[Federal Register Volume 65, Number 68 (Friday, April 7, 2000)]
[Notices]
[Page 18341]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-8744]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-1128-N]
RIN 0938-AK01
Medicare Program; Process for Requesting Recognition of New
Technologies and Certain Drugs, Biologicals, and Medical Devices for
Special Payment Under the Hospital Outpatient Prospective Payment
System
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice.
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SUMMARY: We expect to implement a prospective payment system for
hospital outpatient services for the Medicare program on July 1, 2000.
This system will recognize new technology as discrete payment groups
within the ambulatory payment classification (APC) system. This payment
system will also provide for additional payments to hospitals at
amounts higher than the amounts that would otherwise be paid for
certain specified items, such as: orphan drugs; drugs, biologic agents,
and brachytherapy devices used for the treatment of cancer;
radiopharmaceutical drugs and biologic products; and certain new or
innovative medical devices. We have identified items or services for
inclusion in the new technology APC groups, as well as items
potentially eligible for special additional payments. This notice
addresses the process that interested parties must use to submit
additional items for consideration.
FOR FURTHER INFORMATION CONTACT: Diane Milstead, (410) 786-3355.
SUPPLEMENTARY INFORMATION: We expect to implement a prospective payment
system (PPS) for hospital outpatient services for Medicare on July 1,
2000. One aspect of this system will be to develop a process to
recognize new technologies on an ongoing basis in a timely manner, and
to establish special payments for a number of specified items, in
accordance with section 201 of the Balanced Budget Refinement Act of
1999 (BBRA) (Pub. L. 106-113), enacted on November 29, 1999. New
technologies refer to services and items that have emerged since 1996,
and therefore are not reflected in the cost data that are being used to
develop our PPS. Additionally, section 201(b) of the BBRA requires us
to make additional payments to hospitals for a period of 2 to 3 years
for specific items at amounts higher than the amounts that would
otherwise be paid under the hospital outpatient PPS for items in the
following categories: (a) current orphan drugs, as designated under
section 526 of the Federal Food, Drug, and Cosmetic Act; (b) current
drugs, biologic agents, and brachytherapy devices used for the
treatment of cancer; (c) current radiopharmaceutical drugs and
biologicals; and (d) new or innovative medical devices, new drugs, and
biologic agents, in instances when we were not paying for the item as a
hospital outpatient service as of December 31, 1996, and when the cost
is ``not insignificant'' in relation to the hospital outpatient PPS
payment amount. In this context, ``current'' refers to those items for
which we are making hospital outpatient payment on the first date the
new PPS is implemented.
We will include these items and services within payment groups
called ambulatory payment classifications (APCs), which will be used in
the payment system for hospital outpatient services. In addition to the
APC-related payments, however, hospitals may receive additional payment
for specified items. In order to appropriately assign items to the new
technology APCs and make special payments for the relevant drugs,
biologicals, and medical devices, we must be able to identify the
specific items and services, and ensure that HCFA Common Procedure
Coding System (HCPCS) codes are established for them. To facilitate
this activity, we have placed on our Internet site at http://www.hcfa.gov/medicare/ hopsmain.htm the following information:
(a) A list of those items and services that we have already
identified as potentially eligible for special payments or treatment as
a new technology service; and
(b) The procedures interested parties must follow to bring to our
attention additional items that may be eligible.
If you cannot access this information on our Internet site, you may
request a paper copy by contacting Joan Briscoe in the Division of
Practitioner and Ambulatory Care at (410) 786-4495.
Authority: Section 1833(t) of the Social Security Act (42 U.S.C.
1395l(t)).
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: February 21, 2000.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Approved: March 31, 2000.
Donna E. Shalala,
Secretary.
[FR Doc. 00-8744 Filed 4-6-00; 8:45 am]
BILLING CODE 4120-01-P