42 U.S.C. § 1395f — Conditions of and limitations on payment for services

(a) Requirement of requests and certifications. Except for the rules in subsections (d) and (g) and in section 1395mm of this title, payment for services for an individual may be made only to a provider eligible under section 1395cc of this title. It may be made only if all applicable requirements below are met. The terms "provider of services," "skilled nursing care," "confined to his home," and other terms used here but defined elsewhere are not defined in this section; the cross-referenced provisions control their meanings. (1) A written request for payment must be filed. The individual must sign it unless the Secretary finds that signing is impracticable. The request must be in the form and manner, and filed by the person or persons, required by the Secretary’s regulations. It must be filed no later than the end of the 1-calendar-year period after the service date. The Secretary may specify exceptions to this 1-year period. (2) An enrolled physician must certify the facts required by this paragraph. For services described in subparagraph (B), the certifying person may also be a nurse practitioner, clinical nurse specialist, or physician assistant who is defined in section 1395x(aa)(5), has no direct or indirect employment relationship with the facility, and works with a physician. For services described in subparagraph (C), the certifying person may be a physician, nurse practitioner, clinical nurse specialist, or physician assistant working as State law allows. The person must be enrolled under section 1395cc(j). If services last over time, the person must recertify them in the cases, at the times, and with the supporting material required by regulation. For inpatient hospital services, the first recertification must be made no later than the 20th day of the period. The certification must establish the following: (A) Inpatient psychiatric hospital services must have been required on an inpatient basis, by or under a physician’s supervision, to treat the individual’s psychiatric condition. Either the treatment could reasonably be expected to improve the condition, or an inpatient diagnostic study was medically required and the services were needed for that study. (B) Post-hospital extended care services must have been required because the individual needed daily skilled nursing care, provided directly by or requiring supervision of skilled nursing personnel, or other skilled rehabilitation services. As a practical matter, those services must be services that can be provided only in an inpatient skilled nursing facility. They must concern a condition for which the individual was receiving inpatient hospital services before transfer, including services that would have been inpatient hospital services if the institution had met section 1395x(e)(6) and (9), or a condition that arose after transfer while the individual was still in the facility for treatment of the earlier condition or conditions. (C) Home health services must have been required because the individual was confined to the home, except while receiving the items and services referred to in section 1395x(m)(7), and needed one of the following: intermittent skilled nursing care, other than only drawing blood by venipuncture; physical therapy; speech therapy; or, if the individual previously received home health services because of a need for that care or therapy and no longer needs that care or therapy, occupational therapy. A plan for the services must have been established and periodically reviewed by a physician, nurse practitioner, clinical nurse specialist, or physician assistant, as applicable. The services must have been furnished while the individual was under the care of one of those practitioners. For a physician certification made after January 1, 2010, or for a certification by a nurse practitioner, clinical nurse specialist, or physician assistant after a date set by the Secretary (no later than 6 months after March 27, 2020), the certifying practitioner must first document a face-to-face encounter with the individual within a reasonable time set by the Secretary. The encounter may use telehealth subject to section 1395m(m), but this requirement does not apply to an encounter incident to the services involved. The encounter may be with a physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife defined in section 1395x(gg) and authorized by State law, or physician assistant. For this subparagraph, an individual is "confined to his home" if illness or injury restricts the individual’s ability to leave home except with another person’s help or a supportive device such as crutches, a cane, a wheelchair, or a walker, or if leaving home is medically contraindicated. The person need not be bedridden. The condition must normally prevent leaving home, and leaving must require a considerable and taxing effort. Receiving health care does not disqualify the individual. This includes regular participation in therapeutic, psychosocial, or