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Proposed Rule: Medicare: Hospital outpatient prospective payment system and 2008 CY payment rates; ambulatory service center procedures

Proposed Rule: Medicare: Hospital outpatient prospective payment system and 2008 CY payment rates; ambulatory service center procedures

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Published by Justia.com
Proposed Rule: Medicare:
Hospital outpatient prospective payment system and 2008 CY payment rates; ambulatory service center procedures, 42628-43129 [07-3509] Centers for Medicare & Medicaid Services
Proposed Rule: Medicare:
Hospital outpatient prospective payment system and 2008 CY payment rates; ambulatory service center procedures, 42628-43129 [07-3509] Centers for Medicare & Medicaid Services

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10/14/2013

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text

original

Thursday,
August 2, 2007
Book 2 of 2 Books
Pages 42627\u201343130
Part III
Department of
Health and Human
Services
Centers for Medicare & Medicaid Services
42 CFR Parts 410, 411, 414 et al.
Medicare and Medicaid Programs: CY
2008 Proposed Changes; Proposed Rule
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42628
Federal Register/Vol. 72, No. 148/Thursday, August 2, 2007/Proposed Rules
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 410, 411, 414, 416, 419,
482, and 485
[CMS\u20131392\u2013P]
RIN 0938\u2013AO71

Medicare Program: Proposed Changes
to the Hospital Outpatient Prospective
Payment System and CY 2008 Payment
Rates; Proposed Changes to the
Ambulatory Surgical Center Payment
System and CY 2008 Payment Rates;
Medicare and Medicaid Programs:
Proposed Changes to Hospital
Conditions of Participation; Proposed
Changes Affecting Necessary Provider
Designations of Critical Access
Hospitals

AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
SUMMARY:This proposed rule would

revise the Medicare hospital outpatient
prospective payment system to
implement applicable statutory
requirements and changes arising from
our continuing experience with this
system. In this proposed rule, we
describe the proposed changes to the
amounts and factors used to determine
the payment rates for Medicare hospital
outpatient services paid under the
prospective payment system. These
changes would be applicable to services
furnished on or after January 1, 2008.

In addition, this proposed rule would
update the revised Medicare ambulatory
surgical center (ASC) payment system to
implement certain related provisions of
the Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (MMA). In this proposed rule, we
propose the applicable relative payment
weights and amounts for services
furnished in ASCs, specific HCPCS
codes to which the final policies of the
ASC payment system would apply, and
other pertinent ratesetting information
for the CY 2008 ASC payment system.
These changes would be applicable to
services furnished on or after January 1,
2008.

In this proposed rule, we also are
proposing changes to the policies
relating to the necessary provider
designations of critical access hospitals
(CAHs) that are being recertified when
a CAH enters into a new co-location
arrangement with another hospital or
CAH or when the CAH creates or
acquires an off-campus location.

Further, we are proposing changes to
several of the current conditions of
participation that hospitals must meet to
participate in the Medicare and
Medicaid programs to require the
completion and documentation in the
medical record of medical histories and
physical examinations of patients
conducted after admission and prior to
surgery or a procedure requiring
anesthesia services and for
postanesthesia evaluations of patients
before discharge or transfer from the
postanesthesia recovery area.

DATES:To be assured consideration,

comments on all sections of the
preamble of this proposed rule must be
received at one of the addresses
provided in theADDRESSESsection no
later than 5 p.m. on September 14, 2007.

ADDRESSES: In commenting, please refer

to file code CMS\u20131392\u2013P. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.

You may submit comments in one of
four ways (no duplicates, please):

1.Electronically. You may submit
electronic comments on specific issues
in this regulation tohttp://

www.cms.hhs.gov/eRulemaking.Click

on the link \u2018\u2018Submit electronic
comments on CMS regulations with an
open comment period.\u2019\u2019 (Attachments
should be in Microsoft Word,
WordPerfect, or Excel; however, we
prefer Microsoft Word.)

2. By regular mail. You may mail
written comments (one original and two
copies) to the following address ONLY:
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Attention: CMS\u2013
1392\u2013P, P.O. Box 8011, Baltimore, MD
21244\u20131850.

Please allow sufficient time for mailed
comments to be received before the
close of the comment period.

