---
kind: "section"
citation: "42 C.F.R. § 413.184"
title: "42"
number: "413.184"
heading: "Payment exception: Pediatric patient mix."
url: "https://uscodex.org/cfr/42/413.184"
---

# §413.184. Payment exception: Pediatric patient mix.

- (a) **Qualifications.** To qualify for an exception to its prospective payment rate based on its pediatric patient mix a facility must demonstrate that—
  - (1) At least 50 percent of its patients are individuals under 18 years of age;
  - (2) Its nursing personnel costs are allocated properly between each mode of care;
  - (3) The additional nursing hours per treatment are not the result of an excess number of employees;
  - (4) Its pediatric patients require a significantly higher staff-to-patient ratio than typical adult patients; and
  - (5) These services, procedures, or supplies and their per treatment costs are clearly prudent and reasonable when compared to those of pediatric facilities with a similar patient mix.
- (b) **Documentation.**
  - (1) A pediatric ESRD facility must submit a listing of all outpatient dialysis patients (including all home patients) treated during the most recently completed and filed cost report (in accordance with cost reporting requirements under [§ 413.198](/cfr/42/413.198.md)) showing—
    - (i) Age of patients and percentage of patients under the age of 18;
    - (ii) Individual patient diagnosis;
    - (iii) Home patients and ages;
    - (iv) In-facility patients, staff-assisted, or self-dialysis;
    - (v) Diabetic patients; and
    - (vi) **Patients isolated because of contagious disease.**
  - (2) **The facility also must—**
    - (i) Submit documentation on costs of nursing personnel (registered nurses, licensed practical nurses, technicians, and aides) incurred during the most recently completed fiscal year cost report showing—
      - (A) Amount each employee was paid;
      - (B) Number of personnel;
      - (C) Amount of time spent in the dialysis unit; and
      - (D) **Staff-to-patient ratio based on total hours, with an analysis of productive and nonproductive hours.**
    - (ii) Submit documentation on supply costs incurred during the most recently completed fiscal or calendar year cost report showing—
      - (A) By modality, a complete list of supplies used routinely in a dialysis treatment;
      - (B) The make and model number of each dialyzer and its component cost; and
      - (C) **That supplies are prudently purchased (for example, that bulk discounts are used when available).**
    - (iii) Submit documentation on overhead costs incurred during the most recently completed fiscal or calendar year cost reporting year showing—
      - (A) The basis of the higher overhead costs;
      - (B) The impact on the specific cost components; and
      - (C) **The effect on per treatment costs.**

## Notes

### Amendments

[62 FR 43668, Aug. 15, 1997, as amended at 70 FR 70331, Nov. 21, 2005]

### Source

Source: 62 FR 43668, Aug. 15, 1997, as amended at 86 FR 73515, Dec. 27, 2021, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395m, 1395x(v), 1395x(kkk), 1395hh, 1395rr, 1395tt, and 1395ww.

### Source

Source: 51 FR 34793, Sept. 30, 1986, unless otherwise noted.

### Amendments

[62 FR 43668, Aug. 15, 1997, as amended at 70 FR 70331, Nov. 21, 2005]