[Federal Register Volume 60, Number 233 (Tuesday, December 5, 1995)]
[Proposed Rules]
[Pages 62237-62241]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-29542]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 413

[BPD-788-P]
RIN 0938-AH12


Medicare Program; Uniform Electronic Cost Reporting for Skilled 
Nursing Facilities and Home Health Agencies

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

ACTION: Proposed rule.

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SUMMARY: This proposed rule would add the requirement that, for cost 
reporting periods beginning on or after October 1, 1995, all skilled 
nursing facilities and home health agencies must submit cost reports 
currently required under the Medicare regulations in a standardized 
electronic format. This proposed rule would also allow a delay or 
waiver of this requirement where implementation would result in 
financial hardship for a provider. The proposed provisions would allow 
for more accurate preparation and more efficient processing of cost 
reports.

DATES: Comments will be considered if we receive them at the 
appropriate address, as provided below, no later than 5 p.m. on 
February 5, 1996.

ADDRESSES: Mail written comments (one original and three copies) to the 
following address: Health Care Financing Administration, Department of 
Health and Human Services, Attention: BPD-788-P, P.O. Box 7517, 
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 C5-11-17, 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 BPD-788-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 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: Tom Talbott, (410) 786-4592.

SUPPLEMENTARY INFORMATION:

I. Background

    Generally, under the Medicare program, skilled nursing facilities 
(SNFs) and home health agencies (HHAs) are paid for the reasonable 
costs of the covered items and services they furnish to Medicare 
beneficiaries. Sections 1815(a) and 1833(e) of the Social Security Act 
(the Act) provide that no payments will be made to a provider unless it 
has furnished the information, requested by the Secretary, needed to 
determine the amount of payments due the provider. In general, 
providers submit this information through cost reports that cover a 12-
month period. Rules governing the submission of cost reports are set 
forth at 42 CFR 413.20 and 42 CFR 413.24.
    Under Sec. 413.20(a), all providers participating in the Medicare 
program are required to maintain sufficient financial records and 
statistical data for proper determination of costs payable under the 
program. In addition, providers must use standardized definitions and 
follow accounting, statistical, and reporting practices that are widely 
accepted in the health care industry and related fields. Under 
Secs. 413.20(b) and 413.24(f), providers are required to submit cost 
reports annually, with the reporting period based on the provider's 
accounting year. Additionally, under Sec. 412.52, all hospitals 
participating in the prospective payment system must meet cost 
reporting requirements set forth at Secs. 413.20 and 413.24.
    Section 1886(f)(1)(B)(I) of the Act required the Secretary to place 
into effect a standardized electronic cost reporting system for all 
hospitals participating in the Medicare program. This provision was 
effective for hospital cost reporting periods beginning on or after 
October 1, 1989. On May 25, 1994, we published a final rule with 
comment period implementing the electronic cost reporting requirement 
for hospitals (59 FR 26960). On June 27, 1995, we published a final 
rule that responded to comments on the May 25, 1994 final rule with 
comment period (60 FR 33123).

II. Provisions of the Proposed Regulations

    Currently, Sec. 413.24(f)(4) provides that for cost reporting 
periods beginning on or after October 1, 1989, all hospitals must 
submit cost reports in a standardized electronic format. While the 
existing regulations do not require any other provider types to file 
their cost reports electronically, more than 75 percent of SNFs and 
HHAs currently submit a hard copy of an electronically prepared cost 
report rather than a manually prepared cost report. HCFA's fiscal 
intermediaries then review the information from these cost reports for 
completeness and manually enter the data into their automated data 
reporting systems. This process takes substantially longer than 
processing cost reports submitted in a standardized electronic format 
that allows data to be automatically entered into the intermediary's 
system.
    This proposed rule would revise existing Sec. 413.24(f)(4) to 
require SNFs and HHAs to submit cost reports in a standardized 
electronic format for cost reporting periods beginning on or after 
October 1, 1995. We note that the electronic cost reports would not be 
due until 5 months after the end of the provider's cost reporting 
period. Thus, for a provider with a 12-month cost reporting period 
beginning October 1, 