medical treatment in a State-licensed, State-certified, or accredited adult day-care program. Other absences do not disqualify the individual if they are infrequent or relatively short. An absence for a religious service is treated as infrequent or short. This section does not otherwise define the quoted term. (D) For inpatient hospital services connected with caring for, treating, filling, removing, or replacing teeth or structures directly supporting teeth, the individual must require hospitalization because of the underlying medical condition and clinical status or because of the seriousness of the dental procedure. (3) For inpatient hospital services, other than inpatient psychiatric hospital services, furnished over time, a physician must certify that the services had to be provided on an inpatient basis for the individual’s medical treatment, or that an inpatient diagnostic study was medically required and the services were needed for that purpose. Regulations may limit which cases require certification, its frequency, and its supporting material. The first required certification must be supplied no later than the 20th day of the period. (4) For inpatient psychiatric hospital services, the hospital records must show that the services were furnished while the individual received intensive treatment services, admission and related services needed for a diagnostic study, or equivalent services. This section does not define "equivalent services." (5) For inpatient hospital services furnished after the 20th day of a continuous period, there must not have been, when the individual was admitted, a decision under section 1395cc(d) based on a finding that the hospital was not conducting utilization review of long-stay cases. (6) During a continuous period of inpatient hospital or post-hospital extended care services, the physician members of the utilization-review committee or group described in section 1395x(k)(4) must not have found, under the utilization-review system, that further inpatient hospital services or further post-hospital extended care services were not medically necessary. If such a finding was made, payment may still be made for services furnished before the fourth day after the hospital or skilled nursing facility received notice of the finding. (7) For hospice care, all of the following requirements apply. (A) During the first 90-day period, the individual’s attending physician, as defined in section 1395x(dd)(3)(B) and not including a nurse practitioner or physician assistant for this subparagraph, and the hospice medical director or a physician member of the interdisciplinary group described in section 1395x(dd)(2)(B) must each certify in writing at the beginning of the period that the individual is terminally ill, as defined in section 1395x(dd)(3)(A). Each certification must be based on the certifying physician’s clinical judgment about the normal course of the illness. During each later 90-day or 60-day period, the medical director or physician described above must recertify at the beginning of the period that the individual is terminally ill, based on that clinical judgment. (B) Before the hospice program provides care, or arranges for it, a written hospice-care plan must be established for the individual. The attending physician and the hospice medical director, together with the interdisciplinary group, must periodically review it. (C) The hospice care must be or have been provided under that plan. (D) On and after January 1, 2011, a hospice physician or nurse practitioner must have a face-to-face encounter with the individual before the 180th-day recertification and before each later recertification under subparagraph (A)(ii). The purpose is to determine continued eligibility for hospice care. The practitioner must attest, under procedures set by the Secretary, that the visit occurred. During the emergency period described in section 1320b-5(g)(1)(B), and, if that emergency period ends before December 31, 2024, from the next day through December 31, 2027, the Secretary may allow this encounter to occur through telehealth. For an encounter on or after January 1, 2027, a hospice claim must include one or more Secretary-specified modifiers or codes showing that the encounter used telehealth. This telehealth rule does not apply to an encounter on or after January 31, 2026, if the individual is in an area under a hospice-enrollment moratorium under section 1395cc(j)(7), receives hospice care from a provider under enhanced oversight under section 1395cc(j)(3), or is seen by a hospice physician or nurse practitioner who is not enrolled under section 1395cc(j) and is not an "opt-out physician or practitioner" as defined in section 1395a(b)(6)(D). For hospice care provided for more than 180 days by a program whose number of such cases is more than a Secretary-specified percentage of all such cases for all programs under this subchapter, the care must be medically reviewed under Secretary-set procedures. On and after October 6, 2014, the same review is required when