[Federal Register Volume 64, Number 199 (Friday, October 15, 1999)]
[Notices]
[Pages 55949-55950]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-27027]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-1091-N]


Medicare Program; Open Public Meeting on November 1, 1999 To 
Discuss Activities Related to the Collection of Encounter Data From 
Medicare+Choice Organizations for Risk Adjustment

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

ACTION: Notice of meeting.

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SUMMARY: This notice announces a public meeting to provide 
Medicare+Choice Organizations (M+COs), providers, practitioners, and 
other interested parties an opportunity to ask questions and raise 
issues regarding encounter data collection for risk adjustment. The 
meeting will address the following topics:
     Collection of physician encounter data.
     Collection of hospital outpatient encounter data.
     Training and customer support services.

DATES: The meeting is scheduled for November 1, 1999 from 9 a.m. until 
4 p.m., e.s.t.

ADDRESSES: The meeting will be held in the HCFA Auditorium, 7500 
Security Boulevard, Baltimore, Maryland, 21244-1850.

FOR FURTHER INFORMATION CONTACT: Yvette Cooper-Williams, (410) 786-
5644, [email protected].

SUPPLEMENTARY INFORMATION:

Background

    The Balanced Budget Act of 1997 (BBA) (Public Law 105-33) 
established the Medicare+Choice program that significantly expanded the 
health care options available to Medicare beneficiaries. Under the BBA, 
the Secretary of the Department of Health and Human Services (the 
Secretary) must implement a risk adjustment methodology that accounts 
for variations in per capita costs based on health status and other 
demographic factors for payment to Medicare+Choice organizations 
(M+COs). Risk adjustment implementation must start no later than 
January 1, 2000. The BBA also gives the Secretary the authority to 
collect inpatient hospital data for discharges on or after July 1, 
1997, and additional data for services occurring on or after July 1, 
1998. The schedule for encounter data submission through June 30, 2001 
is as follows:
     September 10, 1999: Deadline for submission of Year 2 data 
(dates of

[[Page 55950]]

service July 1, 1998 through June 30, 1999) for CY 2000 payment.
     June 30, 2000: Deadline for submission of Year 2 data for 
purposes of final reconciliation of CY 2000 payments. Last date of 
service that will be accepted in abbreviated UB-92 format.
     September 8, 2000: Deadline for submission of Year 3 data 
(dates of service July 1, 1999 through June 30, 2000) for CY 2001 
payment.
     October 1, 2000: Submission of physician data begins.
     December 31, 2000: Last date to submit abbreviated UB-92 
(with dates of service not later than June 30, 2000).
     January 1, 2001: Submission of hospital outpatient data 
begins, with dates of services retroactive to October 1, 2000.
     January 30, 2001: Reconciliation of CY 2000 payments to 
include all Year 2 data submitted by June 30, 2000.
    We have decided to implement a transition to comprehensive risk 
adjustment. The principal inpatient diagnostic cost group (PIP-DCG) 
model will be used in initial risk adjustment and a comprehensive risk 
adjustment model using diagnoses from physician, hospital outpatient, 
and physician encounters will be implemented in CY 2004. The transition 
schedule (as stated in the January 15, 1999 advance notice to M+COs) to 
the comprehensive model is as follows:
     CY 2000: 90 percent demographic model with 10 percent PIP-
DCG method.
     CY 2001: 70 percent demographic model with 30 percent PIP-
DCG method.
     CY 2002: 45 percent demographic model with 55 percent PIP-
DCG method.
     CY 2003: 20 percent demographic model with 80 percent PIP-
DCG method.
     CY 2004: 100 percent comprehensive risk adjustment (using 
full encounter data).
    We are announcing a public meeting to provide an opportunity for 
M+COs, providers, practitioners, and other interested parties to ask 
questions and raise issues regarding encounter data collection for risk 
adjustment from M+COs. We intend to discuss our data collection 
efforts, systems processes, training approach, and customer services in 
order to provide information related to the implementation of the 
collection of additional encounter data.
    We are announcing this public meeting to provide an opportunity for 
individuals and organizations familiar with issues related to physician 
and hospital outpatient data collection to furnish information and 
raise issues pertaining to future encounter data collection for risk 
adjustment. The agenda will include short presentations by HCFA staff 
on related topics and will conclude with a question-and-answer session.

Registration

    Registration for this one-day public meeting is required and will 
be on a first-come, first-serve basis, limited to two attendees per 
organization. A waiting list will be available for additional requests. 
Registration will be done via the Internet at www.hcfa.gov/events or by 
paper forms available at the aforementioned Internet address. A 
confirmation notice will be sent to attendees upon finalization of 
registration.
    Attendees will be provided with meeting materials at the time of 
the meeting. We will accept written questions or requests for meeting 
materials either before the meeting or up to 14 days after the meeting. 
Written submissions must be sent to: Health Care Financing 
Administration, ATTN: Yvette Cooper-Williams, Room C4-14-21, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.
    You may contact Yvette Cooper-Williams at: Telephone Number: (410) 
786-5644, Fax Number (410) 786-1048, E-mail: [email protected].

    Authority: Sections 1851 through 1859 of the Social Security Act 
(42 U.S.C. 1395w-21 through 1395w-28).

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

    Dated: October 12, 1999.
Michael M. Hash,
Deputy Administrator, Health Care Financing Administration.
[FR Doc. 99-27027 Filed 10-14-99; 8:45 am]
BILLING CODE 4120-01-P