[[Page 62238]]
1995, the first electronic cost report would be due February 28, 1997.
    The use of electronically prepared cost reports would be beneficial 
for SNFs and HHAs because the cost reporting software for these reports 
would virtually eliminate computational errors and substantially reduce 
preparation time. Preparation time would be decreased because providers 
would no longer have to perform mathematical computations to complete 
the cost report. Instead, the provider would only need to enter the 
correct costs and statistics, and the software would determine the 
appropriate amount of Medicare payment due the provider based on these 
figures. We note that the costs and statistics that would be entered 
into the electronic software are the same as those that are currently 
required for Medicare cost reports. This proposed rule would not 
require the reporting of any additional information.
    The use of cost reporting software would also save time when the 
provider discovers that it needs to change individual entries in the 
cost report. Rather than recalculating the entire cost report, the 
provider would merely enter the new figures, and the software would 
generate a new cost report that would reflect all necessary 
recalculations. The use of cost reporting software would also eliminate 
the need for several administrative tasks associated with filing a cost 
report. Specifically, the provider would no longer be required to 
photocopy, collate, and mail a hard copy of the cost report, which is a 
relatively large, cumbersome document. Instead, the completed cost 
report would be electronically filed with the fiscal intermediary. That 
is, the provider would submit a disk containing the required cost 
report data to the fiscal intermediary.
    In all, we estimate that the use of electronically prepared cost 
reports would result in an average of 4 to 5 hours less preparation 
time for an HHA and 8 to 10 hours less time for an SNF. We recognize 
that, initially, the preparation time saved may not be as great as we 
have estimated for providers that need time to become familiar with the 
cost reporting software. However, we believe that once providers 
overcome this small ``learning curve,'' the accuracy of cost reports 
would increase and the preparation time would decrease in line with 
this estimate. We welcome comments on our estimate of time savings as 
well as on other advantages or disadvantages of electronic cost 
reporting.
    We propose that the provider's software must be able to produce a 
standardized output file in American Standard Code for Information 
Interchange (ASCII) format. All intermediaries have the ability to read 
this standardized file and produce an accurate cost report. SNFs and 
HHAs would be required to use HCFA-approved software to submit cost 
reports to the intermediary. HCFA's approval process requires each 
vendor to submit for review a hard copy cost report produced from their 
software. The purpose of this review process is to establish that the 
commercial vendor's software can produce a completed cost report in 
accordance with the Medicare rules and instructions.
    There are approximately 17 commercial software vendors servicing 
HHAs and SNFs that have developed HCFA-approved software programs 
capable of producing an electronic cost report. In addition, HCFA has 
developed a software package that will enable SNFs and HHAs to file an 
electronic data set to the fiscal intermediary in order to generate an 
electronic cost report. Providers would be able to use either these 
existing commercial software packages or HCFA's free software to comply 
with the requirements in this proposed rule. To receive the free 
software, providers may contact their intermediaries or send a written 
request to the following address: Health Care Financing Administration, 
Division of Cost Principles and Reporting, Room C5-02-23, Central 
Building, 7500 Security Blvd., Baltimore, Maryland 21244-1850.
    We also propose that if a SNF or HHA believes that implementation 
of the electronic submission requirement would cause a financial 
hardship, it may submit a written request for a waiver or a delay of 
these requirements. This request, including supporting documentation, 
would have to be submitted to a provider's intermediary at least 120 
days before the end of the provider's cost reporting period. The 
intermediary would review the request and forward it, with a 
recommendation for approval or denial, to the HCFA central office 
within 30 days of such request. HCFA central office would either 
approve or deny the request by response to the intermediary within 60 
days of receipt of the request. Each delay or waiver would be 
considered on a case-by-case basis.
    We considered proposing set criteria (possibly based on a 
provider's bed size or capacity, for example) under which a SNF or HHA 
could be exempted automatically from the electronic cost reporting 
requirement. However, we have not done so because we do not believe 
that a characteristic such as a provider's size is necessarily a 
reliable indicator that electronic cost reporting would impose a 
financial hardship, since even the smallest SNFs and HHAs are quite 
likely to already be using computer equipment. We welcome comments on 
the process for obtaining a waiver, whether set criteria for obtaining 
a waiver would be beneficial, as well as on the number of providers 
that may request a waiver.
    We note that the electronic cost reporting provision would only 
apply to those providers that are required to file a full Medicare cost 
report. Those providers that are not required to file a full cost 
report (for example, a SNF that furnishes fewer than 1500 Medicare 
covered days in a cost reporting period) would not be subject to the 
electronic cost reporting requirement, and therefore would not have to 
request a waiver.
    If a SNF or HHA (not granted a hardship exemption) does not submit 
its cost report electronically, Medicare payments to that provider may 
be suspended under the provisions of sections 1815(a) and 1833(e) of 
the Act. These sections of the Act provide that no Medicare payments 
will be made to a provider unless it has furnished the information, 
requested by the Secretary, that is needed to determine the amount of 
payments due the provider under the Medicare program. Section 
405.371(d) provides for suspension of Medicare payments to a provider 
by the intermediary if the provider fails to submit information 
requested by the intermediary that is needed to determine the amount 
due the provider under the Medicare program.
    The general procedures that are followed when Medicare payment to a 
provider is suspended for failure to submit information needed by the 
intermediary to determine Medicare payment are located in section 2231 
of the Medicare Intermediary Manual (HCFA Pub. 13). Those procedures 
include timeframes for ``demand letters'' to providers. Demand letters 
remind providers to file timely and complete cost reports and explain 
possible adjustments of Medicare payments to a provider and the right 
to request a 30-day extension of the due date.
    Under this proposed rule, we essentially would apply the current 
hospital reporting requirements to SNFs and HHAs. In our final rule 
with comment period published May 25, 1994, we required that, in 
accordance with section 1886(f)(1)(B)(I) of the Act, all hospitals must 
submit cost reports in a uniform electronic format for cost reporting 
periods beginning on or after October 1, 1989 (59 FR 26960). All 