the program’s number of cases lasting more than 180 days is more than a Secretary-specified percentage of all such cases provided by that program under this subchapter. (8) For inpatient critical access hospital services, a physician must certify that the individual could reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital. Regulations may treat the certification and recertification requirements of paragraph (2) as satisfied by a later certification of the kind described in paragraph (2)(A), (B), (C), or (D), whichever applies, if the certification includes the medical and other evidence required by regulation. For home health services furnished by a nongovernmental home health agency, the Secretary must issue regulations about certification and the establishment and review of the plan. Those regulations had to take effect no later than July 1, 1981. Regulations implementing the CARES Act amendments had to take effect no later than 6 months after March 27, 2020. Except for a sole community home health agency as determined by the Secretary, the regulations must bar a physician, nurse practitioner, clinical nurse specialist, or physician assistant from certifying or establishing or reviewing the plan if that person has a significant ownership interest in, or significant financial or contractual relationship with, the agency. Serving as an uncompensated agency officer or director does not by itself create such an interest or relationship. For documentation supporting a physician’s certification or recertification under paragraph (2) made on or after January 1, 2019, and for documentation supporting certification or recertification by a nurse practitioner, clinical nurse specialist, or physician assistant made no later than 6 months after March 27, 2020, the Secretary may use, when appropriate, the home health agency’s medical record as supporting material. This is in addition to the certifying practitioner’s medical record and, when the individual came directly from an acute or post-acute care facility, that facility’s medical record. (b) Amount paid to provider of services. Except for a hospice program providing hospice care, a critical access hospital providing inpatient critical access hospital services, and a home health agency being paid for durable medical equipment, and subject to sections 1395e, 1395ww, and 1395fff, payment for covered services is determined as follows. (1) Unless paragraph (3) applies, payment is the lesser of two amounts: (A) the reasonable cost of the services, determined under section 1395x(v) and further limited by section 1395rr(b)(2)(B); or (B) the provider’s customary charges for the services. (2) If a public provider supplies the services, or another provider shows to the Secretary’s satisfaction that a significant part of its patients are low-income and asks to be paid under this paragraph, the payment is based on the reasonable-cost items specified in the Secretary’s regulations. The Secretary selects the amount that fairly compensates the provider for the services when the provider supplies them free or for nominal public charges. (3) Special State demonstration systems may continue. This applies if some or all hospitals in a State were reimbursed under a system approved as a demonstration project under section 402 of the Social Security Amendments of 1967 or section 222 of the Social Security Amendments of 1972; the rate of increase in those hospitals’ costs per inpatient admission for people entitled to Part A benefits was no greater than the nationwide rate during the project; and either the State has legal authority and elects to use the system or the hospitals operate it by voluntary agreement and elect to continue it. Subject to section 1395ww(d)(3)(B)(ix)(III), the Secretary may continue paying those hospitals under the system until the Secretary finds that (A) a third-party payer reimburses a hospital on another basis, or (B) from January 1, 1981, through the latest year with annual data, the hospitals’ aggregate rate of increase in cost per Part A inpatient admission is greater than the corresponding nationwide rate. Incentive payments and payment adjustments under section 1395ww(b)(3)(B)(ix) or (n) must be counted in applying this paragraph. If a State has continuously operated such a demonstration system since July 1, 1977, the Secretary must continue payments until the first day of the 37th month beginning after the Secretary determines and notifies the Governor that condition (A) or (B) occurred. By the end of that 36-month period, if the Secretary finds from the Governor’s evidence that neither condition still applies, payments continue without interruption. If either condition still applies, the Secretary must collect net excess reimbursement for the 36 months and give the State a reasonable transition period, no longer than 2 years, to move to the national payment system. Net excess reimbursement is based on the net difference between the State system’s rate of cost increase and the nationwide rate, including cumulative