a","url":"https://img.federalregister.gov/ER01AU03.029/ER01AU03.029_large.png","height":1271},"medium":{"identifier":"ER01AU03.029","content_type":"image/png","size":49697,"width":461,"sha":"96963fab88d70302aca913f6bb8c1a8b","url":"https://img.federalregister.gov/ER01AU03.029/ER01AU03.029_medium.png","height":712},"original_size":{"identifier":"ER01AU03.029","content_type":"image/png","size":227341,"width":3487,"sha":"03f0657f0f6987ccb03f956e86165374","url":"https://img.federalregister.gov/ER01AU03.029/ER01AU03.029_original_size.png","height":5386}},"ER01AU03.019":{"large":{"identifier":"ER01AU03.019","content_type":"image/png","size":101782,"width":823,"sha":"2dc7b6c2f7d0658aed33467cc96012ac","url":"https://img.federalregister.gov/ER01AU03.019/ER01AU03.019_large.png","height":1214},"medium":{"identifier":"ER01AU03.019","content_type":"image/png","size":47709,"width":482,"sha":"590c795de47d7e336ea4b206514287dd","url":"https://img.federalregister.gov/ER01AU03.019/ER01AU03.019_medium.png","height":711},"original_size":{"identifier":"ER01AU03.019","content_type":"image/png","size":233829,"width":3645,"sha":"40511a56e5943c74f23205c279ae65f9","url":"https://img.federalregister.gov/ER01AU03.019/ER01AU03.019_original_size.png","height":5377}},"ER01AU03.023":{"large":{"identifier":"ER01AU03.023","content_type":"image/png","size":102204,"width":823,"sha":"58ec802a2385efa1edf80f1f5a4a87e9","url":"https://img.federalregister.gov/ER01AU03.023/ER01AU03.023_large.png","height":1221},"medium":{"identifier":"ER01AU03.023","content_type":"image/png","size":47668,"width":480,"sha":"a5d9dbc852e2e27efd0ebca37c9d01cd","url":"https://img.federalregister.gov/ER01AU03.023/ER01AU03.023_medium.png","height":712},"original_size":{"identifier":"ER01AU03.023","content_type":"image/png","size":191171,"width":3628,"sha":"385e32691b5cf0862d33e7de832c9301","url":"https://img.federalregister.gov/ER01AU03.023/ER01AU03.023_original_size.png","height":5382}},"ER01AU03.034":{"large":{"identifier":"ER01AU03.034","content_type":"image/png","size":88037,"width":822,"sha":"b608dccc41c6a1aa3d27d35e29fab746","url":"https://img.federalregister.gov/ER01AU03.034/ER01AU03.034_large.png","height":1099},"medium":{"identifier":"ER01AU03.034","content_type":"image/png","size":47981,"width":527,"sha":"f0d85c90e19991c7a488c2e613876959","url":"https://img.federalregister.gov/ER01AU03.034/ER01AU03.034_medium.png","height":704},"original_size":{"identifier":"ER01AU03.034","content_type":"image/png","size":196265,"width":3972,"sha":"385cd73cacc5731e304fca67aeaa68d1","url":"https://img.federalregister.gov/ER01AU03.034/ER01AU03.034_original_size.png","height":5310}},"ER01AU03.024":{"large":{"identifier":"ER01AU03.024","content_type":"image/png","size":110319,"width":822,"sha":"b13e2226c1efac40ad356b8d38bd503a","url":"https://img.federalregister.gov/ER01AU03.024/ER01AU03.024_large.png","height":1236},"medium":{"identifier":"ER01AU03.024","content_type":"image/png","size":47092,"width":475,"sha":"6203726b88fa14ee6fd52ac4b322a782","url":"https://img.federalregister.gov/ER01AU03.024/ER01AU03.024_medium.png","height":714},"original_size":{"identifier":"ER01AU03.024","content_type":"image/png","size":201345,"width":3584,"sha":"5f229852580954edef251f1a88f60e56","url":"https://img.federalregister.gov/ER01AU03.024/ER01AU03.024_original_size.png","height":5386}},"ER01AU03.035":{"large":{"identifier":"ER01AU03.035","content_type":"image/png","size":96061,"width":823,"sha":"a7d50