[[Page 62239]]
hospital cost reports must be electronically transmitted to the 
intermediary in ASCII format. In addition to the electronic file, 
existing Sec. 413.24(f)(4)(iii) requires hospitals to submit a hard 
copy of a settlement summary, a statement of certain worksheet totals 
found in the electronic file, and a statement signed by the hospital's 
administrator or chief financial officer certifying the accuracy of the 
electronic file.
    Further, to preserve the integrity of the electronic file, we 
implemented provisions regarding the processing of the electronic cost 
report once submitted to the intermediary. Specifically, existing 
Sec. 413.24(f)(4)(ii) provides that the intermediary may not alter the 
cost report once it has been filed by the provider. That is, the 
intermediary must maintain an unaltered copy of the provider's 
electronic cost report. This provision is not intended to prohibit the 
intermediary from making audit adjustments to the provider's cost 
report. Additionally, this section provides that the intermediary must 
reject a cost report that does not pass all specified edits. Finally, 
the provider's electronic program must be able to disclose that changes 
have been made to the provider's filed cost report. Again, we would 
apply these same provisions to SNFs and HHAs.
    As stated above, the electronic cost reporting requirement for 
hospitals has been a statutory requirement for over 5 years. Our 
experience with the process of hospitals submitting cost reports to the 
intermediary in ASCII format has been uniformly positive. These cost 
reports are processed more expeditiously and efficiently than manually 
prepared cost reports or hard copies of electronically prepared cost 
reports. In fact, based on comments from hospitals, we amended 
Sec. 413.24(f)(4) in our June 27, 1995 final rule to eliminate the 
requirement that hospitals submit a hard copy of the cost report in 
addition to the electronic file (60 FR 33123). In conclusion, based on 
our experience with the submission of electronic cost reports by 
hospitals, we believe that electronic filing would reduce the 
administrative burden on most SNFs and HHAs, with a waiver available in 
financial hardship cases. Therefore, we propose to amend Sec. 413.24 
accordingly:
     Add a new paragraph (f)(4)(i) to define the word 
``provider'' as a hospital, SNF, or HHA;
     Redesignate existing paragraphs (f)(4)(i) through 
(f)(4)(iv) as (f)(4)(ii) through (f)(4)(v);
      Revise redesignated paragraph (f)(4)(ii) to state that 
SNFs and HHAs must submit cost reports in a standardized electronic 
format for cost reporting periods beginning on or after October 1, 
1995; and
     In redesignated paragraphs (f)(4)(iii) through (f)(4)(v), 
replace the word ``hospital'' wherever it appears with the word 
``provider.''