savings based on that difference from January 1, 1981, through the initial notice date. (c) No payments to Federal providers of services. Subject to section 1395qq, Part A may not pay a Federal provider, except a provider the Secretary finds serves the public generally as a community institution or agency. Part A also may not pay any provider for an item or service that a United States law or contract requires that provider to furnish at public expense. The exceptions in subsections (d) and (h) still apply. (d) Payments for emergency hospital services. (1) Medicare may pay a hospital that has no agreement under this subchapter for inpatient hospital services furnished during a calendar year to a person entitled to hospital insurance benefits under section 426. The hospital may furnish the services itself or under arrangements defined in section 1395x(w). The services must be emergency services; the Secretary would have had to pay if the hospital had an agreement and met the other payment conditions; and the hospital must elect to claim payment for all of its inpatient emergency services and the emergency outpatient services referred to in section 1395n(b) furnished during that year. Payment is limited to the amount under subsection (b). The hospital must agree to follow section 1395cc(a) for the emergency services. (2) If the hospital does not elect to claim payment under paragraph (1), the individual may seek payment on an itemized bill. The individual must be entitled to hospital insurance benefits, the services must be emergency services described in paragraph (1), and payment must be unavailable solely because of the hospital’s election. The individual must file an application within the time and in the form and manner, and with the information and support, required by the Secretary’s regulations. (3) Subject to section 1395e, the amount under paragraph (2) is 60 percent of the lesser of the hospital’s reasonable charges for routine services in the occupied accommodations or in semiprivate accommodations, plus 80 percent of the hospital’s reasonable charges for ancillary services. If the hospital does not separately charge for routine and ancillary services, payment may be based on two-thirds of the hospital’s reasonable charges for all services received, but may not exceed the charges that would have applied in semiprivate accommodations. "Routine services" means regular room, dietary, and nursing services, minor medical and surgical supplies, and use of equipment and facilities for which a separate charge is not customary. "Ancillary services" means special services for which a charge is customarily made in addition to routine services. This section does not define those quoted terms beyond this description. (e) Payment for inpatient hospital services before notice of noneligibility. Even if an individual was not entitled to Part A payment, the hospital must be paid for inpatient hospital services furnished before the Secretary notified the hospital of that fact, unless the hospital declines payment or, when the individual or someone acting for the individual already paid, fails to refund that payment within the Secretary’s deadline. This rule applies only when section 1395d is the sole reason payment is barred; the hospital follows this subchapter and its regulations; and the hospital acted in good faith, without knowing of the lack of entitlement, and reasonably assumed that entitlement existed. Payment is unavailable for services furnished under an admission after the sixth elapsed day after admission, counting no Saturday, Sunday, or legal holiday as an elapsed day. (f) Payment for certain inpatient hospital services outside the United States. (1) Payment is available for inpatient hospital services furnished by, or under arrangements with, a hospital outside the United States to a person entitled to hospital insurance benefits if the person lives in the United States and the foreign hospital was closer to, or substantially more accessible from, the person’s residence than the nearest adequately equipped and available United States hospital able to treat the illness or injury. (2) Payment is also available for emergency inpatient hospital services from a foreign hospital if, when the emergency occurred, the person was physically in the United States or was in Canada while traveling without unreasonable delay on the most direct route, as determined by the Secretary, between Alaska and another State. The foreign hospital must have been closer to, or substantially more accessible from, that place than the nearest adequately equipped and available United States hospital able to treat the illness or injury. (3) The hospital receives the subsection (b) amount if the Secretary would have been required to pay had the hospital had an agreement and met the other conditions; the hospital elects to claim payment; and the hospital agrees to follow section 1395cc(a) for the services. (4) If payment cannot be made under paragraph (3) solely because the hospital does not elect to claim