353bd89032cb6c1e8ffdf5de29d","url":"https://img.federalregister.gov/ER01AU03.035/ER01AU03.035_large.png","height":1132},"medium":{"identifier":"ER01AU03.035","content_type":"image/png","size":50577,"width":520,"sha":"21251c45f42fdcd274d33460f9de9354","url":"https://img.federalregister.gov/ER01AU03.035/ER01AU03.035_medium.png","height":715},"original_size":{"identifier":"ER01AU03.035","content_type":"image/png","size":223850,"width":3925,"sha":"7d2ecc47ae3097c6db27c83c244ad8af","url":"https://img.federalregister.gov/ER01AU03.035/ER01AU03.035_original_size.png","height":5397}},"ER01AU03.025":{"large":{"identifier":"ER01AU03.025","content_type":"image/png","size":108284,"width":823,"sha":"6fa9c3276a9d91ae1350e89eb315f277","url":"https://img.federalregister.gov/ER01AU03.025/ER01AU03.025_large.png","height":1204},"medium":{"identifier":"ER01AU03.025","content_type":"image/png","size":50225,"width":487,"sha":"de557d464f9e5591fc1788a6bde49210","url":"https://img.federalregister.gov/ER01AU03.025/ER01AU03.025_medium.png","height":713},"original_size":{"identifier":"ER01AU03.025","content_type":"image/png","size":201490,"width":3679,"sha":"09208bc7b417b944f828feea298172fa","url":"https://img.federalregister.gov/ER01AU03.025/ER01AU03.025_original_size.png","height":5384}},"ER01AU03.036":{"large":{"identifier":"ER01AU03.036","content_type":"image/png","size":95183,"width":823,"sha":"d76692e4cf1159ee933c10d01b9a07d7","url":"https://img.federalregister.gov/ER01AU03.036/ER01AU03.036_large.png","height":1135},"medium":{"identifier":"ER01AU03.036","content_type":"image/png","size":48899,"width":517,"sha":"6d91a7421aabc5c057df666134b27855","url":"https://img.federalregister.gov/ER01AU03.036/ER01AU03.036_medium.png","height":713},"original_size":{"identifier":"ER01AU03.036","content_type":"image/png","size":194812,"width":3904,"sha":"21df79cc4bdfa5fe4c3d0be519aa7c5f","url":"https://img.federalregister.gov/ER01AU03.036/ER01AU03.036_original_size.png","height":5384}},"ER01AU03.026":{"large":{"identifier":"ER01AU03.026","content_type":"image/png","size":110119,"width":823,"sha":"dbbe609a37deb5e3622ee7787b577ac4","url":"https://img.federalregister.gov/ER01AU03.026/ER01AU03.026_large.png","height":1232},"medium":{"identifier":"ER01AU03.026","content_type":"image/png","size":50332,"width":479,"sha":"5484fb7107c8ff4dbcc28382011475a2","url":"https://img.federalregister.gov/ER01AU03.026/ER01AU03.026_medium.png","height":717},"original_size":{"identifier":"ER01AU03.026","content_type":"image/png","size":201762,"width":3617,"sha":"643706f4735ce024fcb25d2c6c617852","url":"https://img.federalregister.gov/ER01AU03.026/ER01AU03.026_original_size.png","height":5416}},"ER01AU03.037":{"large":{"identifier":"ER01AU03.037","content_type":"image/png","size":90429,"width":822,"sha":"286b8720aed070426ddc103a6f066a7c","url":"https://img.federalregister.gov/ER01AU03.037/ER01AU03.037_large.png","height":1102},"medium":{"identifier":"ER01AU03.037","content_type":"image/png","size":49095,"width":535,"sha":"f32f5f99b4748ddddf2f786724d81ed2","url":"https://img.federalregister.gov/ER01AU03.037/ER01AU03.037_medium.png","height":718},"original_size":{"identifier":"ER01AU03.037","content_type":"image/png","size":203063,"width":4048,"sha":"1aa1f09114924e99a803bcef3719ac8e","url":"https://img.federalregister.gov/ER01AU03.037/ER01AU03.037_original_size.png","height":5428}},"ER01AU03.030":{"large":{"identifier":"ER01AU03.030","content_type":"image/png","size":109