; (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 areas or areas described in section 330(b)(3) of the Public Health Service Act ( 42 U.S.C. 254b(b)(3) ), including areas designated as health professional shortage areas (as defined in section 332(a) of the Public Health Service Act ( 42 U.S.C. 254e(a) )); (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 the Medicare for All Program