{"abstract":"We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems. In addition, in the Addendum to this proposed rule, we describe the proposed changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. We also are setting forth proposed rate-of-increase limits as well as proposed policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These proposed changes would be applicable to discharges occurring on or after October 1, 2005, with one exception: The proposed changes relating to submittal of hospital wage data by a campus or campuses of a multicampus hospital system (that is, the proposed changes to Sec. 412.230(d)(2) of the regulations) would be effective upon publication of the final rule. Among the policy changes that we are proposing to make are changes relating to: the classification of cases to the diagnosis-related groups (DRGs); the long-term care (LTC)-DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; rebasing and revision of the hospital market basket; applications for new technologies and medical services add-on payments; policies governing postacute care transfers, payments to hospitals for the direct and indirect costs of graduate medical education, submission of hospital quality data, payment adjustment for low-volume hospitals, changes in the requirements for provider-based facilities; and changes in the requirements for critical access hospitals (CAHs).","action":"Proposed 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/2005/05/04/05-8507.html","cfr_references":[{"chapter":null,"citation_url":null,"part":405,"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":415,"title":42},{"chapter":null,"citation_url":null,"part":419,"title":42},{"chapter":null,"citation_url":null,"part":422,"title":42},{"chapter":null,"citation_url":null,"part":485,"title":42}],"citation":"70 FR 23306","comment_url":null,"comments_close_on":"2005-06-24","correction_of":null,"corrections":[],"dates":"Comments will be considered if received at the appropriate address, as provided in the ADDRESSES section, no later than 5 p.m. on June 24, 2005.","disposition_notes":null,"docket_ids":["CMS-1500-P"],"dockets":[],"document_number":"05-8507","effective_on":null,"end_page":23673,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2005/05/04/05-8507.xml","html_url":"https://www.federalregister.gov/documents/2005/05/04/05-8507/medicare-program-proposed-changes-to-the-hospital-inpatient-prospective-payment-systems-and-fiscal","images":{"EP04MY05.070":{"large":"https://img.federalregister.gov/EP04MY05.070/EP04MY05.070_large.png","medium":"https://img.federalregister.gov/EP04MY05.070/EP04MY05.070_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.070/EP04MY05.070_original_size.png"},"EP04MY05.030":{"large":"https://img.federalregister.gov/EP04MY05.030/EP04MY05.030_large.png","medium":"https://img.federalregister.gov/EP04MY05.030/EP04MY05.030_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.030/EP04MY05.030_original_size.png"},"EP04MY05.074":{"large":"https://img.federalregister.gov/EP04MY05.074/EP04MY05.074_large.png","medium":"https://img.federalregister.gov/EP04MY05.074/EP04MY05.074_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.074/EP04MY05.074_original_size.png"},"EP04MY05.073":{"large":"https://img.federalregister.gov/EP04MY05.073/EP04MY05.073_large.png","medium":"https://img.federalregister.gov/EP04MY05.073/EP04MY05.073_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.073/EP04MY05.073_original_size.png"},"EP04MY05.072":{"large":"https://img.federalregister.gov/EP04MY05.072/EP04MY05.072_large.png","medium":"https://img.federalregister.gov/EP04MY05.072/EP04MY05.072_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.072/EP04MY05.072_original_size.png"},"EP04MY05.071":{"large":"https://img.federalregister.gov/EP04MY05.071/EP04MY05.071_large.png","medium":"https://img.federalregister.gov/EP04MY05.071/EP04MY05.071_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.071/EP04MY05.071_original_size.png"},"EP04MY05.023":{"large":"https://img.federalregister.gov/EP04MY05.023/EP04MY05.023_large.png","medium":"https://img.federalregister.gov/EP04MY05.023/EP04MY05.023_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.023/EP04MY05.023_original_size.png"},"EP04MY05.067":{"large":"https://img.federalregister.gov/EP04MY05.067/EP04MY05.067_large.png","medium":"https://img.federalregister.gov/EP04MY05.067/EP04MY05.067_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.067/EP04MY05.067_original_size.png"},"EP04MY05.022":{"large":"https://img.federalregister.gov/EP04MY05.022/EP04MY05.022_large.png","medium":"https://img.federalregister.gov/EP04MY05.022/EP04MY05.022_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.022/EP04MY05.022_original_size.png"},"EP04MY05.066":{"large":"https://img.federalregister.gov/EP04MY05.066/EP04MY05.066_large.png","medium":"https://img.federalregister.gov/EP04MY05.066/EP04MY05.066_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.066/EP04MY05.066_original_size.png"},"EP04MY05.021":{"large":"https://img.federalregister.gov/EP04MY05.021/EP04MY05.021_large.png","medium":"https://img.federalregister.gov/EP04MY05.021/EP04MY05.021_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.021/EP04MY05.021_original_size.png"},"EP04MY05.065":{"large":"https://img.federalregister.gov/EP04MY05.065/EP04MY05.065_large.png","medium":"https://img.federalregister.gov/EP04MY05.065/EP04MY05.065_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.065/EP04MY05.065_original_size.png"},"EP04MY05.020":{"large":"https://img.federalregister.gov/EP04MY05.020/EP04MY05.020_large.png","medium":"https://img.federalregister.gov/EP04MY05.020/EP04MY05.020_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.020/EP04MY05.020_original_size.png"},"EP04MY05.064":{"large":"https://img.federalregister.gov/EP04MY05.064/EP04MY05.064_large.png","medium":"https://img.federalregister.gov/EP04MY05.064/EP04MY05.064_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.064/EP04MY05.064_original_size.png"},"EP04MY05.027":{"large":"https://img.federalregister.gov/EP04MY05.027/EP04MY05.027_large.png","medium":"https://img.federalregister.gov/EP04MY05.027/EP04MY05.027_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.027/EP04MY05.027_original_size.png"},"EP04MY05.026":{"large":"https://img.federalregister.gov/EP04MY05.026/EP04MY05.026_large.png","medium":"https://img.federalregister.gov/EP04MY05.026/EP04MY05.026_medium.png","original_size":"https://img.federalregister.gov/EP04MY05.026/EP04MY05.026_original_size.png"},"EP04MY05.025":{"large":"https://img.federalregister.gov/EP04MY05.025/EP04MY05.025_large.png","medium":"https://img.federalregister.gov/EP04MY05.025/EP04MY05.025_medium.png","original_size":"https://img.federalregis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