[Federal Register Volume 63, Number 238 (Friday, December 11, 1998)]
[Notices]
[Pages 68464-68465]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-32977]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-4002-GNC]
RIN 0938-AJ15


Medicare Program; Criteria and Standards for Evaluating 
Intermediary and Carrier Performance: Millennium Compliance

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

ACTION: General notice with comment period.

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SUMMARY: This notice revises the criteria and standards to be used for 
evaluating the performance of fiscal intermediaries and carriers in the 
administration of the Medicare program. This revision establishes a 
performance standard requiring these contractors to meet requirements 
for millennium compliance. We require contractors to certify that they 
have made all necessary system(s) changes and have tested those systems 
in accordance with HCFA guidelines.

DATES: Effective date: This notice is effective December 11, 1998.
    Comment date: Comments will be considered if we receive them at the 
appropriate address, as provided below, no later than 5 p.m. on 
February 9, 1999.

ADDRESSES: Mail written comments (1 original and 3 copies) to the 
following address:

Health Care Financing Administration, Department of Health and Human 
Services, Attention: HCFA-4002-GNC, P.O. Box 31850, Baltimore, MD 
21207-8850

    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, D.C. 20201, or
Room C5-09-26, 7500 Security Blvd, Baltimore, MD 21244-1850.

    Comments may also be submitted electronically to the following e-
mail address: [email protected]. E-mail comments must include the 
full name, postal address, and affiliation (if applicable) of the 
sender and must be submitted to the referenced address to be 
considered. All comments must be incorporated in the e-mail message 
because we may not be able to access attachments.
    Because of staffing and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code HCFA-4002-GNC-N. 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 Ave., SW., 
Washington, DC, on Monday through Friday of each week from 8:30 a.m. to 
5:00 p.m. (Phone: 202-690-7890).

FOR FURTHER INFORMATION CONTACT: Sue Lathroum, (410) 786-7409; Rich 
Morrison, (410) 786-7142.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 1816 of the Social Security Act (the Act) authorizes us to 
enter into agreements with fiscal intermediaries to determine whether 
medical services are covered under Medicare and determine correct 
payment amounts. The intermediaries then make payments to the health 
care providers on behalf of the beneficiaries. Section 1816(f) of the 
Act requires us to develop criteria, standards, and procedures to 
evaluate an intermediary's performance of its functions under its 
agreement.
    Section 1842 of the Act authorizes us to enter into contracts with 
carriers for the payment of Part B claims for Medicare-covered 
services. Under

[[Page 68465]]

section 1842(b)(2) of the Act, we are required to develop criteria, 
standards, and procedures to evaluate a carrier's performance of its 
functions under its contract. We refer to these fiscal intermediaries 
and carriers as Medicare ``contractors''.
    On September 7, 1994, we published in the Federal Register (59 FR 
46258) the criteria and standards to be used to evaluate the 
performance of our contractors under their agreements or contracts with 
us.
    The criteria and standards we published help us determine if a 
contractor's performance measures up to the expectations that we have 
for the activities being evaluated to ensure that our beneficiaries and 
providers are being properly served. We announced that we would use the 
results of the performance evaluations in our contract management 
activities, which might result in the initiation of administrative 
actions. These actions could include entering into, renewing/extending, 
or terminating contracts or contract amendments with our contractors. 
We also announced that we would consider revising the criteria and 
standards if changes were required as a result of administrative 
mandate or congressional action. If changes are necessary, we are 
required to issue a Federal Register notice before implementing a 
change.

II. Provisions of This Notice

    With the approach of the year 2000, we have been focusing on our 
readiness to move into the next century and taking all appropriate 
steps to ensure that Medicare claims are processed without 
interruption. Millennium compliance of all claims processing and 
related systems is our highest priority. We believe it is appropriate 
to add a requirement to our contracts and agreements with our Medicare 
contractors to ensure that all Medicare contractors are making the 
commitment and taking necessary action to meet our requirements in that 
regard. In addition, we are requiring each contractor to certify, under 
the normal penalties that apply to false certifications, that it has 
made all necessary systems changes and has tested its systems in 
accordance with the guidelines we have established. The normal 
penalties for false certification include criminal and/or civil 
prosecution as well as appropriate administrative action, not limited 
to suspension of the contractor from the Medicare program, as well as 
the termination or nonrenewal of a contract or agreement.
    Listed below are the revisions to the ``Administrative Activities'' 
criterion and section VII. ``Action Based on Performance Evaluations'' 
to incorporate the addition of the certification requirements for the 
contractors' systems changes.
    Under the ``Administrative Activities'' criterion in sections IV 
and V for fiscal intermediaries and carriers, respectively, the 
following introductory paragraph is added:
    ``A contractor must efficiently and effectively manage its 
operations to ensure constant improvement in the way it does business. 
Proper systems security, ADP maintenance, and disaster recovery plans 
must be in place. It must also ensure that all necessary actions and 
system changes have been made and tested so that it is meeting 
established milestones along the critical path of HCFA's requirements 
for millennium compliance.'' Year 2000 compliant means information 
technology that accurately processes date and time data (including, but 
not limited to, calculating, comparing, and sequencing) from, into, and 
between the nineteenth, twentieth, and twenty-first centuries, and the 
years 1999 and 2000 and leap year calculations. Furthermore, Year 2000 
compliant information technology, when used in combination with other 
information technology, must accurately process date and time data if 
the other information technology properly exchanges date and time data 
with it. [adapted from: FAR 39.002 Definitions]
    The remaining section of the criterion is unchanged, except for the 
reference to implementation reviews of ``Task management plans''. This 
reference should be to implementation reviews of ``Change management 
plans'' to conform with our recent implementation of the ``Change 
management system'' for issuing instructions to our contractors.
    We are also adding the following requirement to section VII. 
``Action Based on Performance Evaluations'' after the existing 
requirements:
    ``A contractor must certify that it has made all necessary systems 
changes and has tested its systems in accordance with the guidelines 
HCFA has established.''

    Authority: Section 1816(f) and 1842(b)(2) of the Social Security 
Act (42 U.S.C. 1395h and 1395u).

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

    Dated: August 24, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 98-32977 Filed 12-10-98; 8:45 am]
BILLING CODE 4120-01-P