The most significant changes to the PRRB rules in decades will become effective August 21, 2008. These rules affect not just the technical aspects of how to pursue an appeal, but will result in the forfeiture of appeal rights for those who do not pay close attention to these changes, beginning with the initial cost report submission. The changes affect how self-disallowed items must be protested on the cost report to protect appeal rights; limit the ability to add issues to appeals; require greater specificity in the initial request for hearing; and alter rules on discovery of evidence from CMS.