[Federal Register Volume 64, Number 48 (Friday, March 12, 1999)]
[Proposed Rules]
[Pages 12277-12278]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-6134]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 409, 410, 411, 412, 413, 419, 489, 498, and 1003

[HCFA-1005-3N]
RIN 0938-AI56


Medicare Program; Prospective Payment System for Hospital 
Outpatient Services; Extension of Comment Period

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

ACTION: Notice of extension of comment period for proposed rule.

-----------------------------------------------------------------------

SUMMARY: This notice extends the comment period for the third time on a 
proposed rule published in the Federal Register on September 8, 1998, 
(63 FR 47552). In that rule, as required by sections 4521, 4522, and 
4523 of the Balanced Budget Act of 1997, we proposed to eliminate the 
formula-driven overpayment for certain outpatient hospital services, 
extend reductions in payment for costs of hospital outpatient services, 
and establish in regulations a prospective payment system for hospital 
outpatient services (and for Medicare Part B services furnished to 
inpatients who have no Part A coverage.)

DATES: The comment period is extended to 5 p.m. on June 30, 1999.

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-1005-P, 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 443-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-1005-P. 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 443-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: Health Care Financing Administration.

Office of Information Services, Standards And Security Group, Division 
of HCFA Enterprise Standards, Room N2-14-26, 7500 Security Boulevard, 
Baltimore, MD 21244-1850. Attn: John Burke HCFA-1005-P, and
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: Janet Wellham, (410) 786-4510.

SUPPLEMENTARY INFORMATION:
    On September 8, 1998, we issued a proposed rule in the Federal 
Register (63 FR 47552) that would do the following:
     Eliminate the formula-driven overpayment for certain 
hospital outpatient services.
     Extend reductions in payment for costs of hospital 
outpatient services.
     Establish in regulations a prospective payment system for 
hospital outpatient services, for partial hospitalization services 
furnished by community mental health centers, and for certain Medicare 
Part B services furnished to inpatients who have no Part A coverage.
     Propose new requirements for provider departments and 
provider-based entities.
     Implement section 9343(c) of the Omnibus Budget 
Reconciliation Act of 1986, which prohibits Medicare payment for 
nonphysician services furnished to a hospital outpatient by a provider 
or supplier other than a hospital unless the services are furnished 
under an arrangement with the hospital.
     Authorize the Department of Health and Human Services' 
Office of Inspector General to impose a civil money penalty against any 
individual or entity who knowingly presents a bill for nonphysician or 
other bundled services not provided directly or under such an 
arrangement.
    The comment period for the proposed rule closed on November 9, 
1998. Because of the scope of the proposed rule, hospitals and numerous 
professional associations requested more time to analyze the potential 
consequences of the rule. Therefore, we published a notice on November 
13, 1998, (63 FR 63429), which extended the comment period until 
January 8, 1999. Because of further requests from hospitals and 
professional associations, we published another notice on January 12, 
1999, (64 FR 1784) extending the comment period to March 9, 1999. Due 
to additional requests for more time to analyze the potential 
consequences of the proposed rule, we are again extending the comment 
period until June 30, 1999.
    Numerous hospital industry groups that were preparing to comment on 
the proposed rule have requested extensive comparisons of their 
databases and those used to develop the proposed prospective payment 
system for hospital outpatient services. These groups are also 
requesting the provision of detailed programming information and 
analysis of individual proposed rates, including examination of their 
underlying data. Because of frequent modifications to our databases 
during the initial development of the prospective payment system and 
those changes that needed to be made to accommodate the final 
legislative provision enacted under the Balanced Budget Act of 1997, we 
must make extensive revisions of the databases in order to respond to 
the industry. Therefore, we are reprogramming and documenting our 
databases in order to make interaction with the potential commenters 
more efficient.
    Published elsewhere in this issue of the Federal Register is a 
notice extending the comment period for the proposed rule published in 
the June 12, 1998, Federal Register in which we propose to rebase 
Medicare payment rates and update the list of approved procedures for 
ambulatory surgical centers (ASCs) (63 FR 32290). We are extending the 
comment period for the June 12, 1998, ASC proposed rule to be 
concurrent with the extended comment period for the September 8, 1998, 
hospital outpatient proposed rule because Medicare payments to ASCs are 
closely linked to the manner in which Medicare proposes to pay 
hospitals under a prospective payment system for surgical services 
furnished on an outpatient basis.


[[Page 12278]]


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

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

    Dated: March 1, 1999.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.

    Dated: March 9, 1999.
Donna E. Shalala,
Secretary.
[FR Doc. 99-6134 Filed 3-9-99; 2:08 pm]
BILLING CODE BILLING CODE 4120-01-P