it, the individual may apply for reimbursement on an itemized bill. The application must meet the Secretary’s regulatory deadline, form, manner, filing-person, information, and supporting-information requirements. Subject to section 1395e, payment equals the amount that would be payable under subsection (d)(3). (g) Payments to physicians for services in teaching hospitals. For services whose reasonable cost is determined under section 1395x(v)(1)(D), or would be so determined if section 1395ww did not apply, payment goes to a fund designated by the hospital’s organized medical staff. If the hospital’s medical-school faculty furnished the services, payment goes to a fund designated by that faculty. This applies only if the hospital has an agreement under section 1395cc and the Secretary has written assurances that: (1) the fund will use the payment only to improve care of hospital patients or for educational or charitable purposes; and (2) the people who received the services and other people will not be charged for them, or any incorrectly collected money will be returned. (h) Payment for specified hospital services in Department of Veterans Affairs hospitals; amount. (1) Medicare may pay a Department of Veterans Affairs hospital for inpatient hospital services furnished in a calendar year to a person entitled to hospital benefits under section 426, even though the hospital is a Federal provider, if the person was not entitled to receive the services free; admitting authorities reasonably believed the person was entitled to receive them free; the hospital authorities and the person acted in good faith; and the services were furnished until the end of the day when the hospital authorities first learned that the person was not entitled to them free, or, if later, until the first day when it was medically feasible to remove the person by discharge or transfer to a hospital with an agreement under this subchapter. The hospital may furnish the services itself or under arrangements defined in section 1395x(w). (2) Payment equals the charge imposed by the Secretary of Veterans Affairs, or, if less, the amount that would be payable under subsection (b) and section 1395ww, as estimated by the Secretary. Payment goes to the entity that would have received it if the individual or another private person acting for the individual had paid for the services. (i) Payment for hospice care. (1)(A) Subject to paragraph (2), section 1395e(a)(4), and the other rules in this paragraph, a hospice program is paid the reasonable costs related to providing hospice care, or another reasonable amount determined by the Secretary’s regulations, including regulations authorized by section 1395x(v)(1)(A). There is no payment for bereavement counseling. Other counseling services, including nutritional and dietary counseling, cannot be reimbursed as separate services. (B) For hospice care on or after April 1, 1986, the daily payment rate for routine home care is $63.17. The daily rate for other hospice services is the daily rate recognized under subparagraph (A) on July 1, 1985, increased by $10. (C) For routine home care and other hospice services furnished from January 1 through September 30, 1990, rates are 120 percent of the rates in effect on September 30, 1989. Before the first fiscal year in which the paragraph (6)(D) revisions are implemented, later fiscal-year rates increase from the prior year as follows: through fiscal year 1993, by the fiscal year’s "market basket percentage increase" defined in section 1395ww(b)(3)(B)(iii); in fiscal year 1994, by that increase minus 2.0 percentage points; in 1995 and 1996, minus 1.5 points; in 1997, minus 0.5 point; in each of 1998 through 2002, minus 1.0 point, with 5.0 points added in 2001; and in later years, by the market basket increase, subject to clauses (iv) and (vi). After the first fiscal year in which the paragraph (6)(D) revisions are implemented, rates increase from the prior year by the market basket percentage increase, subject to clauses (iv) and (vi). For fiscal year 2013 and later, the Secretary reduces the applicable increase by the productivity adjustment in section 1395ww(b)(3)(B)(xi)(II), and, subject to clause (v), by 0.3 percentage point for fiscal years 2013 through 2019. This can make the increase below zero and can make the payment rate lower than in the preceding year. For fiscal years 2014 through 2019, the 0.3-point reduction becomes 0.0 points if the excess of the preceding fiscal year’s total percentage of the non-elderly insured population, based on the most recent Congressional Budget Office estimates available before the specified congressional vote, over the Secretary’s estimate for that preceding fiscal year exceeds 5 percentage points. For fiscal year 2018, after applying clause (iv), the applicable market basket increase is 1 percent. (2)(A) For an accounting year, hospice payment may not exceed the year’s "cap amount" multiplied by the program’s number of Medicare beneficiaries for that year. This section does not define the