[Federal Register Volume 63, Number 228 (Friday, November 27, 1998)]
[Rules and Regulations]
[Pages 65561-65562]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-31694]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 409, 410, 411, 413, 424, 483, and 489

[HCFA-1913-N2]
RIN 0938-AI47


Medicare Program; Prospective Payment System and Consolidated 
Billing for Skilled Nursing Facilities; Reopening of Comment Period

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

ACTION: Notice of reopening of comment period for interim final rule.

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SUMMARY: We published an interim final rule with comment period in the 
Federal Register on May 12, 1998 (63 FR 26252). That interim final rule 
implements provisions in section 4432 of the Balanced Budget Act of 
1997 related to Medicare payment for skilled nursing facility services. 
Those include the implementation of a Medicare prospective payment 
system for skilled nursing facilities, consolidated billing, and a 
number of related changes.
    A document published on July 13, 1998 extended the comment period 
for the May 12, 1998 interim final rule until September 11, 1998. This 
document reopens and extends the comment period for an additional 30 
days after the date of publication of this notice. The document also 
clarifies the explanation of the Federal rates.

DATES: The comment period is reopened and extended to 5 p.m. on 
December 28, 1998.

ADDRESSES: Mail written comments (one original and three copies) to the 
following address: Health Care Financing Administration, Department of 
Health and Human Services, Attention: HCFA-1913-IFC, P.O. Box 26688, 
Baltimore, MD 21207-0488.
    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 C5-09-26, Central Building, 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 HCFA-1913-IFC. 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:

Laurence Wilson, (410) 786-4603 (for general information).
John Davis, (410) 786-0008 (for information related to the Federal 
rates).
Dana Burley, (410) 786-4547 (for information related to the case-mix 
classification methodology).
Steve Raitzyk, (410) 786-4599 (for information related to the facility-
specific transition payment rates).
Bill Ullman, (410) 786-5667 (for information related to consolidated 
billing and related provisions).

SUPPLEMENTARY INFORMATION: On May 12, 1998, we issued an interim final 
rule with comment period in the Federal Register (63 FR 26252) that 
implements provisions in section 4432 of the Balanced Budget Act of 
1997 related to Medicare payment for skilled nursing facility services. 
Those include the implementation of a Medicare prospective payment 
system for skilled nursing facilities, consolidated billing, and a 
number of related changes. We indicated that comments would be 
considered if we received them by July 13, 1998.
    Because of the complexity and scope of the interim final rule and 
because numerous members of the industry and professional associations 
requested more time to analyze the potential consequences of the rule, 
we published a notice on July 13, 1998, which extended the comment 
period until September 11, 1998.
    Because of further requests from industry and professional 
associations to extend the comment period, we have decided to reopen 
and extend the comment period. This document announces the reopening 
and extension of the public comment period to December 28, 1998.
    Additionally, because of a request from industry and professional 
associations, we are clarifying our explanation of the Federal rates. 
Paragraph A.3.a in section II of the May 12, 1998 interim final rule on 
the prospective payment system for skilled nursing facilities describes 
the cost data used in the development of the Federal rates. This 
paragraph indicates that, in developing the per diem costs of skilled 
nursing facilities, the cost data (including the estimate of Part B 
costs) are separated into components based on their relationship to the 
case-mix indices described earlier in the rule. This is done to 
facilitate standardization of the Federal rates and the application of 
the case-mix adjustment. This paragraph goes on to detail that costs 
related to nursing (excluding nurse management) and social service 
salaries (including benefits) and total costs (after allocation of 
overhead expenses) of non-therapy ancillary services are grouped into 
the component related to the nursing case-mix index. As indicated in 
the rule, this component of cost was related to the ``nursing 
component'' of the Federal rates detailed in Tables 2.A, 2.B, 2.E, and 
2.F.
    Members of the public requested that we publish information in the 
Federal Register concerning this area of the rate-setting process. 
Specifically, members of the public requested information on the 
proportion of non-therapy ancillaries to nursing and social services 
costs included in the nursing component of the rates enumerated in the 
tables cited above. Accordingly, we have determined the approximate 
percentage of non-therapy ancillary costs and nursing and social 
services salary costs (including benefits) included in this component 
of the Federal rate. For the Federal rates associated with urban areas 
(Tables 2.A and 2.E), 43.4 percent of the nursing component is related 
to non-therapy ancillary costs (including Part B non-therapy ancillary 
services) and 56.6 percent is related to nursing and social services 
salary costs. For the Federal rates associated with rural areas (Tables 
2.B and 2.F), 42.7 percent of the nursing component is related to non-

[[Page 65562]]

therapy ancillary costs (including Part B non-therapy ancillary 
services) and 57.3 percent is related to nursing and social services 
salary costs. We invite comments on this or other aspects of the May 
12, 1998 interim final rule.

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: October 20, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.

    Dated: November 23, 1998.
Donna E. Shalala,
Secretary.
[FR Doc. 98-31694 Filed 11-25-98; 8:45 am]
BILLING CODE 4120-01-P