Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships; Extension of Comment Period

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 411, 424, 435, and 455

[HCFA-1809-N]

RIN 0938-AG80

Medicare and Medicaid Programs; Physicians' Referrals to Health

Care Entities With Which They Have Financial Relationships; Extension

of Comment Period

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice of extension of comment period for proposed rule.

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SUMMARY: This document extends the comment period for a proposed rule

published in the Federal Register (63 FR 1659) that generally would

prohibit physician referrals under Medicare and Medicaid, to health

care entities with which the physician (or his or her immediate family

member) has a financial relationship. The comment period is extended 60

days.

DATES: The comment period is extended to 5 p.m. on May 11, 1998.

ADDRESSES: Mail written comments (one original and three copies) to the

following address: Health Care Financing Administration, Department of

Health and Human Services, Attention: HCFA-1809-P, P.O. Box 26688,

Baltimore, MD 21207-0517.

If you prefer, you may deliver your written comments (one original

and three copies) to one of the following addresses: Room 309-G, Hubert

H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC

20201, or Room C5-09-26, Central Building, 7500 Security Boulevard,

Baltimore, MD 21244-1850.

Because of staffing and resource limitations, we cannot accept

comments by facsimile (FAX) transmission. In commenting, please refer

to file code HCFA-1809-P. Comments received timely will be available

for public inspection as they are received, generally beginning

approximately 3 weeks after publication of a document, in Room 309-G of

the Department's offices at 200 Independence Avenue, SW, Washington,

DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m.

(phone: (202) 690-7890).

For comments that relate to information collection and

recordkeeping requirements, mail a copy of comments to: Office of

Information and Regulatory Affairs, Office of Management and Budget,

Room 10235, New Executive Office Building, Washington, DC 20503, Attn:

Allison Herron Eydt, HCFA Desk Officer.

FOR FURTHER INFORMATION CONTACT: Joanne Sinsheimer (410) 786-4620.

SUPPLEMENTARY INFORMATION: On January 9, 1998, we issued a proposed

rulemaking in the Federal Register (63 FR 1659) that would incorporate

into regulations the provisions of sections 1877 and 1903(s) of the

Social Security Act. Under section 1877, if a physician or a member of

a physician's immediate family has a financial relationship with a

health care entity, the physician may not make referrals to that entity

for certain health services (designated health services) under the

Medicare program, unless certain exceptions apply.

In addition, section 1877 provides that an entity may not present

or cause to be presented a Medicare claim or bill to any individual,

third party payer, or other entity for designated health services

furnished under a prohibited referral, nor may the Secretary make

payment for a designated health service furnished under a prohibited

referral.

Section 1903(s) of the Social Security Act extended aspects of the

referral prohibition to the Medicaid program. It denies payment under

the Medicaid program to a State for certain expenditures for designated

health services. Payment would be denied if the services are furnished

to an individual on the basis of a physician referral that would result

in the denial of payment for the services under Medicare if Medicare

covered the services to the same extent and under the same terms and

conditions as under the State plan. We announced that the public

comment period would close 5 p.m. on March 10, 1998.

Due to the complexity of this proposed rule and because numerous

commenters have requested more time to analyze the potential

consequences of the proposed rule, we have decided to extend the

comment period for an additional 60 days. This document announces the

extension of the public comment period to May 11, 1998.

Authority: Secs. 1102 and 1871 of the Social Security Act (42

U.S.C. 1302 and 1395hh).

(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare

Hospital Insurance; Program No. 93.778, Medical Assistance Program)

Dated: March 4, 1998.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing Administration.

Dated: March 6, 1998.

Donna E. Shalala,

Secretary.

[FR Doc. 98-6285 Filed 3-9-98; 8:45 am]

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