evekhm/cms_iom_500 huggingface dataset:
(Medicare Part D Manual)
 The drug itself presents a bona fide public safety hazard (e.g., highly radioactive substance or an environmentally hazardous chemotherapeutic agent) that  requires chain of custody handling to ensure use of appropriate equipment (i.e., safety hood) or persons of special qualifications.    The drug requires special handling to preserve biologic activity and the patient is incapable or unwilling to do so.  (For  instance, a vaccine that must be kept frozen could be a problem if the patient had to transport it a long distance in summer heat.)    The patient presents a high risk of diversion or inappropriate use.  (For instance, giving a heroin addict a vial of morphine.)    The patient has demonstrated unreliability, aversion, or unwillingness in transporting drugs to his doctors office.  (For instance, with respect to dispensing injectable psychiatric meds.)   In the absence of a serious safety concern based on the individual situation, however, there is no basis for denying a prescription presented at a pharmacy based on the availability of Part B coverage in another setting (e.g., physician office).  Finally, it is CMS understanding that the practice of brown -bagging drugs is opposed by medical societies.  CMS continues to urge them to reinforce this message with their members.   Question 3  Most Medicare Advantage plans treat most non -self-injectables as a medical benefit.  Do they have to treat them as a Part D  benefit?   Answer 3 -  If an injectable drug is covered under Part B in a provider or physician office setting, it will continue to be covered under Part B in those settings.  If an injectable drug is not covered in a provider setting (e.g., determined by t he contractor to be usually self -administered), then it will need to be covered under Part D.  In addition, claims for non- Part-B-covered injectables whether usually self -administered or not, when dispensed and submitted by pharmacists could be covered und er Part D.  However, Part D plans could establish medical necessity criteria for limiting coverage of injectable drugs in physician offices.   Question 4 -  What are Part D sponsors to do if their region includes multiple A/B MAC contractor areas and these contractors have differing policies with regard to injectable drugs?
(Medicare Part D Manual)
Question 4 -  What are Part D sponsors to do if their region includes multiple A/B MAC contractor areas and these contractors have differing policies with regard to injectable drugs?   Answer 4  A Part D sponsor will have to modify its coverage based on the variation in Part B coverage across contractor areas within its region.  That is, assume that there are two contr actor areas within a Part D sponsors region, Contractor A and Contractor B.  Further assume that Contractor A covers injectable X when furnished in a physician office but Contractor B does not.  As a result of this difference in Part B coverage, injectabl e X is a Part D drug when furnished in a physician office for members residing in Contractor Bs area, but not in Contractor As area.  In either area, injectable X would be covered under Part D if dispensed by a pharmacy.   For MA -PD plans, rules for selec ting local coverage determinations apply.  That is, if a local MA plans service area includes more than one contractor area, the plan may seek approval from CMS to apply uniformly to all of the plans enrollees local coverage policies that are the most beneficial to enrollees.  Regional MA plans can select a set of local coverage policies to apply uniformly to their enrollees without CMS pre -approval.  In either case, if the selected contractor covers injectable X, the MA -PD would treat injectable X as a b asic A/B benefit.  If the selected contractor does not cover injectable X, the MA -PD would treat it as a Part D drug.   Question 5 What about new injectable drugs?   Answer 5  - As new injectables are approved by the FDA, Part B contractors or CMS would continue to make coverage decisions regarding drugs provided incident to a physicians service based on whether the drug is not usually self -administered.  Injectables not covered under Part B as incident to a physicians service would become Part D drugs.  However, there is no requirement for Part D sponsors to provide coverage of non- Part-B-covered drugs in the physician office setting if the drugs can be safely self -administered and there is no medical necessity for administration in that setting.   INHALAT ION DRUGS
(Medicare Part D Manual)
INHALAT ION DRUGS   Question 1 -  Can claims submitted by a pharmacy for inhalation drugs delivered through metered -dose inhalers be denied based on Part B coverage of inhalation drugs used with a nebulizer?   Answer 1   No.  Since there currently is no coverage under Part B for inhalation drugs delivered through metered- dose inhalers and dispensed by a pharmacy, these drugs would be covered under Part D.  Question 2  Does Part B cover inhalation drugs used with a nebulizer  in the case of  a beneficiary in a hosp ital or SNF bed who does not have Part A coverage, whose Part A coverage for the stay has run out or whose stay is non -covered?   Answer 2   No, inhalation drugs used with a nebulizer  are not covered under Part B under those circumstances because the law li mits coverage under Part Bs DME benefit to those items that are furnished for use in a patients home, and specifies that a hospital or SNF cannot be considered the beneficiarys home for this purpose.  (See list above ( INFUSION DRUGS , Question 3) for other facilities which cannot be considered a beneficiarys home for DME purposes.  VACCINES   Question 1  Are all vaccines covered under Part D?   Answer 1   No.  There are a number of vaccines that remain covered under Part B.  For instance, pneumococcal  and influenza vaccines are not covered under Part D because of Part B coverage.  Hepatitis B vaccine is covered under Part B for individuals at high or intermediate risk; for all other individuals, it would be covered under a Part D benefit.  Part B also covers certain vaccines reasonable and necessary for the treatment of an illness or injury.  All other currently available vaccines and all future preventative vaccines could be covered under Part D.  Question 2  - If a Part D sponsor determines through a p rior authorization program that a hepatitis B vaccine is going to be administered by a physician can the Part D sponsor deny the claim based on Part B coverage in the setting?
