← Knowledge Base · 02_regulations_title42.md

Key Regulations — Title 42 CFR (Hospitals)

Collected 2026-07-21. Regulation text is authoritative on eCFR; always cite the exact section and confirm current text at the linked eCFR page.

Most CMS hospital regulation lives in Title 42 of the Code of Federal Regulations (Public Health), Chapter IV (CMS). The parts below are the ones hospital compliance and quality teams reference most.

Part 482 — Conditions of Participation (CoPs) for Hospitals

The core compliance rulebook. A hospital must meet these CoPs to participate in Medicare/Medicaid. Surveys (by CMS, state agencies, or CMS-approved accreditors) assess compliance. Frequently referenced sections: - § 482.11 Compliance with federal, state, and local laws. - § 482.12 Governing body. - § 482.13 Patient's rights (notice of rights, grievances, privacy/safety, restraint/seclusion, death reporting). - § 482.21 Quality Assessment and Performance Improvement (QAPI). - § 482.22 Medical staff. - § 482.23 Nursing services. - § 482.24 Medical record services. - § 482.42 Infection prevention and control and antibiotic stewardship programs. - § 482.43 Discharge planning. eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482

Part 412 — Prospective Payment Systems for Inpatient Hospital Services (IPPS)

Defines inpatient acute-care payment: MS-DRGs, wage index, outlier payments, DSH, IME, and the value-based program adjustments (VBP, HRRP, HAC) that ride on IPPS. eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-412

Part 419 — Prospective Payment System for Hospital Outpatient Department Services (OPPS)

Defines outpatient payment: APCs (Ambulatory Payment Classifications), packaging, and the outpatient quality-reporting adjustment. eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-419

Part 495 — Standards for the EHR Incentive / Promoting Interoperability Program

Rules for meaningful use of certified EHR technology by eligible hospitals and CAHs. eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-495

Part 480 — Acquisition, Protection, and Disclosure of Quality Improvement Organization (QIO) Information

Governs QIO review information and its confidentiality — relevant to quality review and appeals. eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-480

Part 489 — Provider Agreements and Supplier Approval

Includes EMTALA obligations (§ 489.24 — special responsibilities of Medicare hospitals in emergencies), and provider agreement terms. eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-489

Part 405, Subpart R — Provider Reimbursement Determinations and Appeals (PRRB)

Framework for appealing Medicare payment determinations to the Provider Reimbursement Review Board. eCFR: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-405

How to cite regulations correctly

Format: 42 CFR § 482.13 (title, "CFR", section symbol, part.section).
When quoting, note that the eCFR reflects the current consolidated text; historical versions require the Federal Register or the annual CFR edition.
Rule changes (new/amended sections) appear first in the Federal Register as proposed then final rules before they are incorporated into the eCFR (see 03_recent_rules_and_deadlines.md).

CMS Internet-Only Manuals (IOMs) and transmittals — operational instructions: https://www.cms.gov/medicare/regulations-guidance/manuals
State Operations Manual (SOM), Appendix A — hospital survey interpretive guidelines for the CoPs: https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations
Medicare Learning Network (MLN) — plain-language educational products: https://www.cms.gov/training-education/medicare-learning-network