3. By express or overnight mail. You
may send written comments (one
original and two copies) to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS\u20131392\u2013P, Mail Stop C4\u201326\u201305,
7500 Security Boulevard, Baltimore, MD
21244\u20131850.

4. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments (one original
and two copies) before the close of the
comment period to one of the following
addresses: Room 445\u2013G, Hubert H.
Humphrey Building, 200 Independence
Avenue, SW., Washington, DC 20201; or
7500 Security Boulevard, Baltimore, MD
21244\u20131850.

If you intend to deliver your
comments to the Baltimore address,

please call telephone number (410) 786\u2013
9994 in advance to schedule your
arrival with one of our staff members.

(Because access to the interior of the
Hubert H. Humphrey Building is not
readily available to persons without
Federal Government identification,
commenters are encouraged to leave
their comments in the CMS drop slots
located in the main lobby of the
building. A stamp-in clock is available
for persons wishing to retain proof of
filing by stamping in and retaining an
extra copy of the comments being filed.)

Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.

For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATIONsection.
FOR FURTHER INFORMATION CONTACT:

Alberta Dwivedi, (410) 786\u20130378,
Hospital outpatient prospective
payment issues.

Dana Burley, (410) 786\u20130378,
Ambulatory surgical center issues.

Suzanne Asplen, (410) 786\u20134558, Partial
hospitalization and community
mental health centers issues.

Sheila Blackstock, (410) 786\u20133502,

Reporting of quality data issues.
Mary Collins, (410) 786\u20133189, and
Jeannie Miller, (410) 786\u20133164,

Necessary provider designations for

CAHs Issues.
Scott Cooper, (410) 786\u20139465, and
Jeannie Miller, (410) 786\u20133164, Hospital

conditions of participation Issues.
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome

comments from the public on all issues
set forth in this proposed rule to assist
us in fully considering issues and
developing policies. You can assist us
by referencing file code CMS\u20131392\u2013P
and the specific \u2018\u2018issue identifier\u2019\u2019 that
precedes the section on which you
choose to comment.

Inspection of Public Comments:All

comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following Web
site as soon as possible after they have
been received:http://www.cms.hhs.gov/

eRulemaking. Click on the link

\u2018\u2018Electronic Comments on CMS
Regulations\u2019\u2019 on that Web site to view
public comments.

Comments received timely will also
be available for public inspection as
they are received, generally beginning
approximately 3 weeks after publication

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42629
Federal Register/Vol. 72, No. 148/Thursday, August 2, 2007/Proposed Rules

of a document, at the headquarters of
the Centers for Medicare & Medicaid
Services, 7500 Security Boulevard,
Baltimore, MD 21244, on Monday
through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an
appointment to view public comments,
phone 1\u2013800\u2013743\u20133951.

Electronic Access

This Federal Register document is
also available from the Federal Register
online database through GPO Access, a
service of the U.S. Government Printing
Office. Free public access is available on
a Wide Area Information Server (WAIS)
through the Internet and via
asynchronous dial-in. Internet users can
access the database by using the World
Wide Web; the Superintendent of
Documents\u2019 home page address is

http://www.gpoaccess.gov/index.html,

by using local WAIS client software, or
by telnet to swais.access.gpo.gov, then
login as guest (no password required).
Dial-in users should use
communications software and modem
to call (202) 512\u20131661; type swais, then
login as guest (no password required).

Alphabetical List of Acronyms
Appearing in the Proposed Rule
ACEP American College of Emergency

Physicians
AHA American Hospital Association
AHIMA American Health Information

Management Association
AMA American Medical Association
APC Ambulatory payment

classification
AMP Average manufacturer price
ASC Ambulatory Surgical Center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997,

Pub. L. 105\u201333

BBRA Medicare, Medicaid, and SCHIP
[State Children\u2019s Health Insurance
Program] Balanced Budget
Refinement Act of 1999, Pub. L. 106\u2013
113

BCA Blue Cross Association
BCBSA Blue Cross and Blue Shield
Association
BIPA Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection

Act of 2000, Pub. L. 106\u2013554
CAH Critical access hospital
CAP Competitive Acquisition Program
CBSA Core-Based Statistical Area

CCR Cost-to-charge ratio
CERT Comprehensive Error Rate
Testing
CMHC Community mental health
center
CMS Centers for Medicare & Medicaid
Services
CoP [Hospital] Condition of
participation
CORF Comprehensive outpatient
rehabilitation facility