(Medicare Part D Manual)
Answer 2   No.  Since the Part B benefit for hepatitis B vaccine is separate fr om the incident to benefit, the determination about whether it is a Part D drug depends solely on characteristics of the beneficiary.  However, if the Part D sponsor determines based on Medicare Part B guidelines that the individual is at high or medium risk for hepatitis B, the claim should be denied.  For all other individuals, the vaccine would be a Part D drug.   Question 3 -  Medicare Part B covers hepatitis B vaccine for high and intermediate risk groups if ordered by a doctor of medicine or osteopa thy, how are these groups defined?   Answer 3  The high risk groups for whom vaccination is covered include:   Individuals with End stage renal disease (ESRD);   Individuals with hemophilia who received Factor VIII or IX concentrates;   Clients of institutions for individuals for the mentally handicapped;   Persons who live in the same household as a hepatitis B Virus (HBV) carrier;   Homosexual men;   Illicit injectable drug abusers   Intermediate risk groups include:   Staff in institutions for the mentally handicapped; and   Workers in health care professions who have frequent contact with blood or blood-derived body fluids during routine work.   ANTIGENS   Question 1  If a pharmacy submits a claim for antigens should a Part D sponsor make payment?  Answer 1   No.  Antigens are covered only under Part B.   BLOOD CLOTTING FACTORS   Question 1  If a pharmacy submits a claim for blood clotting factors should a Part D sponsor make payment?   Answer 1   No.  Blood clotting fact ors are covered under Part A and Part B.  Chapter 6  Appendix C - Summary of Coverage Policy   ATTACHMENT III   Web sites for Part B Coverage Information
(Medicare Part D Manual)
Answer 1   No.  Blood clotting fact ors are covered under Part A and Part B.  Chapter 6  Appendix C - Summary of Coverage Policy   ATTACHMENT III   Web sites for Part B Coverage Information   Pub. 100 -04, Medicare Claims Processing Manual  http://www.cms.gov/Regulations -and-Guidance/Guidance/Manuals/Internet -Only -Manuals -IOMs -Items/C MS018912.html?DLPage=1&DLSort=0&DLSortDir=ascending  Pub. 100 -02, Medicare Benefit Policy Manual   http://www.cms.gov/Regulations -and-Guidance/Guidance/Manuals/Internet -Only -Manuals -IOMs -Items/CMS012673.html?DLPage=1&DLSort=0&DLSortDir=ascending  Medicare Coverage Database  http://www.cms.hhs.gov /mcd/search.asp   A/B MAC and DME MAC contact information  http://www.cms.hhs.gov/apps/contacts /   Chapter 6 - Appendix D   (Rev. 10, Issued: 02- 19-10, Effective/Implementation Date: 03- 01-10)  The Most Commonly Prescribed Drug Classes for the Medicare Population
(Medicare Part D Manual)
