; (ii) public health emergencies including outbreaks of epidemics or infectious diseases; (iii) unexpected facility or equipment repairs or purchases; (iv) significant and unexpected increases in pharmaceutical or medical device prices; and (v) unanticipated increases in complex or high-cost patients or care needs. (B) Changes in Federal or State law that result in a change in costs. (C) Reasonable increases in labor costs, including salaries and benefits, and changes in collective bargaining agreements, prevailing wages, or local law. (b) Payment amount (1) In general The amount of each payment to a provider described in subsection (a) shall be determined before the start of each calendar year through negotiations between the provider and the regional director with jurisdiction over such provider. Such amount shall be based on factors specified in paragraph (2). (2) Payment factors Payments negotiated pursuant to paragraph (1) shall take into account, with respect to a provider— (A) the historical volume of items and services provided for each item and service in the previous 3-year period; (B) the actual expenditures of such provider in such provider’s most recent cost report under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) for each item and service compared to— (i) such expenditures for other institutional providers in the director’s jurisdiction; 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 to ensure 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