[Federal Register Volume 64, Number 180 (Friday, September 17, 1999)]
[Proposed Rules]
[Pages 50482-50483]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-24274]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 405

[HCFA-1086-N]


Medicare Program; Meetings of the Negotiated Rulemaking Committee 
on the Ambulance Fee Schedule

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

ACTION: Notice of meetings.

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SUMMARY: In accordance with section 10(a) of the Federal Advisory 
Committee Act, this notice announces the dates and locations for the 
sixth and seventh meetings of the Negotiated Rulemaking Committee on 
the Ambulance Fee Schedule. This meeting is open to the public.
    The purpose of this committee is to develop a proposed rule that 
would establish a fee schedule for the payment of ambulance services 
under the Medicare program through negotiated rulemaking, as mandated 
by section 4531(b) of the Balanced Budget Act (BBA '97) of 1997.

DATES: The sixth meeting is scheduled for October 4, 1999 from 9:00 
a.m. until 5 p.m. and October 5, 1999 from 8:30 a.m. until 4 p.m. 
E.S.T. The seventh meeting is scheduled for December 6, 1999 from 9 
a.m. until 5 p.m., December 7, 1999 from 9 a.m. until 5 p.m., and 
December 8, 1999 from 8:30 a.m. until 4 p.m.

ADDRESSES: The 2-day October meeting will be held at Turf Valley Hotel, 
2700 Turf Road, Ellicott City, Maryland 21042; (410) 465-1500. The 3-
day December meeting will be held at Doyle's Hotel, 1500 New Hampshire 
Avenue, N.W., Washington, D.C. 20036; (202) 483-6000.

FOR FURTHER INFORMATION CONTACT: Inquiries regarding these meetings 
should be addressed to Bob Niemann ((410) 786-4569) or Margot Blige 
((410) 786-4642) for general issues related to ambulance services or to 
Lynn Sylvester, ((202) 606-9140) or Elayne Tempel, ((207) 780-3408) 
facilitators.

SUPPLEMENTARY INFORMATION: Section 4531(b)(2) of the Balanced Budget 
Act of 1997 (BBA '97), Public Law 105-33, added a new section 1834(l) 
to the Social Security Act (the Act). Section 1834(l) of the Act 
mandates implementation, by January 1, 2000, of a national fee schedule 
for payment of ambulance services furnished under Medicare Part B. The 
fee schedule is to be established through negotiated rulemaking. 
Section 4531(b)(2) also provides that in establishing such fee 
schedule, the Secretary will--
     Establish mechanisms to control increases in expenditures 
for ambulance services under Part B of the program;
     Establish definitions for ambulance services that link 
payments to the type of services furnished;
     Consider appropriate regional and operational differences;
     Consider adjustments to payment rates to account for 
inflation and other relevant factors; and

[[Page 50483]]

     Phase in the fee schedule in an efficient and fair manner.
    The Negotiated Rulemaking Committee on the Ambulance Fee Schedule 
has been established to provide advice and make recommendations to the 
Secretary with respect to the text and content of a proposed rule that 
would establish a fee schedule for the payment of ambulance services 
under Part B of the Medicare program.
    The Committee held its third meeting on May 24 and 25, 1999. At 
this meeting, the Committee heard presentations from HCFA staff, 
including a data presentation. The Committee requested another 
presentation by HCFA's Office of the Actuary to obtain clarification 
about its calculation of the fee schedule payment cap. Additionally, a 
Medical Issues workgroup was formed.
    The Committee held its fourth meeting on June 28 and 29, 1999. At 
this meeting a presentation was made by a HCFA Office of the Actuary 
staff member. The presentation clarified that budget neutrality will be 
evaluated by using all ambulance claims for the most current year and 
comparing the results of the proposed models with those paid claims. 
HCFA staff presented more historical Medicare hospital and supplier 
ambulance billing data. Consensus was reached on one possible basic 
structure for the fee schedule. HCFA indicated that the fee schedule 
must be effective as soon as operationally possible after January 1, 
2000. Subcommittees were formed to produce, by July 19, proposals for:
    (1) A rural/urban adjustment; and
    (2) a fee schedule model based on the structure agreed to at the 
June meeting, combined with relative values. These proposals, along 
with the results of the medical issues workgroup, were to serve as the 
basis for the Committee's next meeting.
    The Committee held its fifth meeting on August 2 and 3, 1999. At 
this meeting the Committee heard presentations from HCFA staff on the 
Medicare Physician Fee Schedule's Geographic Practice Cost Index (GPCI) 
and hospital wage index. The Committee is considering the GPCI and 
hospital wage index for possible use as a geographic cost adjuster for 
the ambulance fee schedule. The second presenter, a member of the HCFA 
negotiated rulemaking team, presented additional historical Medicare 
hospital and ambulance supplier billing data. The Committee was advised 
in a letter signed by HCFA's Deputy Administrator, Michael M. Hash, 
that it has until February 15, 2000 to conclude its business. The 
Committee reached consensus on the definitions for Basic Life Support, 
Advanced Life Support (ALS) Level-1, ALS Level-2, and the criteria that 
the service must meet in order for the emergency response modifier 
amount to be paid. During the October meeting, the Committee will work 
on defining the geographic and rural modifiers and establishing the 
relative values of the different levels of service.
    The announced meetings are open to the public without advanced 
registration. Public attendance at the meeting may be limited to space 
available. Mail written statements to the following address: Federal 
Mediation and Conciliation Service, 2100 K Street, NW, Washington, D.C. 
20427, Attention: Lynn Sylvester. Notice of future meetings will be 
published in the Federal Register. A summary of all proceedings will be 
available for public inspection in room 443-G of the Department's 
offices at 200 Independence Avenue, SW., Washington, D.C. on Monday 
through Friday of each week from 8:30 a.m. to 5 p.m. (Phone: (202) 690-
7890), and can be accessed through the HCFA Internet site at http://
www.hcfa.gov/medicare/ambmain.htm. Additional information related to 
the Committee will also be available on the web site.

    Authority: Sec. 1834(l) of the Social Security Act (42 U.S.C. 
1395m).

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

    Dated: September 14, 1999.
Michael M. Hash,
Deputy Administrator, Health Care Financing Administration.
[FR Doc. 99-24274 Filed 9-16-99; 8:45 am]
BILLING CODE 4120-01-P