[Federal Register Volume 62, Number 247 (Wednesday, December 24, 1997)]
[Notices]
[Pages 67388-67389]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-33556]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Form #HCFA-R-224]


Emergency Clearance: Public Information Collection Requirements 
Submitted to the Office of Management and Budget (OMB)

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Health Care Financing 
Administration (HCFA), Department of Health and Human Services (DHSS), 
has submitted to the Office of Management and Budget (OMB) the 
following request for Emergency review. We are requesting an emergency 
review because the collection of this information is needed prior to 
the expiration of the normal time limits under OMB's regulations at 5 
CFR, Part 1320. The Agency cannot reasonably comply with the normal 
clearance procedures because of a statutory deadline imposed by section 
1853(a)(3) of the Balanced Budget Act of 1997. Without this 
information, HCFA would not be able to properly implement the 
requirements set forth in the statute.
    HCFA is requesting OMB review and approval of this collection by 
12/31/97, with a 180-day approval period. Written comments and 
recommendations will be accepted from the public if received by the 
individual designated below, by 12/29/97.
    During this 180-day period HCFA will pursue OMB clearance of this 
collection as stipulated by 5 CFR 1320.5.
    Type of Information Collection Request: New collection;
    Title of Information Collection: Collection of Managed Care Data 
Using the Uniform Institutional Providers Form (HCFA-1450/UB-92) and 
Supporting Statute Section 1853(a)(3) of the Balanced budget Act of 
1997;
    Form No.: HCFA-R-224;
    Use: Section 1853(a)(3) of the Balanced Budget Act (BBA) requires 
Medicare+Choice organizations, as well as eligible organizations with 
risk-sharing contracts under section 1876, to submit encounter data. 
Data regarding inpatient hospital services are required for periods 
beginning on or after July 1, 1997. These data may be collected 
starting January 1, 1998. Other data (as the Secretary deems necessary) 
may be required beginning July 1, 1998.
    The BBA also requires the Secretary to implement a risk adjustment 
methodology that accounts for variation in per capita costs based on 
health status. This payment method must be implemented no later than 
January 1, 2000. The encounter data are necessary to implement a risk 
adjustment methodology.
    Hospital data from the period, July 1, 1997--June 30, 1998, will 
serve as the basis for plan-level estimates of risk adjusted payments. 
These estimates will be provided to plans by March, 1999. Encounter 
data collected from subsequent time periods will serve as the basis for 
actual payments to plans for CY 2000 and beyond.
    In implementing the requirements of the BBA, hospitals will submit 
data to the managed care plan for enrollees who have a hospital 
discharge using the HCFA-1450 (UB-92), Uniform Institutional Provider 
Claim Form. Encounter data for hospital discharges occurring on or 
after July 1, 1997 are required. While submission from the hospital to 
the plan is required, plans are provided with a start-up period during 
which time an alternate submission route is permitted.

[[Page 67389]]

    The six month start up period, beginning January 1, 1998 will 
enable plans to accomplish the requirements of the BBA by the end of 
the start-up period, or June 30, 1998. Special procedures have been 
identified to ensure that hospital encounter data are submitted for 
discharges occurring on or after July 1, 1997 and before June 30, 1998. 
The special procedures for the start up period include the following:
    1. In order to provide plans with an estimate of their Average 
Payment Rate (APR) by March, 1999, HCFA must receive data on hospital 
discharges that occurred on or after July 1, 1997 and before December 
31, 1997, as well as encounter data on discharges that occur during the 
start up period, or January 1, 1998 through June 30, 1998. Currently, 
most plans do not have the capacity to submit data electronically to a 
fiscal intermediary (FI), and the FIs are not capable of receiving 
these data. Therefore, during this period only, unless an alternative 
approach is approved by HCFA, hospitals must submit completed UB-92s 
for the Plan's enrollees. These pseudo-claims must be submitted to the 
hospital's regular fiscal intermediary. This is a current requirement 
for hospitals, and they are expected to comply with this requirement 
throughout this period. Plans must provide hospitals with the Medicare 
identification number of all enrollees admitted who have Medicare 
coverage.
    If hospitals are unable to submit these data on behalf of the plan 
during the start-up period, an alternate method of submitting the data 
may be developed by HCFA. If such a method is developed, it would 
require the plans to submit a subset of data elements that are found on 
the UB-92. Possible data elements include the following: Plan Contract 
Number; HIC (or Medicare Identification Number); enrollee's name; 
enrollee's state and county of residence; enrollee's birthdate and 
gender; Medicare Provider Number for the Hospital; claim from and thru 
date; admission date; and principal and secondary diagnoses codes. HCFA 
will specify the data elements, submission route, and format for these 
data.
    2. During the start up period, the plan is expected to establish an 
electronic data linkage to a FI to be determined by HCFA. By June 30, 
1998, the Plan is expected to have completed this linkage, including 
testing of the linkage, and to be capable of transmitting hospital 
encounter data to a FI. All data submitted after July 1, 1998 will be 
transmitted using this linkage. (See Attachment 1 for additional 
information on the transmission of data to HCFA.) Each plan and/or 
contract will use a single FI.
    HCFA will establish a series of interim deadlines to ensure that 
plans are making sufficient progress toward accomplishing this linkage 
no later than June 30, 1998. HCFA will assist plans in initiating 
discussions with their FI.
    After plans have established linkages to a FI, hospitals will 
submit HCFA-1450 (UB-92) forms to the managed care plan. The HCFA-1450 
(UB92) form is identical to the one used by hospitals in billing for 
Medicare fee-for-service claims. After receiving the pseudo claim from 
the hospital, the plan attaches the plan identifier, which is the HCFA 
assigned managed care organization (MCO) Contract Number, and submits 
the pseudo-claim electronically to the fiscal intermediary (FI). The 
data processing flow by the FI is very similar to current claims 
processing for the fee-for-service system, except that no payment is 
authorized to the plan. Pseudo claims will flow though the FI to our 
Common Working File (CWF) and will be retained by HCFA;
    Frequency: On occasion;
    Affected Public: Business or other for-profit, not-for-profit 
institutions, and Federal government;
    Number of Respondents: 6,700;
    Total Annual Responses: 1.9 million;
    Total Annual Hours: 32,833.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, E-mail your 
request, including your address, phone number, and HCFA form number(s) 
referenced above, to P[email protected], or call the Reports Clearance 
Office on (410) 786-1326.
    Interested persons are invited to send comments regarding the 
burden or any other aspect of these collections of information 
requirements. However, as noted above, comments on these information 
collection and recordkeeping requirements must be mailed and/or faxed 
to the designee referenced below, by 12/29/97:

Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 10235, New Executive Office Building, Washington, DC 
20503, Fax Number: (202) 395-6974 or (202) 395-5167, Attn: Allison 
Herron Eydt, HCFA Desk Officer.

    Dated: December 16, 1997.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA, Office of Information Services, 
Information Technology Investment Management Group, Division of HCFA 
Enterprise Standards.
[FR Doc. 97-33556 Filed 12-23-97; 8:45 am]
BILLING CODE 4120-03-P