[Federal Register Volume 65, Number 227 (Friday, November 24, 2000)]
[Rules and Regulations]
[Pages 70506-70507]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-29991]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

Office of Inspector General

45 CFR Part 61

RIN 0906-AA46


Health Care Fraud and Abuse Data Collection Program: Reporting of 
Final Adverse Actions; Correction

AGENCY: Office of Inspector General (OIG), HHS.

ACTION:  Final rule; correction amendment.

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SUMMARY: This document contains a correction to the final regulations 
which were published in the Federal Register on October 26, 1999 (64 FR 
57740). These regulations established a national health care fraud and 
abuse data collection program for the reporting and disclosing of 
certain adverse actions taken against health care providers, suppliers 
and practitioners, and for maintaining a data base of final adverse 
actions taken against health care providers, suppliers and 
practitioners. An inadvertent error appeared in the text of the 
regulations concerning the definition of the term ``health plan.'' As a 
result, we are making a correction to 45 CFR 61.3, Definitions, to 
assure the technical correctness of these regulations.

EFFECTIVE DATE: November 24, 2000.

FOR FURTHER INFORMATION CONTACT: Joel Schaer, OIG Regulations Officer, 
(202) 619-0089.

SUPPLEMENTARY INFORMATION: The HHS Office of Inspector General (OIG) 
issued final regulations on October 26, 1999 (64 FR 57740) that 
established a national health care fraud and abuse data collection 
program--the Healthcare Integrity and Protection Data Bank (HIPDB)--for 
the reporting and disclosing of certain final adverse actions taken 
against health care providers, suppliers and practitioners, and for 
maintaining a data base of final adverse actions taken against health 
care providers, suppliers and practitioners. The final rule established 
a new 45 CFR part 61 to implement the requirements for reporting of 
specific data elements to, and procedures for obtaining information 
from, the HIPDB. In that final rule, an inadvertent error appeared in 
Sec. 61.3--the definitions section of the regulations--and is now being 
corrected.
    Section 61.3 expanded on previous regulatory definitions and 
provided additional examples of the scope of various terms set fort in 
the statute. In the preamble of the final rule, we reiterated that the 
statutory intent of the definition for the term ``health plan'' was not 
meant to be exclusive or exhaustive, and interpreted congressional use 
of the word ``includes'' in the statutory definition of this term as an 
indication that additional entities may be recognized as ``health 
plans'' if they meet the basic definition of providing health benefits. 
The preamble of the final rule stated that the statutory language 
indicated that Congress intended that guarantors of payment for health 
care items and services--including ``self insured employers'' who are 
often the subjects of health care fraud--have access to HIPDB 
information. As a result, in order to make the term more inclusive, we 
indicated our intention of modifying the fourth element defining this 
term to include, but not be limited to, a plan, program, agreement or 
other mechanism established, maintained or made available by a self 
insured employer or group of self insured employers. This clarifying 
language, however, was not properly reflected in the regulatory text 
that appeared in the October 26, 1999 final regulations.
    To be consistent with the intent of the final rule's preamble, we 
are correcting the inadvertent error that appeared in Sec. 61.3 that 
failed to accurately reflect the definition of the term ``health 
plan.''

List of Subjects in 45 CFR Part 61

    Billing and transportation services, Durable medical equipment 
suppliers and manufacturers, Health care insurers, Health maintenance 
organizations, Health professions, Home health care agencies, 
Hospitals, Penalties, Pharmaceutical suppliers and manufacturers, 
Privacy, Reporting and recordkeeping requirements, Skilled nursing 
facilities.

    Accordingly, 45 CFR part 61 is corrected by making the following 
correcting amendment.

[[Page 70507]]

 PART 61--HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL 
ADVERSE INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND 
PRACTITIONERS

    1. The authority citation for part 61 continues to read as follows:

    Authority: 42 U.S.C. 1320a-7e.


    2. Section 61.3 is amended by republishing the introductory text, 
and by revising the definition for the term Health plan to read as 
follows:


Sec. 61.3  Definitions.

    The following definitions apply to this part:
* * * * *
    Health plan means a plan, program or organization that provides 
health benefits, whether directly, through insurance, reimbursement or 
otherwise, and includes but is not limited to--
    (1) A policy of health insurance;
    (2) A contract of a service benefit organization;
    (3) A membership agreement with a health maintenance organization 
or other prepaid health plan;
    (4) A plan, program, agreement or other mechanism established, 
maintained or made available by a self insured employer or group of 
self insured employers, a practitioner, provider or supplier group, 
third party administrator, integrated health care delivery system, 
employee welfare association, public service group or organization or 
professional association; and
    (5) An insurance company, insurance service or insurance 
organization that is licensed to engage in the business of selling 
health care insurance in a State and which is subject to State law 
which regulates health insurance.
* * * * *

    Dated: November 1, 2000.
William E. Clark,
Acting Director for Information Resource Management.
[FR Doc. 00-29991 Filed 11-22-00; 8:45 am]
BILLING CODE 4152-01-M