Chapter 6 - Appendix D   (Rev. 10, Issued: 02- 19-10, Effective/Implementation Date: 03- 01-10)  The Most Commonly Prescribed Drug Classes for the Medicare Population   3- HYDROXY - 3- METHYLGLUTARYL COENZYME A (HMG COA) REDUCTASE INHIBITORS  HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (THYROID)  5 ALPHA - REDUCTASE INHIBITORS  INSULIN, INTERMEDIATE - ACTING  ADENOSINE DIPHOSPHATE P2Y12 INHIBITORS  INSULIN, LONG - ACTING  ALPHA 1 - ADRENERGIC BLOCKING AGENTS  INSULIN, SHORT - ACTING  ALPHA - ADRENERGIC AGONISTS  LAXATIVES  ALPHA - ADRENERGIC AGONISTS, OPHTHALMIC  LEUKOTRIENE RECEPTOR ANTAGONISTS  ANGIOTENSIN II RECEPTOR ANTAGONISTS  LINCOMYCIN ANTIBACTERIALS  ANGIOTENSIN - CONVERTING ENZYME (ACE) INHIBITORS  LOCAL ANESTHETICS  ANTI - INFLAMMATORIES, INHALED CORTICOSTEROIDS  LOOP DIURETICS  ANTIARRHYTHMICS - CLASS IA/ II/ III/ IV  LTC DRUGS - AMINO DERIVATIVE PENICILLINS (CHEWABLE)  ANTICHOLINERGICS  LTC DRUGS - AMINO DERIVATIVE PENICILLINS (ORAL LIQUID)  ANTICOAGULANTS  LTC DRUGS - ANTIEMETICS (SUPPOSITORY)  ANTIDEPRESSANTS, OTHER  LTC DRUGS - BRONCHODILATORS, SYMPATHOMIMETIC (SHORT - ACTING SOLUTION)  ANTIEMETICS  LTC DRUGS - HISTAMINE2 (H2) BLOCKING AGENTS (ORAL LIQUID)  ANTIHERPETIC AGENTS  LTC DRUGS - LOOP DIURETICS (ORAL LIQUID)  ANTISPASMODICS, GASTROINTESTINAL  LTC DRUGS - MACROLIDES (ORAL LIQUID)  ANTISPASMODICS, URINARY  LTC DRUGS - NONSTEROIDAL ANTI - INFLAMMATORY DRUGS (ORAL LIQUID)  ANTISPASTICITY AGENTS  MACROLIDES  ANXIOLYTICS  MISCELLANEOUS ANTIBACTERIALS  ATYPICALS  NICOTINIC ACID  AZOLE ANTIFUNGALS, ORAL  NITROFURAN ANTIBACTERIALS  BETA - ADRENERGIC BLOCKING AGENTS WITH VASODILATING PROPERTIES  NONSELECTIVE BETA - ADRENERGIC BLOCKING AGENTS  BETA - ADRENERGIC BLOCKING AGENTS, OPHTHALMIC  NONSTEROIDAL ANTI - INFLAMMATORY DRUGS  BETA - LACTAM, PENICILLINS  OPHTHALMIC AMINOGLYCOSIDES  BIGUANIDES  OPHTHALMIC ANTI - ALLERGY AGENTS
(Medicare Part D Manual)
BIPOLAR AGENTS  OPHTHALMIC PROSTAGLANDIN AND PROSTAMIDE ANALOGS  BISPHOSPHONATES, ORAL  OPIOID ANALGESICS, LONG - ACTING  BOWEL PREPARATION PRODUCTS  OPIOID ANALGESICS, SHORT - ACTING  BRONCHODILATORS, ANTICHOLINERGIC  OPIOID ANALGESICS, SHORT - ACTING WITH APAP  BRONCHODILATORS, SYMPATHOMIMETIC (LONG - ACTING)  PHOSPHODIESTERASE III/ ADENOSINE UPTAKE INHIBITORS  BRONCHODILATORS, SYMPATHOMIMETIC (SHORT - ACTING)  POLYENE ANTIFUNGALS  CALCIUM CHANNEL BLOCKING AGENTS (NON - DIHYDROPYRIDINES)  POTASSIUM SUPPLEMENTS  CALCIUM CHANNEL MODIFYING AGENTS  POTASSIUM - SPARING DIURETICS  CARDIOSELECTIVE BETA - ADRENERGIC BLOCKING AGENTS  PROGESTINS  CARDIOVASCULAR AGENTS, OTHER  PROTECTANTS, GASTROINTESTINAL  CEPHALOSPORIN ANTIBACTERIALS, 1ST GENERATION  PROTON PUMP INHIBITORS  CEPHALOSPORIN ANTIBACTERIALS, 2ND GENERATION  QUINOLONES  CHOLESTEROL ABSORPTION INHIBITORS  SEDATIVES/ HYPNOTICS  CHOLINESTERASE INHIBITORS  SELECTIVE ESTROGEN RECEPTOR MODIFIERS  DIHYDROPYRIDINES  SEROTONIN/ NOREPINEPHRINE REUPTAKE INHIBITORS  DOPAMINE AGONISTS, NONERGOT  SKELETAL MUSCLE RELAXANTS  DOPAMINE PRECURSORS  SMOKING CESSATION AGENTS  ESTROGENS  SODIUM CHANNEL INHIBITORS  FIBRATES  SULFONAMIDES  GAMMA - AMINOBUTYRIC ACID (GABA) AUGMENTING AGENTS  SULFONYLUREAS  GLUCOCORTICOIDS, OPHTHALMIC  TETRACYCLINES  GLUCOCORTICOIDS - SYSTEMIC  THIAZIDE DIURETICS  GLUCOCORTICOIDS - TOPICAL - MEDIUM POTENCY  THIAZOLIDINEDIONES  GLUCOCORTICOIDS -TOPICAL -HIGH POTENCY  TRICYCLICS  GLUTAMATE PATHWAY MODIFIERS  VASODILATORS, DIRECT - ACTING ARTERIAL  GLUTAMATE REDUCING AGENTS  VASODILATORS, DIRECT - ACTING ARTERIAL/ VENOUS  HISTAMINE1 (H1) BLOCKING AGENTS, MILDLY/ NON - SEDATING  XANTHINE OXIDASE INHIBITORS  HISTAMINE2 (H2) BLOCKING AGENTS       Chapter 6 - Appendix E  Sample Transition Supply Scenarios and Eligibility  (Rev. 18, Issued: 01- 15-16, Effective:  01-15-16; Implementation:  01-15-16)