III. Impact Statement

    We generally prepare a regulatory flexibility analysis that is 
consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601 
through 612) unless we certify that a proposed rule such as this would 
not have a significant economic impact on a substantial number of small 
entities. For purposes of the RFA, all providers and small businesses 
that distribute cost-report software to providers are considered small 
entities. HCFA's intermediaries are not considered small entities for 
purposes of the RFA.
    In addition, section 1102(b) of the Social Security Act requires us 
to prepare a regulatory impact analysis for any proposed rule that may 
have a significant impact on the operation of a substantial number of 
small rural hospitals. Such an analysis must conform to the provisions 
of section 604 of the RFA. For purposes of section 1102(b) of the Act, 
we define a small rural hospital as a hospital that is located outside 
of a Metropolitan Statistical Area and has fewer than 50 beds. We are 
not preparing a rural impact statement since we have determined, and 
certify, that this proposed rule would not have a significant impact on 
the operations of a substantial number of small rural hospitals.
    As stated above, under Secs. 413.20(b) and 413.24(f), providers are 
required to submit cost reports annually, with reporting periods based 
on the provider's accounting year. This proposed rule would require 
SNFs and HHAs, like hospitals, to submit their Medicare cost reports in 
a standardized electronic format. We anticipate that this requirement 
would take effect for cost reporting periods beginning on or after 
October 1, 1995, meaning that the first electronic cost reports would 
be due February 28, 1997.
    Currently, approximately 75 percent of all SNFs and HHAs submit a 
hard copy of an electronically prepared cost report to the 
intermediary. We believe that the provisions of this proposed rule 
would have little or no effect on these providers, except to reduce the 
time involved in copying and collating a hard copy of the report for 
intermediaries. In addition to the 75 percent of providers that 
currently use electronic cost reporting, this rule would not affect 
those providers that do not file a full cost report and, as stated 
above, would not be required to submit cost reports electronically.
    This proposed rule may have an impact on those providers who do not 
prepare electronic cost reports, some of whom may have to purchase 
computer equipment, obtain the necessary software, and train staff to 
use the software. However, as discussed below, we believe that the 
potential impact of this proposed rule on those providers who do not 
prepare electronic cost reports would be insignificant.
    First, a small number of providers that do not submit electronic 
cost reports may have to purchase computer equipment to comply with the 
provisions of this proposed rule. However, even among the 25 percent of 
SNFs and HHAs that do not submit electronically prepared cost reports, 
we believe that most providers already have access to computer 
equipment, which they are now using for internal recordkeeping 
purposes, as well as for submitting electronically generated bills to 
their fiscal intermediaries, for example. Thus, we do not believe that 
obtaining computer equipment would be a major obstacle to electronic 
cost reporting for most providers. For those providers that would have 
to purchase computer equipment, we note that, in accordance with 
current regulations governing payment of provider costs, Medicare would 
pay for the cost of the equipment as an overhead cost.
    We recognize that a potential cost for providers that do not submit 
electronic cost reports would be that of training staff to use the 
software. Since most SNFs and HHAs currently use computers, we do not 
believe that training staff to use the new software would impose a 
large burden on providers. An additional cost would be the cost of the 
software offered by commercial vendors. However, providers could 
eliminate this cost by obtaining the free software from HCFA.
    The requirement that hospitals submit cost reports in a 
standardized electronic format has been in place since October, 1989. 
Since that time, the accuracy of cost reports has increased and we have 
received very few requests for waivers. Additionally, we have not 
received any comments from the hospital industry indicating that the 
use of electronic cost reporting is overly burdensome. We believe that 
electronic cost reporting would be equally effective for SNFs and HHAs, 
with the benefits (such as increased accuracy and decreased 