603,"width":822,"sha":"76d5c86a807276c28beb82b42f74694d","url":"https://img.federalregister.gov/ER01AU03.030/ER01AU03.030_large.png","height":1223},"medium":{"identifier":"ER01AU03.030","content_type":"image/png","size":49982,"width":480,"sha":"212b168e1239369b9f2066e4d0b6654b","url":"https://img.federalregister.gov/ER01AU03.030/ER01AU03.030_medium.png","height":715},"original_size":{"identifier":"ER01AU03.030","content_type":"image/png","size":195450,"width":3630,"sha":"b814c770f7165dc9091c7c2c796e3ba7","url":"https://img.federalregister.gov/ER01AU03.030/ER01AU03.030_original_size.png","height":5404}},"ER01AU03.020":{"large":{"identifier":"ER01AU03.020","content_type":"image/png","size":104176,"width":823,"sha":"c21bee0def1d1d66c4d5444c53ce4628","url":"https://img.federalregister.gov/ER01AU03.020/ER01AU03.020_large.png","height":1237},"medium":{"identifier":"ER01AU03.020","content_type":"image/png","size":48281,"width":476,"sha":"798e802a372f92246b57a9187cbecdd4","url":"https://img.federalregister.gov/ER01AU03.020/ER01AU03.020_medium.png","height":715},"original_size":{"identifier":"ER01AU03.020","content_type":"image/png","size":197011,"width":3590,"sha":"4271c6615f0b416c1185749b84269050","url":"https://img.federalregister.gov/ER01AU03.020/ER01AU03.020_original_size.png","height":5396}},"ER01AU03.031":{"large":{"identifier":"ER01AU03.031","content_type":"image/png","size":102989,"width":823,"sha":"e51f761659859e1b2f2c9f7a4f3616f8","url":"https://img.federalregister.gov/ER01AU03.031/ER01AU03.031_large.png","height":1224},"medium":{"identifier":"ER01AU03.031","content_type":"image/png","size":49852,"width":482,"sha":"2bc76ff2dbba878cb46d91a14d33aefe","url":"https://img.federalregister.gov/ER01AU03.031/ER01AU03.031_medium.png","height":717},"original_size":{"identifier":"ER01AU03.031","content_type":"image/png","size":203422,"width":3640,"sha":"c5db0f9a8bd98543fe5ccede81f3f666","url":"https://img.federalregister.gov/ER01AU03.031/ER01AU03.031_original_size.png","height":5416}},"ER01AU03.021":{"large":{"identifier":"ER01AU03.021","content_type":"image/png","size":111698,"width":823,"sha":"700c224eaecf79ced3be75c9162f61d1","url":"https://img.federalregister.gov/ER01AU03.021/ER01AU03.021_large.png","height":1253},"medium":{"identifier":"ER01AU03.021","content_type":"image/png","size":50982,"width":468,"sha":"a3ab9bb41d36341f5c6870d1cfa4a401","url":"https://img.federalregister.gov/ER01AU03.021/ER01AU03.021_medium.png","height":713},"original_size":{"identifier":"ER01AU03.021","content_type":"image/png","size":195114,"width":3533,"sha":"f65a655c06a2e2fc869b7f62480c412e","url":"https://img.federalregister.gov/ER01AU03.021/ER01AU03.021_original_size.png","height":5380}},"ER01AU03.032":{"large":{"identifier":"ER01AU03.032","content_type":"image/png","size":106613,"width":823,"sha":"0f11dc38b25bdf73c40774bbd562d603","url":"https://img.federalregister.gov/ER01AU03.032/ER01AU03.032_large.png","height":1218},"medium":{"identifier":"ER01AU03.032","content_type":"image/png","size":49373,"width":483,"sha":"53947a8c4219798d74cf2ae35f1585e2","url":"https://img.federalregister.gov/ER01AU03.032/ER01AU03.032_medium.png","height":715},"original_size":{"identifier":"ER01AU03.032","content_type":"image/png","size":210662,"width":3646,"sha":"7941bdeec2b4956ca10556e9ea454501","url":"https://img.federalregister.gov/ER01AU03.032/ER01AU03.032_original_size.png","height":5397}},"ER01AU03.022":{"large":{"identifier":"ER01AU03.022","content