(Medicare Part D Manual)
Chapter 6 - Appendix E  Sample Transition Supply Scenarios and Eligibility  (Rev. 18, Issued: 01- 15-16, Effective:  01-15-16; Implementation:  01-15-16)  A Part D sponsor must provide for an appropriate transition process for certain enrollees who are prescribed Part D drugs that are non- formulary in order to promote continuity of c are and avoid interruptions in drug therapy while a switch to a therapeutically equivalent medication or the completion of an exception request to maintain coverage of an existing drug based on medical necessity reasons can be effectuated .  See Sections 30.4  30.4.11 for additional guidance.  Coverage Year 1  Coverage Year 2  Transition Eligible?  Sponsor A  Plan ABC (on formulary)   Sponsor A  Plan ABC (on formulary)  No No change in formulary   Sponsor A  Plan ABC (non- formulary and/or new UM criteria)  Yes Negative change; potential interruption of coverage  Sponsor A  Plan EFG (on formulary)  No No change in formulary   Sponsor A  Plan EFG (non- formulary and/or UM criteria)  Yes Non- formulary change; potential interruption of coverage  Sponsor B  Plan JKL (on formulary)  No No interruption of coverage   Sponsor B  Plan JKL (non- formulary and/or UM criteria)  Yes Non- formulary change; potential interruption of coverage  Sponsor A  Plan  DEF (non-formulary)  [filled  under exception]  Any Sponsor  Any Plan  (on formulary)   No No interruption of coverage   Sponsor A  Plan DEF (non- formulary)   Yes Plans may approve an exception or transition to a formulary item prior to the new contract year  Sponsor A  Plan DEF (on formulary, with UM criteria)   Yes Plans may approve an exception or transition to a formulary item prior to the new contract year  Sponsor B  Plan MNO (non -formulary and/or UM criteria)  Yes Potential interruption of coverage     Transmittals Issued for this Chapter   Rev #  Issue Date  Subject  Impl Date  CR#  R18PDB  01/15/2016  Chapter 6 Part D Drugs and Formulary Requirements  01/15/2016  01/15/2016  R10PDB  02/12/2010  Chapter 6 Part D Drugs and Formulary Requirements  03/01/2010  N/A R2PDB  07/18/2008  Initial release of chapter  07/18/2008  N/A
(Medicare Benefit Policy Manual)
Medicare Benefit Policy Manual  Chapter 2 - Inpatient Psychiatric Hospital Services  Table of Contents  (Rev. 253, 12-14-18)  Transmittals for Chapter 2   10 - Inpatient Psychiatric Facility Services  10.1 - Background 10.2 - Statutory Requirements  10.3 - Affected Medicare Providers  10.4 - Conditions for Payment under the IPF Prospective Payment System  20 - Admission Requirements  30 - Medical Records Requirements 30.1 - Development of Assessment/Diagnositic Data  30.2 - Psychiatric Evaluation  30.2.1 - Certification and  Recertification Requirements  30.2.1.1 - Certification  30.2.1.2 - Recertification  