; and (ii) normative payment rates established under comparative payment rate systems, including any adjustments, for such items and services; (C) projected changes in the volume and type of items and services to be furnished; (D) wages for employees, including any necessary increases for mandatory minimum safe registered nurse-to-patient ratios and optimal staffing levels for physicians and other health care workers; (E) the provider’s maximum capacity to provide items and services; (F) education and prevention programs; (G) permissible adjustment to the provider’s operating budget due to factors such as— (i) an increase in primary or specialty care access; (ii) efforts to decrease health care disparities in rural or medically underserved areas; (iii) a response to emergent epidemic conditions; (iv) an increase in complex or high-cost patients or care needs; or (v) proposed new and innovative patient care programs at the institutional level; (H) whether the provider is located in a high social vulnerability index community, ZIP Code, or census track, or is a minority-serving provider; and (I) 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