[[Page 62240]]
preparation time) outweighing the costs of implementation for most 
providers.
    In conclusion, we have determined that this proposed rule would not 
have a significant effect on SNF and HHA costs because these providers 
would not be required to collect any additional data beyond that which 
the regulations currently specify; cost reporting software is available 
at no cost from HCFA to any provider that requests it; most SNFs and 
HHAs have some type of computer equipment through which they currently 
prepare electronic cost reports; and a waiver of the electronic cost 
reporting requirement would be available to providers for whom the 
requirement would impose a financial hardship. SNFs and HHAs would only 
be affected to the extent that, absent a waiver, all would be required 
to submit cost reports in a standardized electronic format to their 
intermediary. A provider that does not comply with the provisions of 
this rule, as specified in the preamble, would be subject to sections 
1815(a) and 1833(e) of the Act, which provide that no payments will be 
made to a provider unless it has furnished the information requested by 
the Secretary that is needed to determine the amount of payments due 
the provider under Medicare.
    We welcome comments on the effect of the electronic cost reporting 
requirement, its benefits or disadvantages, the proposed implementation 
date, and issues related to the waiver process.
    In accordance with the provisions of Executive Order 12866, this 
regulation was reviewed by the Office of Management and Budget (OMB).

IV. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, agencies are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. In 
order to fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act 
of 1995 requires that we solicit comment on the following issues:
     Whether the information collection is necessary and useful 
to carry out the proper functions of the agency;
     The accuracy of the agency's estimate of the information 
collection burden;
     The quality, utility, and clarity of the information to be 
collected; and
     Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    Therefore, we are soliciting public comment on each of these issues 
for the information collection requirements discussed below.
    As discussed in detail above, this proposed rule would require that 
SNFs and HHAs submit cost reports in a standardized electronic format 
for cost reporting periods beginning on or after October 1, 1995. That 
is, providers would be required to file a diskette containing the 
required cost report data in a standardized electronic format. We 
believe that this requirement would reduce the paperwork and 
information collection burden for those SNFs and HHAs that currently do 
not submit electronically prepared cost reports. Specifically, we 
estimate that the number of hours each provider would save by 
submitting an electronically prepared cost report instead of manually 
preparing, and photocopying, the cost report would be an average of 9 
hours for each affected SNF and 4.5 hours for each affected HHA. 
Assuming that approximately 25 percent of all SNFs and HHAs would be 
affected, that is roughly 3,000 SNFs and 2,000 HHAs, we estimate that 
SNFs would save approximately 27,000 hours per year completing cost 
reports, and HHAs would save about 9,000 hours per year.
    We note that the overall information collection and recordkeeping 
burden associated with filing SNF costs reports has been approved by 
OMB through January 1998 (OMB approval number 0938-0463). Additionally, 
OMB has approved the information collection burden for HHA cost reports 
through October 1997 (approval number 0938-0022). We would not require 
SNFs and HHAs to report any information on the electronic cost report 
that is not already required in the Medicare cost reports currently 
submitted by these providers.
    The information collection and recordkeeping requirements contained 
in Sec. 413.24 are not effective until they have been approved by OMB. 
A notice will be published in the Federal Register when approval is 
obtained. Organizations and individuals that wish to submit comments on 
the information and recordkeeping requirements set forth in Sec. 413.24 
should direct them to the OMB official whose name appears in the 
ADDRESSES section of this preamble.

V. Response to Comments

    Because of the large number of items of correspondence we normally 
receive on Federal Register documents published for comment, we are not 
able to acknowledge or respond to them individually. We will consider 
all comments we receive by the date and time specified in the ``DATES'' 
section of this preamble, and, if we proceed with a subsequent 
document, we will respond to the comments in the preamble to that 
document.

List of Subjects in 42 CFR Part 413

    Health facilities, Kidney diseases, Medicare, Puerto Rico, 
Reporting and recordkeeping requirements.