30.2.1.3 -  Delayed/Lapsed Certification and Recertification  30.2.2 - Active Treatment  30.2.2.1 - Principals for Evaluating a Period of Active Treatment  30.2.3 - Services Supervised and Evaluated by a Physician  30.3 - Treatment Plan  30.3.1 - Individualized Treatment or Diagnostic Plan 30.3.2 - Services Expected to Improve the Condition or for Purpose of Diagnosis  30.4 - Recording Progress  30.5 - Discharge Planning and Discharge Summary  40 - Personnel Requirements  40.1 - Director of Inpatient Psychiatric Services; Medical Staff 40.2 - Nursing Services  50 - Psychological Services  60 - Social Services  70 - Therapeutic Activities 80 - Benefit Limits in Psychiatric Hospitals   90 - Benefits Exhaust  10 - Inpatient Psychiatric Facility Services (Rev. 59, Issued: 11- 09-06, Effective: 01- 01-05, Implementation: 12 -04-06)
(Medicare Benefit Policy Manual)
10.1  Background (Rev. 253, Issued: 1 2- 14-18, Effective: 01- 16-19, Implementation: 01 - 16-19) This section and its subsections provide instructions about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS).  The IPF PPS replaced the reasonable cost/Tax Equity and Fiscal Responsibility Act (TEFRA) based payments subject to TEFRA limits under 1886 (b)  of the Social Security Act (the Act) for discharges beginning on and after the first day of the IPFs first cost reporting period beginning on or after January 1, 2005.  The IPF PPS, codified at 42 CFR 412 , Subpart N, provides payment for inpatient psychiatric treatment when provided to a patient in psychiatric hospitals, and distinct part psychiatric units of acute care hospitals and critical access hospitals (CAHs).  Psychiatric hospitals and psychiatric units that used to be paid reasonable -cost under TEFRA, 1886(b) of the Act, are now paid under the IPF PPS.  As described in 42 CFR 412.23(a), a psychiatric hospital must meet the following requirements to be excluded from the Inpatient Prospective Payment System (IPPS) and paid under the IPF PPS:  (1) Be primarily engaged in providing, by or under the supervision of a psychiatrist, psychiatric services for the diagnosis and treatment of mentally ill persons; and (2) Meet the conditions of participation for hospitals and special conditions of participation for psychiatric hospitals set forth in 42 CFR part 482.   As described in 42 CFR 412.27, a psychiatric unit must meet the following requirements to be excluded from the IPPS payment system, and paid under the IPF PPS:  (1) Admit only patients whose admission to the unit is required for active treatment, of an intensity that can be provided appropriately only in an inpatient hospital setting, of a psychiatric principal diagnosis that is listed in the International Classification of Diseases, Ten th Revision, Clinical Modification.  (2) Furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, and therapeutic activities.  (3) Maintain medical records that permit determination of the degree and intensity of the treatment provided to individuals who are furnished services in the unit, and that meet the requirements given in section 30 of this chapter.
