Medicare Program; Prospective Payment System for Hospital Outpatient Services; Extension of Comment Period

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 409, 410, 411, 412, 413, 419, 489, 498, and 1003

[HCFA-1005-4N]

RIN 0938-AI56

Medicare Program; Prospective Payment System for Hospital

Outpatient Services; 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 notice extends the comment period for the fourth time on

a proposed rule published in the Federal Register on September 8, 1998,

(63 FR 47552). In that rule, as required by sections 4521, 4522, and

4523 of the Balanced Budget Act of 1997, we proposed to eliminate the

formula-driven overpayment for certain outpatient hospital services,

extend reductions in payment for costs of hospital outpatient services,

and establish in regulations a prospective payment system for hospital

outpatient services (and for Medicare Part B services furnished to

inpatients who have no Part A coverage.)

DATES: The comment period is extended to 5 p.m. on July 30, 1999.

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-1005-P, P.O. Box 26688,

Baltimore, MD 21207-0488.

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

and three copies) to one of the following addresses: Room 443-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-1005-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 443-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 requirements,

mail a copy of comments to:

Health Care Financing Administration. Office of Information Services,

Standards And Security Group, Division of HCFA Enterprise Standards,

Room N2-14-26, 7500 Security Boulevard, Baltimore, MD 21244-1850. Attn:

John Burke HCFA-1005-P

and,

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: Janet Wellham, (410) 786-4510.

SUPPLEMENTARY INFORMATION: On September 8, 1998, we issued a proposed

rule in the Federal Register (63 FR 47552) that would do the following:

Eliminate the formula-driven overpayment for certain

hospital outpatient services.

Extend reductions in payment for costs of hospital

outpatient services.

Establish in regulations a prospective payment system for

hospital outpatient services, for partial hospitalization services

furnished by community mental health centers, and for certain Medicare

Part B services furnished to inpatients who have no Part A coverage.

Propose new requirements for provider departments and

provider-based entities.

Implement section 9343(c) of the Omnibus Budget

Reconciliation Act of 1986, which prohibits Medicare payment for

nonphysician services furnished to a hospital outpatient by a provider

or supplier other than a hospital unless the services are furnished

under an arrangement with the hospital.

Authorize the Department of Health and Human Services'

Office of Inspector General to impose a civil money penalty against any

individual or entity who knowingly presents a bill for nonphysician or

other bundled services not provided directly or under such an

arrangement.

The comment period for the proposed rule initially closed on

November 9, 1998. Because of the scope of the proposed rule, hospitals

and numerous professional associations requested more time to analyze

the potential consequences of the rule. Therefore, we published a

notice on November 13, 1998, (63 FR 63429), which extended the comment

period until January 8, 1999. Because of further requests from

hospitals and professional associations, we published another notice on

January 12, 1999, (64 FR 1784) extending the comment period to March 9,

1999. Due to additional requests for more time to analyze the potential

consequences of the proposed rule on March 12, 1999,(64 FR 12277) we

again extended the comment period until June 30, 1999.

On June 30, 1999 we published a correction notice (64 FR 35258) in

the Federal Register that corrects a number of technical and

typographical errors contained in the September 8, 1998 proposed rule.

The correction notice is entitled ``Medicare Program; Prospective

Payment System for Hospital Outpatient Services; Correction Notice.''

Due to the publication of the correction notice and our wish to provide

potential commenters adequate time to analyze the potential

consequences of the proposed rule, we are again extending the comment

period to July 30, 1999.

Numerous hospital industry groups, in preparing to comment on the

proposed rule, had asked for extensive information on the databases

used to develop the proposed prospective payment system for hospital

outpatient services. These requests included detailed programming

specifications and analysis of individual proposed rates, including

underlying data. Because the correction notice reflecting these

corrected data was not published until June 30, 1999 and because these

data will engender additional analysis by interested parties, we

believe that further extending the current comment period is

appropriate.

Published elsewhere in this issue of the Federal Register is a

notice extending the comment period for the proposed rule published in

the June 12, 1998, Federal Register in which we propose to rebase

Medicare payment rates and update the list of approved procedures for

ambulatory surgical centers (ASCs) (63 FR 32290). We are

[[Page 36321]]

extending the comment period for the June 12, 1998, ASC proposed rule

to be concurrent with the extended comment period for the September 8,

1998, hospital outpatient proposed rule because Medicare payments to

ASCs are closely linked to the manner in which Medicare proposes to pay

hospitals under a prospective payment system for surgical services

furnished on an outpatient basis.

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

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

(Catalog of Federal Domestic Assistance Program No. 93.774,

Medicare--Supplementary Medical Insurance Program)

Dated: June 24, 1999.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing Administration.

Dated: June 30, 1999.

Donna E. Shalala,

Secretary.

[FR Doc. 99-17026 Filed 6-30-99; 2:00 pm]

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