CPT [Physicians\u2019] Current Procedural
Terminology, Fourth Edition, 2007,
copyrighted by the American Medical
Association

CRNA Certified registered nurse
anesthetist
CY Calendar year
DMEPOS Durable medical equipment,
prosthetics, orthotics, and supplies
DMERC Durable medical equipment
regional carrier
DRA Deficit Reduction Act of 2005,

Pub. L. 109\u2013171
DSH Disproportionate share hospital
EACH Essential Access Community

Hospital
E/M Evaluation and management
EPO Erythropoietin
ESRD End-stage renal disease
FACA Federal Advisory Committee

Act, Pub. L. 92\u2013463
FAR Federal Acquisition Regulations
FDA Food and Drug Administration

FFS Fee-for-service
FSS Federal Supply Schedule
FTE Full-time equivalent
FY Federal fiscal year
GAO Government Accountability
Office
HCPCS Healthcare Common Procedure
Coding System
HCRIS Hospital Cost Report

Information System
HHA Home health agency
HIPAA Health Insurance Portability

and Accountability Act of 1996, Pub.

L. 104\u2013191
HOPD Hospital outpatient department
HOP QDRP Hospital Outpatient

Quality Data Reporting Program
ICD\u20139\u2013CM International Classification
of Diseases, Ninth Edition, Clinical
Modification
IDE Investigational device exemption
IOL Intraocular lens
IPPS [Hospital] Inpatient prospective
payment system
IVIG Intravenous immune globulin
MAC Medicare Administrative
Contractors
MedPAC Medicare Payment Advisory
Commission
MDH Medicare-dependent, small rural
hospital
MIEA\u2013TRHCA Medicare

Improvements and Extension Act
under Division B, Title I of the Tax
Relief Health Care Act of 2006, Pub.
L. 109\u2013432

MMA Medicare Prescription Drug,
Improvement, and Modernization Act
of 2003, Pub. L. 108\u2013173

MPFS Medicare Physician Fee

Schedule
MSA Metropolitan Statistical Area
NCCI National Correct Coding

Initiative
NCD National Coverage Determination
NTIOL New technology intraocular

lens
OCE Outpatient Code Editor
OMB Office of Management and

Budget
OPD [Hospital] Outpatient department
OPPS [Hospital] Outpatient
prospective payment system
PHP Partial hospitalization program
PM Program memorandum

PPI Producer Price Index
PPS Prospective payment system
PPV Pneumococcal pneumonia (virus)
PRA Paperwork Reduction Act

QIO Quality Improvement

Organization
RFA Regulatory Flexibility Act
RHQDAPU Reporting Hospital Quality

Data for Annual Payment Update
[Program]
RHHI Regional home health

intermediary
SBA Small Business Administration
SCH Sole community hospital
SDP Single Drug Pricer

SI Status indicator

TEFRA Tax Equity and Fiscal
Responsibility Act of 1982, Pub. L.
97\u2013248

TOPS Transitional outpatient
payments
USPDI United States Pharmacopoeia
Drug Information
WAC Wholesale acquisition cost

In this document, we address two
payment systems under the Medicare
program: the hospital outpatient
prospective payment system (OPPS) and
the revised ambulatory surgical center
(ASC) revised payment system. The
provisions relating to the OPPS are
included in sections I. through XV.,
XVII., and XIX. through XXII. of this
proposed rule and in Addenda A, B, C
(Addendum C is available on the
Internet only; see section XIX. of this
proposed rule), D1, D2, E, L, and M to
this proposed rule. The provisions
related to the revised ASC payment
system are included in sections XVI.,
XVII., and XIX. through XXII. of this
proposed rule and in Addenda AA, BB,
DD1, and DD2 to this proposed rule.

Table of Contents
I. Background for the OPPS
A. Legislative and Regulatory Authority for
the Hospital Outpatient Prospective

Payment System
B. Excluded OPPS Services and Hospitals
C. Prior Rulemaking
D. APC Advisory Panel
1. Authority of the APC Panel
2. Establishment of the APC Panel
3. APC Panel Meetings and Organizational

Structure

E. Provisions of the Medicare
Improvements and Extension Act under
Division B of Title I of the Tax Relief and
Health Care Act of 2006

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