[Federal Register Volume 68, Number 163 (Friday, August 22, 2003)]
[Rules and Regulations]
[Pages 50717-50722]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-21441]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 413

[CMS-1199-F]
RIN 0938-AL51


Medicare Program; Electronic Submission of Cost Reports

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule.

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SUMMARY: This final rule amends regulation by requiring that, for cost 
reporting periods ending on or after December 31, 2004, all hospices, 
organ procurement organizations, rural health clinics, Federally 
qualified health centers, community mental health centers, and end-
stage renal disease facilities must submit cost reports currently 
required under the Medicare regulations in a standardized electronic 
format. This rule also allows a delay or waiver of this requirement 
when implementation would result in financial hardship for a provider. 
The provisions of this rule allow for more accurate preparation and 
more efficient processing of cost reports.

DATES: Effective Date: The provisions of this final rule are effective 
September 22, 2003.
    Applicability Date: The provisions of this final rule are effective 
for cost reporting periods ending on or after December 31, 2004.

FOR FURTHER INFORMATION CONTACT: Larry Stevenson, (410) 786-5529.

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I. Background

    Generally, under the Medicare program, hospices, organ procurement 
organizations (OPOs), rural health clinics (RHCs), Federally qualified 
health centers (FQHCs), community mental health centers (CMHCs), and 
end-stage renal disease (ESRD) facilities are paid for the reasonable 
costs of the covered items and services they furnish to Medicare 
beneficiaries. Sections 1815(a) and 1833(e) of the Social Security Act 
(the Act) provided that no payments will be made to a provider unless 
it has furnished the information, requested by the Secretary of the 
Department of Health and Human Services (the Secretary), needed to 
determine the amount of payments due the provider. In general, 
providers submit this information through cost reports that cover a 12-
month period. Rules governing the submission of cost reports are set 
forth in title 42 of the Code of Federal Regulations (CFR) 413.20 and 
413. 24.
    Under Sec.  413.20(a), all providers participating in the Medicare 
program are required to maintain sufficient financial records and 
statistical data for proper determination of costs payable under the 
program. In addition, providers must use standardized definitions and 
follow accounting, statistical, and reporting practices that are widely 
accepted in the health care industry and related fields. Under Sec.  
413.20(b) and Sec.  413.24(f), providers are required to submit cost 
reports annually, with the reporting period based on the provider's 
accounting year. Additionally, under Sec.  412.52, all hospitals 
participating in the prospective payment system must meet cost 
reporting requirements set forth at Sec.  413.20 and Sec.  413.24.
    Section 1886(f)(l)(B)(i) of the Act requires the Secretary to 
establish a standardized electronic cost reporting system for all 
hospitals participating in the Medicare program. This provision was 
effective for hospital cost reporting periods beginning on or after 
October 1, 1989. On January 2, 1997, we revised our regulations at 
Sec.  413.24(f)(4)(ii) to extend the electronic cost reporting 
requirement to skilled nursing facilities (SNFs) and home health 
agencies (HHAs) (62 FR 26-31).
    The required cost reports must be electronically transmitted to the 
intermediary in American Standard Code for Information Interchange 
(ASCII) format. In addition to the electronic file, hospitals, SNFs, 
and HHAs were initially required to submit a hard copy of the full cost 
report. We later revised our regulations in Sec.  413.24(f)(4)(iv) to 
state that providers were required to submit, instead, a hard copy of a 
one-page settlement summary, a statement of certain worksheet totals 
found in the electronic file, and a statement signed by the provider's 
administrator or chief financial officer certifying the accuracy of the 
electronic file. In order to preserve the integrity of the electronic 
file, in the January 1997 final rule we specified procedures regarding 
the processing of the electronic cost report once it is submitted to 
the intermediary (62 FR 27).

II. Provisions of the Proposed Regulations

    With the exception of revising the first cost reporting period 
affected from those ending on or after December 31, 2002 to those 
ending on or after December 31, 2004, we have adopted the provisions as 
set forth in our proposed rule, published in the Federal Register on 
July 26, 2002 (67 FR 48840-48844). We revised the cost reporting 
periods affected to take into account the publication date for this 
final rule. We discuss the finalized provisions in section IV of this 
final rule.

