; (ii) efforts to decrease health care disparities in rural or medically underserved areas; (iii) a response to emergent epidemic conditions; and (iv) proposed new and innovative patient care programs at the institutional level; and (H) any other factor determined appropriate by the Secretary. (3) Limitation Payment amounts negotiated pursuant to paragraph (1) may not— (A) take into account capital expenditures of the provider or any other expenditure not directly associated with the provision of items and services by the provider to an individual; (B) be used by a provider for capital expenditures or such other expenditures; (C) exceed the provider’s capacity to provide care under this Act