quoted terms except through the rules below. (B) Unless clause (ii) applies, the cap amount is $6,500, increased or decreased for accounting years ending after October 1, 1984, by the same percentage increase or decrease in the medical-care-expenditure category of the Consumer Price Index for All Urban Consumers, United States city average, published by the Bureau of Labor Statistics, from March 1984 to the fifth month of the accounting year. For accounting years ending after September 30, 2016, and before October 1, 2035, the cap is the preceding accounting year’s cap updated by the hospice payment-rate percentage update under paragraph (1)(C) for the fiscal year beginning on the October 1 before the accounting year begins, including the productivity or other adjustment in paragraph (1)(C)(iv). For accounting years ending after September 30, 2035, the cap is computed under clause (i) as though clause (ii) had never applied. (C) The program’s number of Medicare beneficiaries equals the number of people who elected hospice under subsection (d), received hospice care from or arranged by that program under Part A during the accounting year, and then had that number reduced to reflect the share of each person’s care provided in a different accounting year or under another hospice program’s plan. (D) A hospice program must submit a home-hospice claim under this subchapter based only on the geographic location where the service was furnished, as the Secretary determines. (3) Beginning with fiscal year 1999, each hospice program paid under this subsection must submit to the Secretary the cost data the Secretary finds necessary for each fiscal year. (4) Payment to a hospice program for services under section 1395d(a)(5) equals the amount established under the section 1395w-4(b) fee schedule for an office or other outpatient evaluation-and-management visit involving moderately severe presenting problems and low-complexity medical decisionmaking, excluding the amount attributable to the practice-expense component. (5) Quality reporting. (A) For fiscal year 2014 and later, if a hospice program does not submit the data required by subparagraph (C), the Secretary first determines the applicable market basket increase under paragraph (1)(C)(ii)(VII) or (iii) and applies paragraph (1)(C)(iv) and (vi), then reduces that increase by 2 percentage points. For fiscal year 2024 and later, the reduction is 4 points. The result may be below zero and may make the payment rate lower than the preceding year. (B) The reduction applies only to the fiscal year involved. The Secretary may not use it when computing a later year’s payment. (C) For fiscal year 2014 and later, each hospice program must submit data on quality measures specified under subparagraph (D), in the form, manner, and time set by the Secretary. (D) A specified measure generally must have been endorsed by the entity holding a contract under section 1395aaa(a). If the Secretary finds a suitable area or medical topic for which that entity has not endorsed a feasible and practical measure, the Secretary may specify a non-endorsed measure, after giving due consideration to measures endorsed or adopted by a Secretary-identified consensus organization. By October 1, 2012, the Secretary had to publish the measures selected for fiscal year 2014. (E) The Secretary must establish procedures to make submitted data public. A hospice program must have a chance to review the data about it before publication. The Secretary must report hospice quality measures on the Centers for Medicare & Medicaid Services website. (6)(A) The Secretary must collect additional data and information the Secretary considers appropriate to revise hospice payment under subparagraph (D) and for other appropriate purposes. Collection had to begin no later than January 1, 2011. (B) The data may include charges and payments; the number of hospice days attributable to people entitled to or enrolled for Part A benefits; and, for each type of hospice service, the number of days attributable to that service, its cost, and its payment. It may also include charitable contributions and other program revenue, the number of visits, the type of practitioner making each visit, the visit’s length, and other basic visit information. (C) The Secretary may collect the data through cost reports, claims, or other appropriate methods. (D) Not earlier than October 1, 2013, and despite the preceding paragraphs, the Secretary must by regulation implement appropriate revisions to the method for setting payment rates for routine home care and other hospice services. The revisions may use the collected data and may adjust per-diem payments to reflect changing resource intensity over the whole hospice episode. The revisions must produce the same estimated aggregate hospice expenditures for the implementation fiscal year as would have occurred without the revisions. (E) The Secretary must consult hospice programs and the Medicare Payment Advisory Commission about the data collection and payment revisions. (7) If