III. Analysis of and Responses to Public Comments

    We received approximately 20 comments on the proposed electronic 
submission of cost reports requirements. These comments were from 
providers, professional organizations, trade associations, vendors and 
individuals. Summaries of the public comments

[[Page 50718]]

received and our responses to those comments are set forth below.
    Comment: Several commenters requested that we add language to the 
regulation that would prohibit fiscal intermediaries (FIs) from 
requesting paper copies of the Medicare cost report, in addition to the 
electronic cost report.
    Response: According to our CMS manual provisions (Provider 
Reimbursement Manual 15-2, chapter 1, sections 131 and 132), the 
electronic cost report file is considered the official cost report by 
the FI and, as a result, must be accepted by the FI. Since March 31, 
1993, hospitals have not been required to submit a paper copy of the 
cost report to the FI . Similarly, since March 31, 2000, SNFs and HHAs 
have not been required to submit a paper copy of the cost report to the 
FI. We have, however, provided a two-year phase-in period for the 
providers that are subject to this regulation. During this two-year 
phase-in period, the paper copy of the cost report will be considered 
the official copy. After the expiration of the two-year period, though, 
a paper copy of the cost report will not be required to be submitted to 
the FI. We believe this phase-in period is necessary, so that providers 
are familiar with the requirements of electronic cost reporting.
    Comment: We received several comments concerning our proposal to 
distribute free electronic cost reporting software to providers who can 
demonstrate that it would be a financial hardship to purchase software 
from vendors. One comment, from a software vendor, requested that we 
add language that would preclude the distribution of free software 
because it would be ``unfair'' to small vendors and the software would 
be poor quality. Another commenter asked that we specify a date that 
the free software would be available to providers. Also, we received a 
comment that the CMS-provided software would not allow providers to 
determine final settlement and that providers would still have to 
complete the cost report manually.
    Response: With regard to the comment concerning adding language to 
the regulation that would preclude the distribution of free software, 
free software is made available to the providers based upon financial 
need only. The provider must demonstrate to the FI that the provider is 
financially unable to purchase commercial software. It has been our 
experience, with the hospitals, SNFs, and HHAs currently required to 
file electronically, that relatively few providers request the free 
software. If, however, the provider requests the free software and can 
demonstrate to the FI that it would be a financial hardship to purchase 
the software from a vendor, we will provide the software so that the 
provider can comply with the provisions of this rule. The quality of 
the software will be sufficient to allow the provider to comply with 
all provisions of this rule in a timely and efficient manner.
    With regard to the comment concerning the projected date that the 
free software will be available, we expect that it should be available 
by September 30, 2004.
    The comment that the CMS-provided software would not allow 
providers to determine final settlement and, as a result, that 
providers would still have to complete the cost report manually, is 
correct. The software allows the provider to create an electronic cost 
report file only for use by the FI and a final settlement amount is not 
necessary in this instance. Providers who use free software are always 
required to manually complete the cost report and to manually determine 
the final settlement.
    Comment: We received a comment that the final regulation should 
also require that Comprehensive Outpatient Rehabilitation Facilities 
(CORFs) and Outpatient Physical Therapy providers (OPTs) file cost 
reports electronically.
    Response: We are not requiring CORFs and OPTs to file 
electronically because CORFs are paid on a fee schedule for services 
furnished on or after April 1, 2001 and OPTs will be paid on a fee 
schedule for services furnished on or after July 1, 2003. For those 
providers with cost reporting periods beginning on or after the 
aforementioned dates, cost reports will no longer be required. We 
believe that it would be administratively burdensome as well as not 
economically feasible to require these providers to meet the electronic 
filing requirements for such a short period of time.
    Comment: We received a comment that the final rule should include 
an exemption from the electronic filing requirement for no or low 
utilization providers because it appears that these providers are 
exempt from such filing requirements in Sec.  413.24(h).
    Response: Section 413.24(h) does not address the electronic filing 
requirement but it does provide that an FI may waive the requirement 
that a provider submit a full cost report if it qualifies as low 
utilization or no cost Medicare provider. Thus, based upon a waiver by 
the FI, under Sec.  413.24(h), a low utilization or no Medicare 
utilization provider would not be required to file an electronic cost 
report. Because our current regulations clearly state that a full cost 
report need not be filed by a low utilization or no Medicare 
utilization provider, we believe that an exception, such as the one 
requested by the commenter, is not necessary for this final rule.
    Comment: We received a comment that we should clarify the minimum 
requirements of what constitutes a financial hardship for the purposes 
of qualifying for the waiver and/or free software.
    Response: Given the wide spectrum of the providers affected, we 
believe it is best to determine financial hardship on a case-by-case 
basis. Some examples of financial hardship include cash flow problems, 
previous year's net operating loss, and a required repayment of the 
past year's overpayment. These are some examples of financial hardship 
but should not be seen as all-encompassing. The flexibility to make 
these determinations is necessary as the providers differ greatly in 
terms of size, location, expenses, and services provided. The FI will 
need to have this flexibility in order to make a fair and reasonable 
determination for each provider.
    Comment: We received several comments concerning the one-time pass 
through of costs (direct reimbursement on a dollar-for-dollar basis) 
for RHCs and FQHCs rather than reimbursing those providers based on the 
determination of the total allowable costs of the RHCs and FQHCs.
    Response: We are unable to reimburse RHCs and FQHCs in a way other 
than direct reimbursement because to do so would require a statutory 
change in the method of reimbursement for the RHCs and FQHCs.
    Comment: We received a comment reflecting concern that the cost of 
dial up Internet service required to file electronically would be a 
burden for rural providers.
    Response: There is no requirement to use the Internet to 
electronically file a cost report. The medium for transfer of cost 
reports submitted electronically to FIs is a 3\1/2\'' diskette.
    Comment: We received two comments expressing concern about the 
phase-in period. One concern was that the two-year phase-in period was 
too long. Another concern was that the two-year period should be 
extended to three years.
    Response: We believe that the two-year phase-in period is necessary 
to allow providers to become familiar with the requirements of 
electronic filing and that a shorter phase-in period would be 
insufficient to accomplish this.
    Similarly, prior experience with the hospital cost report, the SNF 
cost report,

