42 CFR § 413.233 - Additional facility-level adjustments.

---
identifier: "/us/cfr/t42/s413.233"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 413.233 - Additional facility-level adjustments."
title_number: 42
title_name: "Public Health"
section_number: "413.233"
section_name: "Additional facility-level adjustments."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "413"
part_name: "PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
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."
regulatory_source: "51 FR 34793, Sept. 30, 1986, unless otherwise noted."
cfr_part: "413"
---


# 413.233 Additional facility-level adjustments.

(a) CMS adjusts the base rate for facilities in rural areas, as defined in § 413.231(b)(2).

(b) CMS adjusts the non-labor-related portion of the base rate for facilities in Alaska, Hawaii, Guam, American Samoa, and the Northern Mariana Islands.

[90 FR 53139, Nov. 24, 2025]