[Federal Register Volume 65, Number 196 (Tuesday, October 10, 2000)]
[Rules and Regulations]
[Pages 60104-60105]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-25497]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 413

[HCFA-1883-F2]
RIN 0938-AI80


Medicare Program; Revision of the Procedures for Requesting 
Exceptions to Cost Limits for Skilled Nursing Facilities and 
Elimination of Reclassifications; Correction

AGENCY: Health Care Financing Administration (HCFA) HHS.

ACTION: Technical corrections.

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

SUMMARY: In the August 5, 1999 issue of the Federal Register (64 FR 
42610), we published a final rule addressing the procedures for 
granting exceptions to the Medicare skilled nursing facility (SNF) 
routine service cost limits, and we removed the provision allowing for 
reclassification for SNFs and home health agencies. This document 
amends the regulations text to make technical corrections to those 
parts of the regulation unrelated to the SNF exception procedures that 
were inadvertently changed.

EFFECTIVE DATE: September 7, 1999.

FOR FURTHER INFORMATION CONTACT: Julie Stankivic, (410) 786-5725.

SUPPLEMENTARY INFORMATION:   

Background

    In the August 5, 1999 final rule (64 FR 42610), we amended the 
regulations to allow the fiscal intermediaries to make final 
determinations on requests by skilled nursing facilities (SNFs) for 
exceptions to the Medicare routine service cost limits under 42 CFR 
Sec. 413.30(f). In the preamble to both the proposed and final rules 
(63 FR 42797 and 64 FR 42610, respectively), we specifically stated 
that the changes are limited to our procedures regarding SNF 
exceptions. We did not intend to change the new provider exemption 
under Sec. 413.30(e) or any other provision relating to home health 
agencies (HHAs). The changes in Sec. 413.30 as set forth in the final 
rule, however, have raised questions as to whether policy changes had 
been made in these unrelated areas.

The New Provider Exemption

    The preamble to the proposed and final rules (63 FR 42797 and 64 FR 
42610, respectively) discussed the three types of relief available to 
SNFs that exceed the SNF routine service cost limits found in 
Sec. 413.30. In the preamble concerning Sec. 413.30(c), we indicated 
that a provider may seek relief from the effects of applying the cost 
limits, either by requesting an exemption from its limits as a new 
provider of inpatient services, by requesting a reclassification of its 
provider status, or by requesting an exception to the cost limit. Of 
these three types of relief, the proposed and final rules focused 
solely on the exception process and our proposal to revise the approval 
process for granting exceptions to the cost limits for SNFs and to 
remove the provision for obtaining a reclassification for a SNF or an 
HHA. We did not make changes to the exemption requirements for a new 
provider. However, the recently promulgated changes to 
Sec. 413.30(c)(2), with regard to the processing of SNF exception 
requests, may have created confusion with regard to the processing of 
new provider exemption requests. In addition, editorial changes to 
Sec. 413.30(d), meant to clarify which provisions applied to which 
provider type may have created an impression that a policy change has 
occurred; no policy changes were intended. The only two provider types 
subject to the regulations found in Sec. 413.30 at present are SNFs and 
HHAs. We did not propose any changes to our existing policies with 
regard to the new provider exemption provision or the processing of new 
provider exemption requests. The intermediary makes a recommendation to 
HCFA, and HCFA makes the final determination on requests by SNFs for a 
new provider exemption under Sec. 413.30(d) as redesignated.

Home Health Agencies

    In the preamble to the proposed and final rules (63 FR 42797, 64 FR 
42610), we clearly stated that we are retaining the current procedures 
for HHA exception requests and that these provisions would remain 
unchanged. We modified Sec. 413.30 (in its entirety), in an attempt to 
clarify which provisions applied to which provider type. The only two 
provider types subject to Sec. 413.30 at present are SNFs and HHAs. 
HHAs, however, have never been eligible to receive an exception for 
``areas with fluctuating populations,'' an impression that may have 
been created by these editorial changes.

Provisions of the Rule

    For the reasons discussed above, we are making the necessary 
technical corrections to restore the regulations to conform with our 
longstanding and unchanged policies for both the new provider exemption 
for SNFs, and the procedures for exceptions to the cost limits for 
HHAs.

List of Subjects in 42 CFR Part 413

    Health facilities, Kidney diseases, Medicare, Puerto Rico, 
Reporting and recordkeeping requirements.

    Accordingly, 42 CFR part 413 is corrected by making the following 
correcting amendments:

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT 
RATES FOR SKILLED NURSING FACILITIES

    1. The authority citation for part 413 continues to read as 
follows:

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and 
(n), 1871, 1881, 1883, and 1886 of the Social Security Act (42 
U.S.C. 1302, 1395f(b), 1395g, 13951, 13951(a), (i), and (n), 
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww).

    2. In Sec. 413.30, the following changes are made:


Sec. 413.30  [Corrected]

    A. In paragraph (a) introductory text, at the end of the second 
sentence after the word ``situations'', the phrase ``of particular 
providers'' is added.
    B. In paragraph (a)(2), at the beginning of the first sentence, the 
words ``Payable SNF and HHA'' are removed, and the words ``Reimbursable 
provider'' are added in their place.
    C. In paragraph (c) introductory text, in the last sentence, the 
words ``intermediary's notice of program pay'' are removed, and the 
words ``intermediary's notice of program reimbursement'' are added in 
their place.
    D. In paragraph (c)(2), the heading is corrected to read ``Skilled 
nursing facility exception''; and in the first sentence, the word 
``exception'' is added between the words ``SNFs'' and ``request''.
    E. In paragraph (d), add the sentence ``The intermediary makes a 
recommendation on the provider's request to HCFA, which makes the 
decision.'' after the first sentence; and remove the words ``the type 
of'' from the first sentence and add the word ``a'' in their place.

[[Page 60105]]

    F. In paragraph (e)(3) introductory text, the words ``or HHA'' are 
removed; and in paragraph (e)(3)(ii), the word ``similar'' is added 
before each occurrence of the word ``services'', and the words ``or 
HHA'' are removed.

(Catalog of Federal Domestic Assistance Program No. 93.773 
Medicare--Hospital Insurance)

    Dated: September 21, 2000.
Brian P. Burns,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 00-25497 Filed 10-6-00; 8:45 am]
BILLING CODE 4120-01-P