_type":"image/png","size":104156,"width":823,"sha":"ccd9e867ec813a687611c95554cada27","url":"https://img.federalregister.gov/ER01AU03.022/ER01AU03.022_large.png","height":1228},"medium":{"identifier":"ER01AU03.022","content_type":"image/png","size":48983,"width":476,"sha":"ed05365861d985772bc3ec366fd0a279","url":"https://img.federalregister.gov/ER01AU03.022/ER01AU03.022_medium.png","height":710},"original_size":{"identifier":"ER01AU03.022","content_type":"image/png","size":195237,"width":3591,"sha":"a5ed3e0dfff6e39a16daa3d494e7f27d","url":"https://img.federalregister.gov/ER01AU03.022/ER01AU03.022_original_size.png","height":5357}},"ER01AU03.033":{"large":{"identifier":"ER01AU03.033","content_type":"image/png","size":6811,"width":823,"sha":"135a3880e881b22ea5fbb90ead773ff8","url":"https://img.federalregister.gov/ER01AU03.033/ER01AU03.033_large.png","height":103},"medium":{"identifier":"ER01AU03.033","content_type":"image/png","size":3594,"width":509,"sha":"77de4e5ae7d154e667cd562a93893968","url":"https://img.federalregister.gov/ER01AU03.033/ER01AU03.033_medium.png","height":64},"original_size":{"identifier":"ER01AU03.033","content_type":"image/png","size":13936,"width":3844,"sha":"ebc5dcf42f0abf44c7cdd38a09839086","url":"https://img.federalregister.gov/ER01AU03.033/ER01AU03.033_original_size.png","height":480}},"ER01AU03.040":{"large":{"identifier":"ER01AU03.040","content_type":"image/png","size":33484,"width":823,"sha":"db2859eafc74182a4e6b29d124806ae6","url":"https://img.federalregister.gov/ER01AU03.040/ER01AU03.040_large.png","height":1131},"medium":{"identifier":"ER01AU03.040","content_type":"image/png","size":17721,"width":523,"sha":"86fb4628298eaa1f6f54c0773a61b28a","url":"https://img.federalregister.gov/ER01AU03.040/ER01AU03.040_medium.png","height":718},"original_size":{"identifier":"ER01AU03.040","content_type":"image/png","size":79018,"width":3953,"sha":"bc1c2bd9f8cef5c6626d4dc65c2dd07f","url":"https://img.federalregister.gov/ER01AU03.040/ER01AU03.040_original_size.png","height":5430}}},"json_url":"https://www.federalregister.gov/api/v1/documents/03-19363?publication_date=2003-08-01","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2003-08-01/03-19363/mods.xml","not_received_for_publication":null,"page_length":327,"page_views":{"count":4028,"last_updated":"2026-10-24 04:15:05 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2003-08-01/pdf/03-19363.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2003-08-01","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2003/08/01/03-19363.txt","regulation_id_number_info":{"0938-AL89":{"issue":"200304","html_url":"https://www.federalregister.gov/regulations/0938-AL89/changes-to-the-hospital-inpatient-prospective-payment-system-and-fy-2004-rates-cms-1470-p-","title":"Changes to the Hospital Inpatient Prospective Payment System and FY 2004 Rates (CMS-1470-P)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=200304&RIN=0938-AL89&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AL89"],"regulations_dot_gov_info":{},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":45346,"subtype":null,"title":"Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2004 Rates","toc_doc":"Hospital inpatient prospective payment systems and 2004 FY rates","toc_subject":"Medicare:","topics":["Administrative practice and procedure","Health facilities","Kidney diseases","Medicare","Puerto Rico","Reporting and recordkeeping requirements"],"type":"Rule","volume":68}