Medicare: Ambulatory surgical centers; ratesetting methodology, payment rates and policies, and covered surgical procedures list,
[Federal Register: October 1, 1998 (Volume 63, Number 190)]
[Proposed Rules]
[Page 52663-52665]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01oc98-37]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 416 and 488
[HCFA-1885-2N]
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; Reopening of Comment Period and Delay in Adoption of the Proposed Rule as Final
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice of reopening of comment period for proposed rule and delay in adoption of provisions of the proposed rule as final.
SUMMARY: This notice reopens the comment period for a proposed rule affecting Medicare payments to ambulatory surgical centers (ASCs) that was originally published in the Federal Register on June 12, 1998 (63 FR 32290). This document gives notice 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 (PPS) that is the subject of a proposed rule published in the Federal Register on September 8, 1998 (63 FR 47551). In addition this document confirms that the current ASC payment rates that are effective for services furnished on or after October 1, 1998, will remain in effect until rebased ASC rates and the provisions of the June 12, 1998 ASC proposed rule are adopted as final to be concurrent with the adoption as final of the Medicare hospital PPS.
DATES: The comment period is reopened to 5 p.m. on November 9, 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-1885-P, P.O. Box 26688, Baltimore, MD 21207-5178.
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: 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: Joan H. Sanow (410) 786-5723.
SUPPLEMENTARY INFORMATION: On June 12, 1998, we issued a proposed rule in the Federal Register (63 FR 32290) that would--
‹bullet› Update the criteria for determining which surgical procedures can be appropriately and safely performed in an ambulatory surgical center (ASC);
‹bullet› Make additions to and deletions from the current list of Medicare covered ASC procedures based on the revised criteria;
‹bullet› Rebase the ASC payment rates applying cost, charge, and utilization data collected by a 1994 survey of ASCs to a clinically coherent ambulatory payment classification (APC) system of grouping procedures;
‹bullet› Refine the ratesetting methodology that was implemented by a final notice published on February 8, 1990 in the Federal Register;
‹bullet› 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;
‹bullet› Reduce regulatory burden; and
‹bullet› Make several technical policy changes.
The proposed rule would also implement requirements of section
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1833(i)(1) and (2) of the Social Security Act (the Act). We indicated that comments would be considered if we received them by August 11, 1998.
Representatives of numerous industry and professional associations and organizations requested additional time to analyze the June 12, 1998 ASC proposed rule to determine its impact on ASCs, physician practices, and hospitals and to allow comparison of the ASC proposed rule with the outpatient PPS rule. We agreed to extend the comment period an additional 30 days, to September 10, 1998.
Members of trade and professional associations also strongly urged us to postpone implementing the changes contained in the June 12, 1998 ASC proposed rule from October 1, 1998 to January 1, 1999, to coincide with implementation of the hospital outpatient prospective payment system (PPS) authorized by the Balanced Budget Act of 1997. They based their argument for delaying implementation of the ASC changes both on the need for more time for cross-analysis of the ASC proposed rule with the hospital outpatient PPS proposed rule and the overlap and interrelationship between the two payment systems.
On September 8, 1998, a proposed rule outlining the provisions of a Medicare prospective payment system for hospital outpatient services was published in the Federal Register (63 FR 47551).
The ambulatory payment classification (APC) system introduced in the June 12, 1998 ASC rule is the same classification system we used to set rates that are proposed for surgical services in the September 8, 1998 hospital outpatient PPS rule. In both rules, we explicitly propose a method of setting payment rates for ASC services and for hospital outpatient surgical services that is as consistent as possible, within the constraints imposed by statutory requirements. When we drafted these proposed rules, we did so with the intent of using APC groups as the basis for setting payment rates for surgical services furnished at ASCs to coincide with using APC groups as the basis for prospectively setting payment rates for surgical services furnished in hospital outpatient settings. We assumed that implementation of APCs and the other provisions of the June 12, 1998 ASC proposed rule would be approximately concurrent with implementation on January 1, 1999 of a hospital outpatient prospective payment system and would replace the payment blend required for hospital services under the provisions of section 1833(i)(3) of the Act.
However, when we projected these implementation dates, we did not take into account the emergent challenges posed by year 2000 issues that are now compelling us to delay implementation of some Medicare program changes in order to assure that health care services for Medicare beneficiaries are not affected by computer failures on January 1, 2000. The outpatient PPS is one of the program changes affected by HCFA's Millennium (``Y2K'')compliance project, and, as we explain in the September 8, 1998 proposed rule, the outpatient PPS is now scheduled for implementation as soon as possible after January 1, 2000.
