[Federal Register Volume 63, Number 180 (Thursday, September 17, 1998)]
[Notices]
[Pages 49699-49700]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-24881]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-R-224]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Health Care Financing Administration.
    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, is 
publishing the following summary of proposed collections for public 
comment. Interested persons are invited to send comments regarding this 
burden estimate or any other aspect of this collection of information, 
including any of the following subjects: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the agency's functions; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; and (4) the use of automated collection techniques or 
other forms of information technology to minimize the information 
collection burden.
    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 (OMB No. 0938-0711); 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 an alternate submission 
route for the start-up year.
    Special procedures have been identified to ensure that hospital 
encounter data are submitted for discharges occurring between July 1, 
1997 and June 30, 1998, the start-up year. HCFA has identified three 
alternatives for the submission of hospital encounter data for 
discharges during the start-up year, including the following:
    Option 1: The Plan will have a hospital submit UB-92s or Medicare 
Part A ANSI ASC X12 837 (ANSI 837) records using the traditional HMO 
``No Pay'' bill method.
    Option 2: The Plan can currently produce a complete UB-92/ANSI 837 
and will hold the data until the fiscal intermediary (FI) can accept 
it.
    Option 3: The Plan will submit an abbreviated UB-92 data set via an 
alternative route.
    During the start up year, the plan is expected to establish an 
electronic data linkage to a FI to be determined by

[[Page 49700]]

HCFA. HCFA will assist Plans in initiating discussions with their FI. 
By July 15, 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. Data for the start-up year must be 
transmitted to the plan's FI by September, 18, 1998. All data with 
discharge dates after July 1, 1998 will be transmitted using this 
linkage. (See Appendix III 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 July 15, 1998.
    After plans have established linkages to a FI, hospitals will 
submit HCFA-1450 (UB-92) forms to the managed care plan. The HCFA-1450 
(UB-92) 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 through 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: 6,547.
    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. Written comments and 
recommendations for the proposed information collections must be mailed 
within 30 days of this notice directly to the OMB desk officer: OMB 
Human Resources and Housing Branch, Attention: Allison Eydt, New 
Executive Office Building, Room 10235, Washington, D.C. 20503.

    Dated: September 8, 1998.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 98-24881 Filed 9-16-98; 8:45 am]
BILLING CODE 4120-03-P