r other qualified individual in accordance with state scope of practice laws.”). 42 C.F.R. § 485.530. 42 U.S.C. § 1395x(kkk)(1)(A), (2)(A)-(B); 42 C.F.R. § 485.502. 42 C.F.R. § 485.524(a). 42 C.F.R. § 485.524(b)(3). 42 C.F.R. 485.510(a)-(b). 42 C.F.R. § 526; 42 C.F.R. § 536. Rural hospitals not designated as a CAH are paid on prospective payment systems for both inpatient stays under Medicare Part A (the inpatient prospective payment system (“IPPS”) is categorized into different diagnosis-related groups (“DRGs”) to categorize patient stays) and outpatient care pursuant to the OPPS, whereas CAHs receive “cost-based” reimbursement for 101% of their reasonable costs for most inpatient and outpatient services. Information for Critical Access Hospitals, Medicare Learning Network MLN006400, at 5 (April 2023), available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CritAccessHospfctsht.pdf. 42 U.S.C. § 1395m(x)(1); 42 C.F.R. § 419.92(a).See 87 Fed. Reg. 71748, 72162 (Nov. 23, 2022); 42 U.S.C. § 1395l(t)(1)(B). 42 U.S.C. § 1395m(x)(2)(B). 42 U.S.C. § 1395m(x)(2); see also MLN Fact Sheet: Rural Emergency Hospitals, Medicare Learning Network MLN2259384 (Oct. 2022), available at https://www.cms.gov/files/document/mln2259384-rural-emergency-hospitals.pdf. 42 U.S.C. § 1395m(x)(2)(D). 42 C.F.R. § 419.92(c). Those services excluded from payment under the OPPS, and which cannot therefore be considered REH services, are set forth at 42 C.F.R. § 419.22. See also 87 Fed. Reg. 71748, 72164 (Nov. 23, 2022) (“However, section 125 of the CAA is silent on how CMS should pay for other services furnished by an REH, such as services paid under the Clinical Laboratory Fee Schedule (CLFS) or outpatient therapy services, that may be provided on an outpatient basis by hospital outpatient departments, but that are not covered OPD services. . . .”).Id. Stark Law generally prohibits a physician from making referrals to an entity for certain “designated health services” (“DHS”) when the ph

t, and structure” in calculating the Medicare fraction for purposes of Medicare Part A benefits, without any mention of Chevron); Vanda Pharms., Inc. v. Ctrs. for Medicare & Medicaid Servs.,98 F.4th 483 (2024) (holding that CMS’s definitions of “line-extension” and “new formulation” did not conflict with the Medicaid statute).[5]Loper Bright Enterprises v. Raimondo, No. 22-451, slip op. 35 (June 28, 2024).[6]Id. at slip. op. 14 (citing 5 U.S.C. §§ 706(2)(A), (E)).[7]Id. at slip op. 18.[8]Id. at slip op. 25 (citing Skidmore v. Swift & Co., 323 U.S. 134 (1944).[9]See KFF, Medicare 101 (published May 28, 2024), available here.[10]See 42 U.S.C. §§ 1395–1395lll.[11]Loper Bright Enterprises v. Raimondo, No. 22-451, slip op. 34 (June 28, 2024).[12]See Am. Health Care Ass’n v. Becerra, No. 24-cv-114 (N.D. Tex) (challenging the rule issued at 89 Fed. Reg. 40876 (May 10, 2024).[13] Conditions of Participation, 42 C.F.R. §§ 485.500-485.546 (Subpart E), and Payments, §§ 419.90-419.95 (Subpart J), 87 Fed. Reg. 71748, 72292-93 (Nov. 23, 2022),[14] 21 C.F.R. § 809, 89 Fed. Reg. 37286 (May 6, 2024).[15]See, e.g., Baptist Mem’l Hosp. – Golden Triangle, Inc. v. Azar, 956 F.3d 689 (5th Cir. 2020) (deferring to CMS’s rule addressing “costs incurred” for calculating Medicaid Disproportionate Share Hospital payments).[View source.]