    42 CFR part 413 is amended as set forth below:

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES

    1. The authority citation for part 413 continues to read as 
follows:

    Authority: Secs. 1102, 1861(v)(1)(A), and 1871 of the Social 
Security Act (42 U.S.C. 1302, 1395x(v)(1)(A), and 1395hh).

    2. Section 413.24 is amended by redesignating existing paragraphs 
(f)(4)(i) through (f)(4)(iv) as paragraphs (f)(4)(ii) through 
(f)(4)(v); adding a new paragraph (f)(4)(i); and revising redesignated 
paragraphs (f)(4)(ii) through (f)(4)(v) to read as follows:


Sec. 413.24  Adequate cost data and cost finding.

* * * * *
    (f) Cost reports. * * *
    (4) Electronic submission of cost reports. (i) As used in this 
paragraph, provider means a hospital, skilled nursing facility, or home 
health agency.
    (ii) Effective for cost reporting periods beginning on or after 
October 1, 1989, for hospitals and cost reporting periods beginning on 
or after October 1, 1995, for skilled nursing facilities and home 
health agencies, a provider is required to submit cost reports in a 
standardized electronic format. The provider's electronic program must 
be capable of producing the HCFA standardized output file in a form 
that can be read by the fiscal intermediary's automated system. This 
electronic file, which must contain the input data required to complete 
the cost report and the data required to pass specified edits, is 
forwarded to the fiscal intermediary for processing through its system.
    (iii) The fiscal intermediary stores the provider's as-filed 
electronic cost report and may not alter that file for any reason. The 
fiscal intermediary makes a ``working copy'' of the as-filed electronic 
cost report to be used, as necessary, throughout the settlement process 
(that is, desk review, processing audit adjustments, final settlement, 
etc). The provider's electronic program must 

[[Page 62241]]
be able to disclose if any changes have been made to the as-filed 
electronic cost report after acceptance by the intermediary. If the as-
filed electronic cost report does not pass all specified edits, the 
fiscal intermediary rejects the cost report and returns it to the 
provider for correction. For purposes of the requirements in paragraph 
(f)(2) of this section concerning due dates, an electronic cost report 
is not considered to be filed until it is accepted by the intermediary.
    (iv) Effective for cost reporting periods ending on or after 
September 30, 1994, for hospitals and cost reporting periods beginning 
on or after October 1, 1995, for skilled nursing facilities and home 
health agencies, a provider must submit a hard copy of a settlement 
summary, a statement of certain worksheet totals found within the 
electronic file, and a statement signed by its administrator or chief 
financial officer certifying the accuracy of the electronic file or the 
manually prepared cost report. The following statement must immediately 
precede the dated signature of the provider's administrator or chief 
financial officer:

    I hereby certify that I have read the above certification 
statement and that I have examined the accompanying electronically 
filed or manually submitted cost report and the Balance Sheet 
Statement of Revenue and Expenses prepared by ____________________ 
(Provider Name(s) and Number(s)) for the cost reporting period 
beginning ________________ and ending ________________ and that to 
the best of my knowledge and belief, this report and statement are 
true, correct, complete and prepared from the books and records of 
the provider in accordance with applicable instructions, except as 
noted. I further certify that I am familiar with the laws and 
regulations regarding the provision of health care services, and 
that the services identified in this cost report were provided in 
compliance with such laws and regulations.

    (v) A provider may request a delay or waiver of the electronic 
submission requirement in paragraph (f)(4)(ii) of this section if this 
requirement would cause a financial hardship. The provider must submit 
a written request for delay or waiver with necessary supporting 
documentation to its intermediary at least 120 days prior to the end of 
its cost reporting period. The intermediary reviews the request and 
forwards it with a recommendation for approval or denial, to HCFA 
central office within 30 days of receipt of the request. HCFA central 
office either approves or denies the request and notifies the 
intermediary within 60 days of receipt of the request.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: June 21, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 95-29542 Filed 12-4-95; 8:45 am]
BILLING CODE 4120-01-P