{"abstract":"We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. In addition, we are finalizing an interim final rule with comment period that implements section 203 of the Medicare and Medicaid Extenders Act of 2010 relating to the treatment of teaching hospitals that are members of the same Medicare graduate medical education affiliated groups for the purpose of determining possible full-time equivalent (FTE) resident cap reductions.","action":"Final rules.","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/2011/08/18/2011-19719.html","cfr_references":[{"chapter":null,"citation_url":null,"part":412,"title":42},{"chapter":null,"citation_url":null,"part":413,"title":42},{"chapter":null,"citation_url":null,"part":476,"title":42}],"citation":"76 FR 51476","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective dates: These final rules are effective on October 1, 2011, except for the provisions of Sec. 412.230(d)(5), which are effective September 1, 2011. Effective July 29, 2011, the interim rule published March 14, 2011, at 76 FR 13515, is confirmed as final without change.","disposition_notes":null,"docket_ids":["CMS-1518-F","CMS-1430-F"],"dockets":[],"document_number":"2011-19719","effective_on":"2011-10-01","end_page":51846,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2011/08/18/2011-19719.xml","html_url":"https://www.federalregister.gov/documents/2011/08/18/2011-19719/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the","images":{"ER18AU11.003":{"large":"https://img.federalregister.gov/ER18AU11.003/ER18AU11.003_large.png","medium":"https://img.federalregister.gov/ER18AU11.003/ER18AU11.003_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.003/ER18AU11.003_original_size.png"},"ER18AU11.025":{"large":"https://img.federalregister.gov/ER18AU11.025/ER18AU11.025_large.png","medium":"https://img.federalregister.gov/ER18AU11.025/ER18AU11.025_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.025/ER18AU11.025_original_size.png"},"ER18AU11.002":{"large":"https://img.federalregister.gov/ER18AU11.002/ER18AU11.002_large.png","medium":"https://img.federalregister.gov/ER18AU11.002/ER18AU11.002_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.002/ER18AU11.002_original_size.png"},"ER18AU11.024":{"large":"https://img.federalregister.gov/ER18AU11.024/ER18AU11.024_large.png","medium":"https://img.federalregister.gov/ER18AU11.024/ER18AU11.024_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.024/ER18AU11.024_original_size.png"},"ER18AU11.005":{"large":"https://img.federalregister.gov/ER18AU11.005/ER18AU11.005_large.png","medium":"https://img.federalregister.gov/ER18AU11.005/ER18AU11.005_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.005/ER18AU11.005_original_size.png"},"ER18AU11.027":{"large":"https://img.federalregister.gov/ER18AU11.027/ER18AU11.027_large.png","medium":"https://img.federalregister.gov/ER18AU11.027/ER18AU11.027_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.027/ER18AU11.027_original_size.png"},"ER18AU11.004":{"original_size":"https://img.federalregister.gov/ER18AU11.004/ER18AU11.004_original_size.gif"},"ER18AU11.026":{"large":"https://img.federalregister.gov/ER18AU11.026/ER18AU11.026_large.png","medium":"https://img.federalregister.gov/ER18AU11.026/ER18AU11.026_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.026/ER18AU11.026_original_size.png"},"ER18AU11.021":{"large":"https://img.federalregister.gov/ER18AU11.021/ER18AU11.021_large.png","medium":"https://img.federalregister.gov/ER18AU11.021/ER18AU11.021_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.021/ER18AU11.021_original_size.png"},"ER18AU11.020":{"large":"https://img.federalregister.gov/ER18AU11.020/ER18AU11.020_large.png","medium":"https://img.federalregister.gov/ER18AU11.020/ER18AU11.020_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.020/ER18AU11.020_original_size.png"},"ER18AU11.001":{"large":"https://img.federalregister.gov/ER18AU11.001/ER18AU11.001_large.png","medium":"https://img.federalregister.gov/ER18AU11.001/ER18AU11.001_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.001/ER18AU11.001_original_size.png"},"ER18AU11.023":{"large":"https://img.federalregister.gov/ER18AU11.023/ER18AU11.023_large.png","medium":"https://img.federalregister.gov/ER18AU11.023/ER18AU11.023_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.023/ER18AU11.023_original_size.png"},"ER18AU11.000":{"large":"https://img.federalregister.gov/ER18AU11.000/ER18AU11.000_large.png","medium":"https://img.federalregister.gov/ER18AU11.000/ER18AU11.000_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.000/ER18AU11.000_original_size.png"},"ER18AU11.022":{"large":"https://img.federalregister.gov/ER18AU11.022/ER18AU11.022_large.png","medium":"https://img.federalregister.gov/ER18AU11.022/ER18AU11.022_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.022/ER18AU11.022_original_size.png"},"ER18AU11.007":{"large":"https://img.federalregister.gov/ER18AU11.007/ER18AU11.007_large.png","medium":"https://img.federalregister.gov/ER18AU11.007/ER18AU11.007_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.007/ER18AU11.007_original_size.png"},"ER18AU11.029":{"large":"https://img.federalregister.gov/ER18AU11.029/ER18AU11.029_large.png","medium":"https://img.federalregister.gov/ER18AU11.029/ER18AU11.029_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.029/ER18AU11.029_original_size.png"},"ER18AU11.006":{"large":"https://img.federalregister.gov/ER18AU11.006/ER18AU11.006_large.png","medium":"https://img.federalregister.gov/ER18AU11.006/ER18AU11.006_medium.png","original_size":"https://img.federalregister.gov/ER18AU11.006/ER18AU11.006_original_size.png"},"ER18AU11.028":{"large":"https://img.federalregister.gov/ER18AU11.028/ER18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