[Federal Register Volume 60, Number 237 (Monday, December 11, 1995)]
[Rules and Regulations]
[Pages 63438-63440]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-30064]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 411
[BPD-850-F]
Medicare Program; Physician Self-Referral Regulations: Change in
Date for Submission of Group Attestation Statement
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule--Technical amendment.
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SUMMARY: This final rule changes (delays) the date by which a group of
[[Page 63439]]
physicians that wishes to be identified as a group practice for
purposes of the physician self-referral regulations (42 CFR 411.350
through 411.361) must file a statement attesting that it meets certain
specified conditions.
DATES: These regulations are effective on December 11, 1995.
FOR FURTHER INFORMATION CONTACT: Patricia Snyder (attestation issues)
(410) 786-5991, Betty Burrier (other physician referral issues) (410)
786-4649.
SUPPLEMENTARY INFORMATION:
I. Background
On August 14, 1995, we published, at 60 FR 41914, a final rule with
comment period entitled, ``Medicare program; Physician Financial
Relationships With, and Referrals to, Health Care Entities That Furnish
Clinical Laboratory Services and Financial Relationship Reporting
Requirements.'' That rule specified that, if a physician or a member of
a physician's immediate family has a financial relationship with an
entity, the physician may not make referrals to the entity for the
furnishing of clinical laboratory services under the Medicare program
except under specified circumstances. Under the rule, being designated
as a group practice may enable a group of physicians to meet the
conditions that would qualify it for an exception to the prohibition on
referrals. Specifically, the rule required, at Sec. 411.360 (a) and
(b), that a group of physicians that intends to be identified as a
group practice (as defined at Sec. 411.351) submit a written statement
to attest that, during the most recent 12-month period (calendar year,
fiscal year, or immediately preceding 12-month period), 75 percent of
the total patient care services of group practice members was furnished
through the group, was billed under a billing number assigned to the
group, and the amounts so received were treated as receipts of the
group. In the case of a newly formed group practice, the group would
submit a statement to attest that during the next calendar year, fiscal
year, or 12-month period, it expects to meet the 75-percent standard.
The rule further required, at Sec. 411.360(e), that the attestation be
submitted to the appropriate Medicare carrier by December 12, 1995.
II. Provisions of This Rule
This rule changes the above submittal date to require that the
attestation statement be submitted no later than 60 days after receipt
of instructions from the carrier.
We have been in the process of developing a method for groups to
provide us with their attestation statements. However, we have come to
realize that those individuals who would be completing the attestation
statement need to be offered more guidance than we had originally
anticipated providing in the attestation instructions. The attestation
instructions will not be available early enough to give the respondents
sufficient time to submit the statement by the deadline stated in the
regulations. Therefore, this final rule revises Sec. 411.360(e) to
require that the attestation be submitted no later than 60 days after
receipt of the attestation instructions from the carrier. In the
interim, a group of physicians can regard itself as a group practice if
it believes it meets the definition of group practice that was
incorporated in our regulations, at Sec. 411.351, by the August 14
rule.
III. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, agencies are required to
provide a 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 requirement discussed
below.
Section 411.360 contains a requirement concerning those groups of
physicians attempting to be identified as a ``group practice.'' It
specifies that the group must attest that, in the aggregate, 75 percent
of total patient care services furnished by all physician members are
(or, in the case of a newly formed group, are expected to be) furnished
through the group and billed under a billing number assigned to the
group. This information collection requirement was established by the
August 14, 1995 rule discussed earlier. As stated in the August 14,
1995 rule, public reporting burden for this collection of information
is estimated to be 1 hour per response. Organizations and individuals
were given an opportunity to comment on the information collection
requirements at the time the August 14 rule was published. However,
because this rule changes the date by which the attestation must be
submitted, we are again soliciting public comment on this requirement
and providing the 60-day notice. As also stated in the August 14 rule,
a document will be published in the Federal Register after Office of
Management and Budget approval is obtained.
Organizations and individuals desiring to submit comments on these
information collection and recordkeeping requirements should mail
written comments (1 original and 3 copies) to the following address:
Health Care Financing Administration, Department of Health and Human
Services, Attention: BPD-850-F, P.O. Box 26688, Baltimore, MD 21207.
If you prefer, you may deliver your written comments (1 original
and 3 copies) to one of the following addresses: Room 309-G, Hubert H.
Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201,
or Room C5-09-26, 7500 Security Boulevard, Baltimore, MD 21224-1850.
IV. Waiver of Proposed Rulemaking and Delay in Effective Date
As required by the Administrative Procedure Act, we generally
provide notice and opportunity for comment on regulations and provide
that final rules are not effective until 30 days after the date of
publication unless we can find good cause for waiving the notice-and-
comment procedure and delayed effective date as impracticable,
unnecessary, or contrary to the public interest.
Unless the requirement at Sec. 411.360(e) is revised before
December 12, 1995, the regulations would contain a requirement that,
through no fault of their own, groups of physicians would be unable to
meet. Therefore, we find good cause to waive the notice-and-comment
procedure as being contrary to the public interest. We also find good
cause to waive the delay in effective date.
V. Regulatory Impact Statement
Consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601
through 612), we prepare a regulatory flexibility analysis unless we
certify that a rule will not have a significant economic impact on a
substantial number of small entities. For purposes of the RFA, all
physicians are considered to be small entities.
[[Page 63440]]
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations 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.
This rule merely makes a technical amendment to delay the due date
for the submission, by a group of physicians that wishes to be
identified as a ``group practice,'' of a statement attesting that it
meets certain conditions. For this reason, we are not preparing
analyses for either the RFA or section 1102(b) of the Act because we
have determined, and we certify, that this rule will not have a
significant economic impact on a substantial number of small entities
or a significant impact on the operations of a substantial number of
small rural hospitals.
In accordance with the provisions of Executive Order 12866, this
regulation was not reviewed by the Office of Management and Budget.
List of Subjects in 42 CFR Part 411
Kidney diseases, Medicare, Physician referral, Reporting and
recordkeeping requirements.
42 CFR part 411 is amended as set forth below:
PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATION ON MEDICARE
PAYMENT
1. The authority citation for part 411 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
2. In Sec. 411.360, paragraph (e) is revised to read as follows:
Sec. 411.360 Group practice attestation.
* * * * *
(e) A group that intends to meet the definition of a group practice
in order to qualify for an exception described in Secs. 411.355 through
411.357, must submit the attestation required by paragraph (a) or
paragraph (b)(1) of this section, as applicable, to its carrier no
later than 60 days after receipt of the attestation instructions from
its carrier.
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: November 21, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
Dated: November 29, 1995.
Donna E. Shalala,
Secretary.
[FR Doc. 95-30064 Filed 12-8-95; 8:45 am]
BILLING CODE 4120-01-P