Medicare: Ambulance Fee Schedule Negotiated Rulemaking Committee— Meetings,

[Federal Register: January 7, 2000 (Volume 65, Number 5)]

[Proposed Rules]

[Page 1081-1082]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr07ja00-19]

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 405

[HCFA-1125-N]

Medicare Program; Meetings of the Negotiated Rulemaking Committee on the Ambulance Fee Schedule

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

ACTION: Notice of meeting.

SUMMARY: In accordance with section 10(a) of the Federal Advisory Committee Act, this notice announces the dates and locations for the eighth meeting of the Negotiated Rulemaking Committee on the Ambulance Fee Schedule. This meeting is open to the public.

The purpose of this committee is to develop a proposed rule that would establish a fee schedule for the payment of ambulance services under the Medicare program through negotiated rulemaking, as mandated by section 4531(b) of the Balanced Budget Act of 1997 (BBA '97).

DATES: The eighth meeting is scheduled for January 24, 2000 from 9:00 a.m. until 5:00p.m., January 25, 2000 from 9 a.m. until 5 p.m., and January 26, 2000 from 8:30 a.m. until 4 p.m.

ADDRESSES: The 3-day January meeting will be held at the Turf Valley Hotel, 2700 Turf Road, Ellicott City, Maryland 21042; (410) 465-1500.

FOR FURTHER INFORMATION CONTACT: Inquiries regarding these meetings should be addressed to Bob Niemann ((410) 786-4569) or Margot Blige ((410) 786-4642) for general issues related to ambulance services or to Lynn Sylvester ((202) 606-9140) or Elayne Tempel ((207) 780-3408), facilitators.

SUPPLEMENTARY INFORMATION: Section 4531(b)(2) of the Balanced Budget Act of 1997 (BBA '97) added a new section 1834(l) to the Social Security Act (the Act) which mandates by January 1, 2000, implementation of a national fee schedule for payment of ambulance services furnished under Medicare Part B. The fee schedule is to be established through negotiated rulemaking. Section 4531(b)(2) of the BBA '97 also provides that, in establishing such fee schedule, the Secretary will--

Establish mechanisms to control increases in expenditures for ambulance services under Part B of the program;

Establish definitions for ambulance services that link payments to the type of services furnished;

Consider appropriate regional and operational differences;

Consider adjustments to payment rates to account for inflation and other relevant factors; and

Phase in the fee schedule in an efficient and fair manner.

The Negotiated Rulemaking Committee on the Ambulance Fee Schedule has been established to provide advice and make recommendations to the Secretary with respect to the text and content of a proposed rule that would establish a fee schedule for the payment of ambulance services under Part B of the Medicare program.

The first and second meetings were for organizational purposes solely. There were no significant decisions made in these two meetings.

The Committee held its third meeting on May 24 and 25, 1999. At this meeting, the Committee heard presentations from HCFA staff, including a data presentation. The Committee requested another presentation by HCFA's Office of the

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Actuary to obtain clarification about its calculation of the fee schedule payment cap. Additionally, a Medical Issues workgroup was formed.

The Committee held its fourth meeting on June 28 and 29, 1999. At this meeting a presentation was made by a HCFA Office of the Actuary staff member. The presentation clarified that budget neutrality will be evaluated by using all ambulance claims for the most current year and comparing the results of the proposed models with those paid claims. HCFA staff presented more historical Medicare hospital and supplier ambulance billing data. Consensus was reached on one possible basic structure for the fee schedule. HCFA indicated that the fee schedule must be effective as soon as operationally possible after January 1, 2000. Subcommittees were formed to produce, by July 19, 2000 proposals for--

(1) A rural/urban adjustment; and

(2) A fee schedule model based on the structure agreed to at the June meeting, combined with relative values. These proposals, along with the results of the medical issues workgroup, were to serve as the basis for the Committee's next meeting.

The Committee held its fifth meeting on August 2 and 3, 1999. At this meeting the Committee heard presentations from HCFA staff on the Medicare Physician Fee Schedule's Geographic Practice Cost Index (GPCI) and hospital wage index. The Committee is considering the GPCI and hospital wage index for possible use as a geographic cost adjuster for the ambulance fee schedule. The second presenter, a member of the HCFA negotiated rulemaking team, presented additional historical Medicare hospital and ambulance supplier billing data. The Committee was advised in a letter signed by HCFA's Deputy Administrator, Michael M. Hash, that it has until February 15, 2000 to conclude its business. The Committee reached consensus on the definitions for Basic Life Support, Advanced Life Support (ALS) Level-1, ALS Level-2, and the criteria that the service must meet in order for the emergency response modifier amount to be paid. During the October meeting, the Committee planned to work on defining the geographic and rural modifiers and establishing the relative values of the different levels of service.

The seventh meeting of the Negotiated Rulemaking Committee was held December 6 through 8, 1999. The Committee reached consensus on the relative values to be used for the different levels of ambulance service to be modeled for evaluation purposes. The physicians' fee schedule Geographic Practice Cost Index (practice expense component) will be used as the ambulance fee schedule geographic adjuster. An additional payment will be made for ambulance services if the point of pickup is in a rural area. Rural is defined as a location in a non-MSA (with Goldsmith modification, if possible). An additional payment for an emergency response will be paid if the condition as presented was an emergency condition and the supplier responded ``immediately''.

The Committee is expected to conclude its work by February 15, 2000. The main items remaining include evaluating the results of the rural modifier and preparing the Committee's official report.

The announced meeting is open to the public without advanced registration. Public attendance at the meeting may be limited to space available. Mail written statements to the following address: Federal Mediation and Conciliation Service, 2100 K Street, NW., Washington, DC 20427, Attention: Lynn Sylvester. Notice of future meetings will be published in the Federal Register. A summary of all proceedings will be available for public inspection 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), and can be accessed through the HCFA Internet site at http:// www.hcfa.gov/medicare/ambmain.htm. Additional information related to the Committee will also be available on the web site.

Authority: Section 1834(l) of the Social Security Act (42 U.S.C. 1395m).

(Catalog of Federal Domestic Assistance Program No. 93.774, Medicare--Supplementary Medical Insurance Program)

Dated: January 4, 2000. Nancy-Ann Min DeParle, Administrator, Health Care Financing Administration.

[FR Doc. 00-423Filed1-6-00; 8:45 am]

BILLING CODE 4120-01-P