[Federal Register Volume 65, Number 19 (Friday, January 28, 2000)]
[Proposed Rules]
[Pages 4545-4546]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-2042]


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 Proposed Rules
                                                 Federal Register
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 This section of the FEDERAL REGISTER contains notices to the public of 
 the proposed issuance of rules and regulations. The purpose of these 
 notices is to give interested persons an opportunity to participate in 
 the rule making prior to the adoption of the final rules.
 
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 

  Federal Register / Vol. 65, No. 19 / Friday, January 28, 2000 / 
Proposed Rules  

[[Page 4545]]



DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 405

[HCFA-1002-N3]


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

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

ACTION:  Notice of meeting.

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

SUMMARY:  In accordance with section 10(a) of the Federal Advisory 
Committee Act, this notice announces the date and location for the 
final 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).

DATES:  The final meeting is scheduled for Monday, February 14, 2000 
from 8:30 a.m. until 6:00 p.m., e.s.t.

ADDRESSES:  The meeting will be held at the Health Care Financing 
Administration, Grand Auditorium, 7500 Security Boulevard, Baltimore, 
Maryland 21244; (410) 786-1000.

FOR FURTHER INFORMATION CONTACT: In order to gain access to the 
building if you are interested in attending this final meeting, it is 
important that you notify the agency contact listed below by February 
10, 2000. If you fail to notify the agency contact by February 10, 2000 
of your intent to attend the meeting, you may be delayed in entering 
the building. The agency contact is Margot Blige ((410) 786-4642 or E-
mail: [email protected]).
    Inquiries regarding this meeting 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 BBA added a new 
section 1834(l) to the Social Security Act (the Act) that mandates by 
January 1, 2000, that we implement 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 also provides that, in establishing the fee schedule, we 
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 us 
with respect to the text and content of a proposed rule that would 
establish a fee schedule for the payment of ambulance services under 
Medicare Part B.
    The Committee's first and second meetings were for organizational 
purposes solely. No significant decisions were made in these two 
meetings.
    The Committee's third meeting was held on May 24 and May 25, 1999. 
At that meeting, the Committee heard presentations from our staff, 
including a data presentation. The Committee requested another 
presentation by our Office of the Actuary (OACT) to obtain 
clarification about its calculation of the fee schedule payment cap. 
Additionally, a Medical Issues workgroup was formed.
    The Committee's fourth meeting was held on June 28 and June 29, 
1999. At that meeting, a staff member from OACT made a presentation 
clarifying 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. Our staff presented more 
historical Medicare hospital and supplier ambulance billing data. 
Consensus was reached on one possible basic structure for the fee 
schedule. We indicated that the fee schedule must be effective as soon 
as operationally possible after January 1, 2000. Subcommittees were 
formed to produce proposals by July 19, 1999 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's fifth meeting was held on August 2 and August 3, 
1999. At that meeting the Committee heard presentations from our staff 
on the Medicare Physician Fee Schedule's Geographic Practice Cost Index 
(GPCI) and the 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 our negotiated rulemaking team, presented additional historical 
Medicare hospital and ambulance supplier billing data. The Committee 
was advised in a letter signed by our 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 for the emergency response modifier amount to be 
paid.
    During the October meeting, the Committee worked on defining the 
geographic and rural modifiers and establishing the relative values of 
the different levels of service.
    The Committee's seventh meeting was held December 6 through 
December 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 GPCI 
(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

[[Page 4546]]

defined as a location in a non-Metropolitan Statistical Area (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's eighth meeting is scheduled for January 24 through 
January 26, 2000. It is expected that this meeting will focus on 
evaluating the results of the rural modifier and preparing the 
Committee's official report. The Committee is expected to conclude its 
work by February 14, 2000.
    The purpose of this final meeting is to allow Committee members to 
officially conclude the business of the Committee by signing and 
finalizing the Committee's official report. No other agenda has been 
established.
    In accordance with Federal Advisory Committee Act requirements, 
this meeting is open to the public with advanced registration 
preferred. 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.
    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 24, 2000.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 00-2042 Filed 1-27-00; 8:45 am]
BILLING CODE 4120-01-P