one hospice program arranges hospice care under section 1395x(dd)(5)(D) for another hospice program, the program that made the arrangements must bill and be paid for the care. (j) Elimination of lesser-of-cost-or-charges provision. (1) The lesser-of-cost-or-charges rules listed in paragraph (2) do not apply to services of a class of provider if the Secretary determines and certifies to Congress that removing the rules will not increase payments for that class’s services under this subchapter. The change applies to services furnished, or provider cost-reporting periods, on or after the date stated in the certification. The Secretary must end the change for that class if the Secretary determines and tells Congress that it increased payments. (2) The rules covered are: (A) subsection (b)(1)(B) and (b)(2); (B) section 1395m(a)(1)(B); (C) the part of section 1395l(a)(2)(A) that provides payment other than the reasonable cost determined under section 1395x(v); and (D) section 1395l(a)(2)(B)(i)(II) and (ii). (k) Payments to home health agencies for durable medical equipment. For durable medical equipment payable under Part A, the amount paid to a home health agency is the amount described in section 1395m(a)(1). (l) Payment for inpatient critical access hospital services. (1) Unless a later paragraph provides otherwise, payment for inpatient critical access hospital services is 101 percent of the hospital’s reasonable costs of providing them. (2) For a distinct psychiatric or rehabilitation unit of a critical access hospital described in section 1395i-4(c)(2)(E), payment equals the amount that would otherwise be paid if the services were inpatient hospital services of the corresponding distinct psychiatric or rehabilitation unit described after section 1395ww(d)(1)(B)(v). (3)(A) Special rules apply to costs described in subparagraph (C) for a critical access hospital that would be a "meaningful EHR user" during an "EHR reporting period" for a cost-reporting period beginning in a "payment year" if it were treated as an "eligible hospital" under section 1395ww(n). This section does not define those quoted terms; section 1395ww(n) supplies their meanings. The Secretary computes the reasonable costs by expensing them in one payment year instead of depreciating them over several years. Costs from earlier cost-reporting periods that have not been fully depreciated must be included for a period beginning during a payment year. The Medicare share otherwise used under paragraph (1) is replaced by a percentage no higher than 100 percent equal to the sum of the hospital’s Medicare share that would apply under section 1395ww(n)(2)(D) if it were an eligible hospital, plus 20 percentage points. (B) The payment is a prompt interim payment, subject to reconciliation, after the hospital submits and the Secretary reviews the information needed to make the payment, including information needed to apply this paragraph. No payment may be made for a cost-reporting period beginning in a payment year after 2015, and a hospital may not receive payment for more than 4 consecutive payment years. (C) The covered costs are costs of buying certified EHR technology for which purchase depreciation, excluding interest, would apply under paragraph (1) rather than this paragraph. (D) For paragraphs (3), (4), and (5), the terms "certified EHR technology," "eligible hospital," "EHR reporting period," and "payment year" have the meanings given in section 1395ww(n). (4)(A) Subject to subparagraph (C), for cost-reporting periods beginning in fiscal year 2015 or later, if a critical access hospital is not a meaningful EHR user for an EHR reporting period for that fiscal year, paragraph (1) applies using the percentage in subparagraph (B) instead of 101 percent. (B) The replacement percentage is 100.66 percent for fiscal year 2015, 100.33 percent for fiscal year 2016, and 100 percent for fiscal year 2017 and every later fiscal year. (C) Section 1395ww(b)(3)(B)(ix)(II) applies to subparagraph (A) for a critical access hospital and a cost-reporting period beginning in a fiscal year in the same way it applies to section 1395ww(b)(3)(B)(ix)(I) for a subsection (d) hospital in that fiscal year. (5) There is no administrative or judicial review under section 1395ff, section 1395oo, or any other authority of: (A) the methods and standards for determining payment and reasonable cost under paragraph (3), the payment adjustments under paragraph (4), or the selection of periods under section 1395ww(n)(2) for determining, estimating, or using proxies for inpatient bed days, hospital charges, charity charges, and Medicare share under section 1395ww(n)(2)(D); (B) the methods and standards for determining a meaningful EHR user under section 1395ww(n)(3), as applied on the assumption that the hospital were an eligible hospital, or the hardship exception under paragraph (4)(C); (C) the specification of EHR reporting periods under section 1395ww(n)(6)(B), as applied under paragraphs (3) and (4); or (D) identifying costs for paragraph (3)(C).