[[Page 50719]]

and the HHA cost report indicate that the two-year phase-in period 
provides ample time for the providers to adjust to the electronic 
methods for filing the cost report, and a longer period is not 
necessary.
    Comment: We received a comment that we should delay the 
implementation of the electronic filing requirement for FQHCs from 
December 31, 2002 until June 30, 2003 to allow those providers more 
time for implementation.
    Response: We are revising the implementation date to December 31, 
2004 to allow all providers more time to implement the rule.
    Comment: We received a comment that recommended that we have a 
pilot testing period before implementing the electronic filing 
requirement.
    Response: Electronic filing of cost reports has been required since 
March 31, 1993 for hospitals and for SNFs and HHAs since March 31, 2000 
and, based on our experiences with hospitals, SNFs, and HHAs, we 
believe that the electronic filing requirements will be implemented by 
hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD facilities, as efficiently 
as has been the case with the other providers mentioned. Moreover, the 
two-year phase-in period, which will end May 31, 2007, will allow 
sufficient time for the providers subject to this regulation to adapt 
to the electronic filing requirement. The hard copy of the cost report 
is the official copy during the two-year transition period. For this 
two-year phase-in period, no cost report will be rejected but the FIs 
will make the provider aware of the edits that the provider did not 
pass. This flexibility will allow the provider to correct any problems 
that the provider has encountered with electronic filing before the 
phase-in period ends.
    Comment: We received a comment that a correction period of 60 days 
be allowed for providers to resubmit electronic cost reports that are 
rejected by the FI.
    Response: While it is the responsibility of the provider to submit 
an acceptable cost report to the FI by the required due date of the 
cost report, we have established a two-year phase-in period where the 
hardcopy of the cost report will be the official cost report and will 
not be rejected by the FI--a concern of the commenter. The two-year 
phase-in period has been established to allow the provider sufficient 
time to familiarize itself with the electronic filing requirements. 
Also, during this two-year phase-in period, the FI will inform the 
provider concerning any problems that the provider may encounter with 
the electronic filing requirement that would cause rejection in the 
future. It should be noted, as well, that there already exists a 30-day 
period during which providers can correct errors and resubmit 
electronic cost reports to the FI (See Provider Reimbursement Manual 
15-II, Chapter 1, section 140).
    Comment: We received a comment that all current cost reports should 
be settled by the FIs before the implementation of the electronic 
filing requirement.
    Response: The settlement of cost reports is not governed by this 
final rule and any changes regarding the settlement of cost reports are 
beyond the scope of this rule which is concerned solely with electronic 
filing requirements.
    Comment: We received a comment that we should provide electronic 
Provider Statistical Reimbursement & Report data (PS&R)--reimbursement 
and statistical data that we prepare--to providers.
    Response: Although this comment does not fall within the scope of 
this rule, we believe that it may be helpful to address this process 
issue. We note, therefore, that this information is used by the FI for 
the settlement of cost reports. The detailed PS&R, however, is 
available from the FI upon written request from the provider if there 
are any discrepancies between the provider's data and the PS&R summary 
report. The FI is required to send the summary PS&R report to the 
provider 30 days before the due date of the cost report.
    Comment: A commenter requested that we not extend the ``complex'' 
and ``punitive'' criteria for acceptable cost reports currently imposed 
on hospitals, SNFS, and HHAs to the other providers affected by this 
final rule.
    Response: We do not believe that acceptability criteria for 
electronic cost report filings are complex and they certainly are not 
intended to be punitive. We developed these criteria both to help the 
provider and to ensure that the provider is aware of what is required 
to file an acceptable cost report. We believe these criteria, which we 
attempt to keep at a minimum, will help ensure accuracy and save time 
to both the provider and the FI. Generally included in the criteria, 
for example, are the level one electronic edits that all cost reports 
must pass in order for the cost report to be acceptable. By clearly 
enumerating these level one edits in our criteria--the criteria most 
critical in the filing of an acceptable electronic cost report--we 
believe providers will have every opportunity to meet the requirements 
in a timely and accurate manner.

