Medicare Program; Update of Ratesetting Methodology, Payment Rates, Payment Policies, and the List of Covered Procedures for Ambulatory Surgical Centers Effective October 1, 1998; Extension of Comment Period

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 416 and 488

[HCFA-1885-6N]

RIN 0938-AH81

Medicare Program; Update of Ratesetting Methodology, Payment

Rates, Payment Policies, and the List of Covered Procedures for

Ambulatory Surgical Centers Effective October 1, 1998; 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 sixth time on a

proposed rule published in the Federal Register on June 12, 1998, (63

FR 32290). In that rule we proposed to make various changes, including

changes to the ambulatory surgical center (ASC) payment methodology and

the list of Medicare covered procedures.

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-1885-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-1885-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-1885-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: Terri Harris, (410) 786-6830.

SUPPLEMENTARY INFORMATION: On June 12, 1998, we issued a proposed rule

in the Federal Register (63 FR 32290) that would do the following:

Update the criteria for determining which surgical

procedures can be appropriately and safely performed in an ASC.

Make additions to and deletions from the current list of

Medicare covered ASC procedures based on the revised criteria.

Rebase the ASC payment rates using cost, charge, and

utilization data collected by a 1994 survey of ASCs.

Refine the ratesetting methodology that was implemented by

a final notice published on February 8, 1990, in the Federal Register.

Require that ASC payment, coverage, and wage index updates

be implemented annually on January 1 rather than having these updates

occur randomly throughout the year.

Reduce regulatory burden.

Make several technical policy changes.

The proposed rule would also implement requirements of section

1833(i)(1) and (2) of the Social Security Act. We indicated that

comments would be considered if we received them by August 11, 1998.

We received requests from numerous ASCs and professional

associations for more time to analyze the potential consequences of the

rule. We issued a notice in the Federal Register on August 14, 1998,

(63 FR 43655) announcing extension of the public comment period to

September 10, 1998.

On September 8, 1998, we published a proposed rule in the Federal

Register entitled ``Medicare Program; Prospective Payment System for

Hospital Outpatient Services'' (63 FR 47552). We received additional

requests from ASCs and professional associations for more time to

analyze the impact of the hospital outpatient proposed rule, and for a

delay in the implementation of the ASC final rule to be concurrent with

implementation of the hospital outpatient prospective payment system.

On October 1, 1998, we reopened the comment period for the June 12,

1998 ASC proposed rule until November 9, 1998, to coincide with the

comment period for the September 8, 1998, hospital outpatient proposed

rule. We also gave notice in the October 1, 1998, Federal Register (63

FR 52663) of a delay in the adoption of the provisions of the June 12,

1998 ASC proposed rule as a final rule to be concurrent with the

adoption as final of the hospital outpatient prospective payment system

as soon as possible after January 1, 2000. In the November 13, 1998

Federal Register (63 FR 63430), we further extended the comment period

until January 8, 1999. In the January 12, 1999, Federal Register (64 FR

1785), we again extended the comment period until March 9, 1999. In the

March 12, 1999 Federal Register (64 FR 12278), we again extended the

comment period to June 30, 1999 due to further requests from the

industry. 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 hospital

outpatient PPS 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 to have adequate

time to analyze the potential consequences of the proposed rule and

because Medicare payments to ASCs are

[[Page 36322]]

closely linked to the way Medicare proposes to pay hospitals under a

prospective payment system for surgical services furnished on an

outpatient basis, we find it appropriate to extend the current comment

period. Therefore, we are again extending the comment period to July

30, 1999 to be concurrent with the hospital outpatient PPS proposed

rule. Also published elsewhere in this issue of the Federal Register is

a notice extending the comment period for the September 8, 1998

hospital outpatient proposed rule, (63 FR 47552) until July 30, 1999.

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. 99-17027 Filed 6-30-99; 2:00 pm]

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