[Federal Register Volume 65, Number 5 (Friday, January 7, 2000)]
[Proposed Rules]
[Pages 1081-1082]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-423]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 405
[HCFA-1125-N]
Medicare Program; Meetings of the Negotiated Rulemaking Committee
on the Ambulance Fee Schedule
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice of meeting.
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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
eighth meeting 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 of 1997 (BBA '97).
DATES: The eighth meeting is scheduled for January 24, 2000 from 9:00
a.m. until 5:00 p.m., January 25, 2000 from 9 a.m. until 5 p.m., and
January 26, 2000 from 8:30 a.m. until 4 p.m.
ADDRESSES: The 3-day January meeting will be held at the Turf Valley
Hotel, 2700 Turf Road, Ellicott City, Maryland 21042; (410) 465-1500.
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) added a new section 1834(l) to the Social
Security Act (the Act) which mandates by January 1, 2000,
implementation 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) of the
BBA '97 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
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 first and second meetings were for organizational purposes
solely. There were no significant decisions made in these two meetings.
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
[[Page 1082]]
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, 2000 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 planned to
work on defining the geographic and rural modifiers and establishing
the relative values of the different levels of service.
The seventh meeting of the Negotiated Rulemaking Committee was held
December 6 through 8, 1999. The Committee reached consensus on the
relative values to be used for the different levels of ambulance
service to be modeled for evaluation purposes. The physicians' fee
schedule Geographic Practice Cost Index (practice expense component)
will be used as the ambulance fee schedule geographic adjuster. An
additional payment will be made for ambulance services if the point of
pickup is in a rural area. Rural is defined as a location in a non-MSA
(with Goldsmith modification, if possible). An additional payment for
an emergency response will be paid if the condition as presented was an
emergency condition and the supplier responded ``immediately''.
The Committee is expected to conclude its work by February 15,
2000. The main items remaining include evaluating the results of the
rural modifier and preparing the Committee's official report.
The announced meeting is 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, DC
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, DC 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: Section 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: January 4, 2000.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 00-423 Filed 1-6-00; 8:45 am]
BILLING CODE 4120-01-P