(Medicare Benefit Policy Manual)
(4) Meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning, as given in section 40 of this chapter.   The term "inpatient psychiatric facility services" means inpatient hospital services furnished to a patient of an inpatient psychiatric facility.  IPFs are certified under Medicare as inpatient psychiatric hospitals and distinct psychiatric units of acute care hospitals and C AHs.  . 10.2 - Statutory Requirements  (Rev. 253, Issued: 1 2- 14-18, Effective: 01- 16-19, Implementation: 01 - 16-19)  Section 124 of the Medicare, Medicaid, and SCHIP (State Children's Health Insurance Program) Balanced Budget Refinement Act of 1999 (BBRA) ( Pub. L.106- 113), mandated that the Secretary -(1) develop a per diem PPS for inpatient hospital services furnished in psychiatric hospitals and psychiatric units; (2) include in the PPS an adequate patient classification system that reflects the differences in patient resource use and costs among psychiatric hospitals and psychiatric units; (3) maintain budget neutrality; (4) is permitted  to require psychiatric hospitals and psychiatric units to submit information necessary for the development of the PPS; a nd (5) submit a report to the Congress describing the development of the PPS.  Section 124 of the BBRA also required that the IPF PPS be implemented for cost reporting periods beginning on or after October 1, 2002. The Medicare Prescription Drug, Improveme nt, and Modernization Act of 2003 (MMA) (Pub. L. 108- 173), section 405(g) authorized extend ing the IPF PPS to distinct part psychiatric units of CAHs, effective for cost reporting periods beginning on or after October 1, 2004.  10.3 - Affected Medicare Pro viders  (Rev. 253, Issued: 1 2- 14-18, Effective: 01- 16-19, Implementation: 01 - 16-19)
(Medicare Benefit Policy Manual)
10.3 - Affected Medicare Pro viders  (Rev. 253, Issued: 1 2- 14-18, Effective: 01- 16-19, Implementation: 01 - 16-19)  IPFs are certified under Medicare as inpatient psychiatric hospitals, which means, an institution that is primarily engaged in providing, by or under the supervision of a physician, psychiatric services for the diagnosis and treatment of mentally ill patie nts, maintains clinical records necessary to determine the degree and intensity of the treatment provided to the mentally ill patient, and meets staffing requirements sufficient to carry out active programs of treatment for individuals who are furnished ca re in the institution.  A distinct part psychiatric unit may also be certified if it meets the clinical record and staffing requirements in 42 CFR 412.27 .   The regulations at 42 CFR 412.402  define an IPF as a hospital that m eets the requirements specified in 42 CFR 412.22 and 42 CFR412.23(a) , 42 CFR 482.60, 42 CFR 482.61 , and 42 CFR 482.62, and a unit that meet s the requirements specified in 42 CFR 412.22 , 42 CFR 412.25 , and 42 CFR 412.27 .  The IPF PPS does not change the basic criteria for a hospital or hospital unit to be classified as a psychiatric hospital or psychiatric unit that is excluded from the hospital prospective payment systems under 1886(d)  and 1886(g) of the Act, nor does it revise the survey and certification procedures applicable to entities seeking this classification.   The provider number ranges (Online Survey and Certification and Reporting System (OSCAR) number) for IPFs are from xx -4000 through xx- 4499, xx- Sxxx, and xx- Mxxx.    The following hospitals are not included in IPF PPS.   Veterans Administration hospitals; s ee 42 CFR 412.22 (c) .
(Medicare Benefit Policy Manual)
The following hospitals are not included in IPF PPS.   Veterans Administration hospitals; s ee 42 CFR 412.22 (c) .   Hospitals that are reimbursed under state cost control systems approved under 42 CFR Part 403 ; Psychiatric hospitals (provider numbers xx -4000 -  xx-4499) in the State of Maryland are paid under the IPF PPS.  Psychiatric distinct part units located in an acute care hospital in Maryland identified by S in the th ird position of the OSCAR number are waived from the IPF PPS, as are the acute hospital in which they are located.  Currently there are no CAHs in Maryland.    Hospitals that are reimbursed in accordance with demonstration projects authorized under 42 CFR 402(a)  of Pub.L. 90- 248 (42 U. S. C. 1395b- 1) or 222(a) of Pub.L. 92- 603 (42 U. S. C. 1395b- 1); IPFs in acute care hospitals that are paid in accordance with demonstration projects are paid in accordance with the demonstration project;    Nonparticipating hospitals furnishing emergency services to Medicare beneficiaries. See 42 CFR 412.22(c ). Payments to foreign hospitals are made in accordance with the provisions set forth in 42 CFR 413.74 .  10.4 - Conditions for payment under the IPF Prospective Payment System  (Rev. 253, Issued: 1 2- 14-18, Effective: 01- 16-19, Implementation: 01 - 16-19)