Given the delay in publication of the hospital outpatient PPS proposed rule and our having to postpone for a year or more implementation of the hospital outpatient PPS; given our efforts to relate to the maximum possible extent the provisions of the June 12, 1998 ASC proposed rule with the new hospital outpatient PPS; and given the concerns expressed by members of trade and professional organizations about the financial and systems impact of implementing the provisions of the June 12, 1998 ASC proposed rule separately from implementing the hospital outpatient PPS, we have decided upon the following course of action.
‹bullet› We are reopening the comment period for the ASC proposed rule. The comment period for the ASC proposed rule published on June 12, 1998, entitled ``Medicare Program; Update of Ratesetting Methodology, Payment Rates, Payment Policies, and the List of Covered Surgical Procedures for Ambulatory Surgical Centers Effective October 1, 1998'' (HCFA-1885-P), is hereby reopened until 5:00 pm on November 9, 1998, concurrent with the end of the comment period for the hospital outpatient PPS proposed rule that was published on September 8, 1998.
‹bullet› There is considerable, intentional overlap between the payment system for surgical services contained in the June 12, 1998 ASC proposed rule and the payment system for surgical services contained in the September 8, 1998 hospital outpatient PPS proposed rule. We envisioned that implementation of the former would coincide with implementation of the latter. Hospitals are concerned about the impact on their systems of implementing APCs for ASCs without their also implementing APCs for hospital outpatient services. Given the overlap and close relationship between the two payment systems, and the unknown effect of implementing the changes proposed in the June 12, 1998 notice for ASCs, without concurrently implementing the changes proposed in the September 8, 1998 hospital outpatient PPS notice, we are delaying implementation of the provisions of the June 12, 1998 ASC proposed rule until such time as the provisions of the September 8, 1998 hospital outpatient PPS proposed rule are implemented. This means that implementation of the rebased ASC rates using 1994 ASC survey data, of the APC groups, of the additions to and deletions from the ASC list, and of the other technical policy and regulatory changes proposed in the June 12, 1998 are all deferred, pending implementation of the hospital outpatient PPS as early as possible after January 1, 2000.
‹bullet› During years in which the Secretary has not otherwise updated ASC rates based on a survey of actual audited costs, section 1833(i)(2)(C) of the Act requires application of an inflation adjustment. Section 4555 of the Balanced Budget Act of 1997 amends section 1833(i)(2)(C) of the Act to require that the inflation adjustment be the percentage increase in the consumer price index for all urban consumers (CPI-U) as estimated by the Secretary for the 12- month period ending with the midpoint of the year involved, reduced (but not below zero) by 2.0 percentage points in each of the fiscal years 1998 through 2002. Based on estimates prepared by Data Resources, Inc./McGraw Hill, the rate of increase in the CPI-U forecast for the fiscal year that ends March 31, 1999 is 2.1 percent. Reducing the CPI-U factor by 2.0 percentage points results in an adjustment factor of 0.1 percent. Because applying this factor to the current ASC rates yields a negligible change of less than $1 for each of the payment groups, we elected to keep the current ASC rates in effect for services furnished on or after October 1, 1998 and until rebased ASC rates and other provisions of the June 12, 1998 ASC proposed rule are implemented to be concurrent with implementation of the hospital outpatient PPS. The ASC payment rates for services furnished on or after October 1, 1998 are as follows. These rates remain in effect until rebased ASC rates are implemented concurrent with implementation of the hospital outpatient PPS.
Group 1--$314 Group 2--422 Group 3--482 Group 4--595 Group 5--678 Group 6--789 ($639+$150 for IOL) Group 7--941 Group 8--928 ($778+150 for IOL)
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‹bullet› Carriers will continue using the same fiscal year 1998 wage index values that they are using currently to standardize ASC payment rates for wage differences, for services furnished on or after October 1, 1998 and until rebased ASC rates are implemented to be concurrent with implementation of the Medicare outpatient PPS.
‹bullet› Additions to and deletions from the ASC list (other than procedure codes deleted by the American Medical Association from Physicians' Current Procedural Terminology (CPT)) are deferred until APC groups are implemented as the basis for setting payment rates for ASC services, to be concurrent with implementation of APC groups under the hospital outpatient PPS proposed in the September 8, 1998 Federal Register.
Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).
(Catalog of Federal Domestic Assistance No. 93.774, Medicare-- Supplementary Medical Insurance Program)
Dated: September 10, 1998. Nancy-Ann Min DeParle, Administrator, Health Care Financing Administration.
Dated: September 22, 1998. Donna E. Shalala, Secretary.
[FR Doc. 98-26249Filed9-30-98; 8:45 am]
BILLING CODE 4120-01-P
