Section 419.20 - Hospitals subject to the hospital outpatient prospective payment system(a)Applicability. The hospital outpatient prospective payment system is applicable to any hospital participating in the Medicare program, except those specified in paragraph (b) of this section, for services furnished on or after August 1, 2000.(b)Hospitals excluded from the outpatient prospective payment system.(1) Those services furnished by Maryland hospitals that are paid under a cost containment waiver in accordance with section 1814(b)(3) of the Act are excluded from the hospital outpatient prospective payment system.(2) Critical access hospitals (CAHs) are excluded from the hospital outpatient prospective payment system.(3) A hospital located outside one of the 50 States, the District of Columbia, and Puerto Rico is excluded from the hospital outpatient prospective payment system.(4) A hospital of the Indian Health Service.(5) A rural emergency hospital (REH). 65 FR 18542 , Apr. 7, 2000, as amended at 66 FR 59922 , Nov. 30, 2001; 88 FR 82180 , Nov. 22, 2023