IV. Provisions of the Final Rule

    In this final rule, we are applying the current hospital, SNF, and 
HHA electronic cost reporting requirements to hospices, OPOs, RHCs, 
FQHCs, CMHCs, and ESRD facilities with the exception that, for the 
first 2 years, the hard copy of the cost report must be submitted with 
the electronic cost report. Over that 2-year period (until May 31, 
2007) the hard copy will continue to be the official copy. We believe 
that the use of electronically prepared cost reports will be beneficial 
for hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD facilities because the 
cost reporting software for these reports will virtually eliminate 
computational errors and substantially reduce preparation time. 
Moreover, the use of cost reporting software will save time whenever 
the provider needs to change individual entries in a cost report.
    This rule provides that a hospice, organ procurement organization, 
RHC, FQHC, CMHC, or ESRD facilities may submit a written request for a 
waiver or a delay of these requirements if it believes that 
implementation of the electronic submission requirement would cause a 
financial hardship. Consistent with the existing regulations (see Sec.  
413.24(h)), we are continuing to allow providers with low or no 
Medicare utilization to request a waiver of full or simplified cost 
reporting.

V. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995 (PRA 1995), we are 
required to provide 30 days notice in the Federal Register and solicit 
public comment before a collection of information requirement is 
submitted to the Office of Management and Budget (OMB) for review and 
approval. However, the requirements referenced and discussed below are 
currently approved by OMB.

Section 413.24 Adequate Cost Data and Cost Finding

    Currently, Sec.  413.24 requires hospitals, SNFs, and HHAs to 
submit electronic cost reports. However, as proposed in the regulation, 
hospices, OPOs, RHCs, FQHCs, CMHCs, or ESRD facilities will no longer 
have the option of submitting either a hard copy or electronic cost 
report. In addition to the electronic cost report, these providers will 
also continue to be required to submit to the appropriate FI, hard 
copies of a settlement summary, statement of certain worksheet totals, 
and the Federally prescribed statement signed

