[Federal Register Volume 63, Number 73 (Thursday, April 16, 1998)]
[Notices]
[Pages 18924-18925]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-10105]
-----------------------------------------------------------------------
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 (DHHS),
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 5/
8/98, with a 180-day approval period. Written comments and
recommendations will be accepted from the public if received by the
individual designated below, by 5/6/98.
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: Extension of a currently
approved 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.
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
[[Page 18925]]
linkage, including testing of the linkage, and to be capable of
transmitting hospital encounter data to an 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: 1.9 million;
Total Annual Responses: 1.9 million;
Total Annual Hours: 13,310.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access HCFA's
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail
your request, including your address, phone number, OMB number, and
HCFA document identifier, 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 5/6/98:
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: April 9, 1998.
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. 98-10105 Filed 4-15-98; 8:45 am]
BILLING CODE 4120-03-P