{"abstract":"We are revising 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, and to implement certain provisions made by the Deficit Reduction Act of 2005, the Medicare Improvements and Extension Act, Division B, Title I of the Tax Relief and Health Care Act of 2006, the TMA, Abstinence Education, and QI Programs Extension Act of 2007, and the Medicare Improvements for Patients and Providers Act of 2008. In addition, in the Addendum to this final rule, we describe the 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 generally applicable to discharges occurring on or after October 1, 2008. We also are setting forth the update to the rate-of-increase limits for certain hospitals and hospital units excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2008. In addition to the changes for hospitals paid under the IPPS, this document contains revisions to the patient classifications and relative weights used under the long-term care hospital prospective payment system (LTCH PPS). This document also contains policy changes relating to the requirements for furnishing hospital emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). In this document, we are responding to public comments and finalizing the policies contained in two interim final rules relating to payments for Medicare graduate medical education to affiliated teaching hospitals in certain emergency situations. We are revising the regulatory requirements relating to disclosure to patients of physician ownership or investment interests in hospitals and responding to public comments on a collection of information regarding financial relationships between hospitals and physicians. In addition, we are responding to public comments on proposals made in two separate rulemakings related to policies on physician self-referrals and finalizing these policies.","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/2008/08/19/E8-17914.html","cfr_references":[{"chapter":null,"citation_url":null,"part":411,"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":422,"title":42},{"chapter":null,"citation_url":null,"part":489,"title":42}],"citation":"73 FR 48434","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective Dates: This final rule is effective on October 1, 2008, with the following exceptions: Amendments to Sec. Sec. 412.230, 412.232, and 412.234 are effective on September 2, 2008. Amendments to Sec. Sec. 411.357(a)(5)(ii), (b)(4)(ii), (1)(3)(i) and (ii), and (p)(1)(i)(A) and (B) and the definition of entity in Sec. 411.351 are effective on October 1, 2009.","disposition_notes":null,"docket_ids":["CMS-1390-F","CMS-1531-IFC1","CMS-1531-IFC2","CMS-1385-F4"],"dockets":[],"document_number":"E8-17914","effective_on":"2008-10-01","end_page":49083,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2008/08/19/E8-17914.xml","html_url":"https://www.federalregister.gov/documents/2008/08/19/E8-17914/medicare-program-changes-to-the-hospital-inpatient-prospective-payment-systems-and-fiscal-year-2009","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/E8-17914?publication_date=2008-08-19","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2008-08-19/E8-17914/mods.xml","not_received_for_publication":null,"page_length":650,"page_views":{"count":9909,"last_updated":"2026-07-27 02:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2008-08-19/pdf/E8-17914.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2008-08-19","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2008/08/19/E8-17914.txt","regulation_id_number_info":{"0938-AO65":{"issue":"200710","html_url":"https://www.federalregister.gov/regulations/0938-AO65/revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-part-b-payment-policies-cy-","title":"Revisions to Payment Policies Under the Physician Fee Schedule, and Other Part B Payment Policies CY 2008; Revisions to the Payment Policies of Ambulance Fee Schedule CY 2008","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=200710&RIN=0938-AO65&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"},"0938-AO35":null,"0938-AP15":{"issue":"200804","html_url":"https://www.federalregister.gov/regulations/0938-AP15/changes-to-the-hospital-inpatient-prospective-payment-systems-and-fy-2009-rates-cms-1390-p-","title":"Changes to the Hospital Inpatient Prospective Payment Systems and FY 2009 Rates (CMS-1390-P)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=200804&RIN=0938-AP15&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AO35","0938-AO65","0938-AP15"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS_FRDOC_0001","supporting_documents_count":0,"docket_id":"CMS_FRDOC_0001","regulation_id_number":null,"title":"Recently Posted CMS Rules and Notices.","checked_regulationsdotgov_at":"2011-11-14T15:58:30Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":48434,"subtype":null,"title":"Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals","toc_doc":"Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations","toc_subject":"Medicare Program:","topics":["Administrative practice and procedure","Grant programs-health","Health care","Health facilities","Health insurance","Health maintenance organizations (HMO)","Kidney diseases","Loan programs-health","Medicare","Puerto Rico","Reporting and recordkeeping requirements"],"type":"Rule","volume":73}