[[Page 50720]]

by its administrator or chief financial officer certifying the accuracy 
of the electronic file or the manually prepared cost report. We believe 
that these electronic filing requirements will initially increase the 
burden by approximately 40 hours and cost approximately $5000 for each 
cost reporting period. We expect that this burden will decrease as the 
providers become familiar and proficient in electronic filing.
    However, as currently approved, these providers may request a delay 
or waiver of the electronic submission requirement in paragraph 
(f)(4)(ii) of this section if this requirement would cause a financial 
hardship.
    As noted above, while all the above reporting requirements are 
subject to the PRA, they are currently approved under OMB approval 
numbers 0938-0050, ``Hospital/Healthcare Complex Cost Report,'' with a 
current expiration date of November 30, 2005, 0938-0463; ``Skilled 
Nursing Facility Cost Report,'' with a current expiration date of May 
31, 2004; 0938-0022, ``Home Health Agency Cost Report,'' with a current 
expiration date of May 31, 2004; 0938-0758, ``Hospice Cost Report,'' 
with a current expiration date of March 31, 2005; 0938-0102, ``Organ 
Procurement Agency/Laboratory Statement of Reimbursable Costs,'' with a 
current expiration date of October 31, 2003, which is currently at OMB 
awaiting re-approval; 0938-0107, ``Independent Rural Health Clinic/
Freestanding Federally Qualified Health Center Cost Report,'' with a 
current expiration date of October 31, 2005; 0938-0236, ``Medicare 
Independent Renal Dialysis Facility Cost Report,'' with a current 
expiration date of August 31, 2004; and 0938-0657, ``End Stage Renal 
Disease Network Cost Report,'' with a current expiration date of 
December 31, 2003, which is currently in the re-approval process.

VI. Regulatory Impact Statement

    We have examined the impacts of this final rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 16, 1980 Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1955 (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more annually). This 
rule will not have a significant economic impact on hospices, OPOs, 
RHCs, FQHCs, CMHCs, and ESRD facilities, and, therefore, is not a major 
rule. There are no requirements for hospices, OPOs, RHCs, FQHCs, CMHCs, 
and ESRD facilities to initiate new processes of care, and reporting; 
to increase the amount of time spent on providing or documenting 
patient care services; or to purchase computer software.
    The RFA requires agencies to analyze options for regulatory relief 
of small entities. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having annual 
receipts of $6 million to $29 million or less annually (see 65 FR 
69432). For purposes of the RFA, all providers and small businesses 
that distribute cost-report software to providers are considered small 
entities. We do not believe that this rule will have a significant 
impact on these providers as no or low utilization providers already 
have the ability to file for a waiver of the electronic filing 
requirement. In demonstrated cases of financial hardship, however, we 
will provide free software. With computers so common in the work place 
today it is hard to imagine that a provider does not already access to 
a computer and, in the rare instance when a provider would have to 
purchase a computer, we believe the cost would be neglible. In 
addition, the providers have a period of almost two years to 
familiarize themselves with the electronic filing requirements, since 
the first cost reports will not be due until May 31, 2005. Our 
intermediaries are not considered small entities for the purposes of 
the RFA. Individuals and States are not included in the definition of 
small entities.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area and has fewer than 100 beds.
    We are not preparing analyses for either the RFA or section 1102(b) 
of the Act because we have determined, and we certify, that this rule 
will not have a significant economic impact on a substantial number of 
small entities or a significant impact on the operations of a 
substantial number of small rural hospitals.
    As stated above, under Sec.  413.20(b) and Sec.  413.24(f), 
providers are required to submit cost reports annually, with reporting 
periods based on the provider's accounting year. This final rule 
requires hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD facilities, like 
hospitals, SNFs and HHAs, to submit their Medicare cost reports in a 
standardized electronic format. This requirement will take effect for 
cost reporting periods ending on or after December 31, 2004, meaning 
that the first electronic cost reports will be due May 31, 2005.
    Currently, approximately 55 percent of all hospices, OPOs, RHCs, 
FQHCs, CMHCs, and ESRD facilities submit a hard copy of an 
electronically prepared cost report to the intermediary. We believe 
that the provisions of this final rule will have little or no effect on 
these providers, except to reduce the time involved in copying and 
collating a hard copy of the report for intermediaries. Under this 
rule, instead of submitting a complete hard copy of the report, 
providers will be required to submit only hard copies of a settlement 
summary, statement of certain worksheet totals, and a statement signed 
by the administrator or chief financial officer certifying the accuracy 
of the electronic file or the manually prepared cost report. In 
addition to the 55 percent of providers that currently use electronic 
cost reporting, this rule will not affect those providers that do not 
file a full cost report and, as stated above, would not be required to 
submit cost reports electronically.
    This rule may have an impact on those providers who do not prepare 
electronic cost reports, some of whom may have to purchase computer 
equipment, obtain the necessary software, and train staff to use the 
software. However, as discussed below, we believe that the potential 
impact of this final rule on those providers who do not prepare 
electronic cost reports will be insignificant.
    First, a small number of the 45 percent of providers that do not 
submit electronic cost reports may have to purchase computer equipment 
to comply with the provisions of this rule. These providers are 
generally owned

[[Page 50721]]

and operated by one or two individuals and are often located in rural 
areas. They include approximately 1,500 RHCs and 1,500 FQHCs. We 
estimate that 1,350 of the 3000 RHCs and FQHCs may not have the 
necessary computer equipment. We believe, however, that most providers 
already have access to computer equipment, which they are now using for 
internal record keeping purposes, as well as for submitting 
electronically generated bills to their fiscal intermediaries, for 
example. Thus, we do not believe that obtaining computer equipment will 
be a major obstacle to electronic cost reporting for most providers. 
For those providers that may have to purchase computer equipment, we 
note that, in accordance with current regulations governing payment of 
provider costs, we will pay for the cost of the equipment as an 
overhead cost. Rural health clinics and FQHCs will be reimbursed 
subject to a payment limit; OPOs reimbursed based on costs; hospices 
reimbursed according to fee schedule; ESRDs paid a composite rate, and 
CMHCs will be reimbursed through a blend of prospective payment (PPS) 
and cost.
    We recognize that a potential cost for providers that do not submit 
electronic cost reports will be that of training staff to use the 
software. Since most hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD 
facilities currently use computers, we do not believe that training 
staff to use the new software will impose a large burden on providers. 
An additional cost would be the cost of the software offered by 
commercial vendors. However, providers could eliminate this cost by 
obtaining the necessary software from us, free of charge. In those 
instances when these requirements may cause hardship, a waiver can be 
granted.
    The requirement that hospitals submit cost reports in a 
standardized electronic format has been in place since October 1989. 
Since that time, the accuracy of cost reports has increased and we have 
received very few requests for waivers. Additionally, we have not 
received any comments from the hospital industry indicating that the 
use of electronic cost reporting is overly burdensome. We believe that 
electronic cost reporting will be equally effective for hospices, OPOs, 
RHCs, FQHCs, CMHCs, and ESRD facilities, with the benefits (such as 
increased accuracy and decreased preparation time) outweighing the 
costs of implementation for most providers.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in an expenditure in any one year by 
State, local, or tribal governments, in the aggregate, or by the 
private sector, that exceeds the inflation-adjusted threshold of $110 
million. This rule does not impose any costs that would exceed the $110 
million threshold on the governments mentioned, or the private sector.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct compliance costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. We have examined this final rule and have determined that 
this rule will not have an impact on the rights, roles, and 
responsibilities of State, local, or tribal governments.
    In accordance with the provisions of Executive Order 12866, this 
final rule was reviewed by the Office of Management and Budget.

List of Subjects in 42 CFR Part 413

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

0
For the reasons set forth in the preamble, the Centers for Medicare & 
Medicaid amends 42 CFR chapter IV part 413 as follows:

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

0
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), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act 
(42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww).


0
2. Section 413.24 is amended by revising existing paragraphs (f)(4)(i) 
through (f)(4)(v) to read as follows:


Sec.  413.24  Adequate cost data and cost finding.

* * * * *
    (f) Cost reports. * * *
    (4) Electronic submission of cost reports.
    (i) As used in this paragraph, ``provider'' means a hospital, 
skilled nursing facility, home health agency, hospice, organ 
procurement organization, rural health clinic, Federally qualified 
health clinic, community mental health center, or end-stage renal 
disease facility.
    (ii) Effective for cost reporting periods beginning on or after 
October 1, 1989 for hospitals, cost reporting periods ending on or 
after December 31, 1996 for skilled nursing facilities and home health 
agencies, and cost reporting periods ending on or after December 31, 
2004 for hospices, organ procurement organizations, rural health 
clinics, Federally qualified health centers, community mental health 
centers, and end-stage renal disease facilities, a provider is required 
to submit cost reports in a standardized electronic format. The 
provider's electronic program must be capable of producing the CMS 
standardized output file in a form that can be read by the fiscal 
intermediary's automated system. This electronic file, which must 
contain the input data required to complete the cost report and to pass 
specified edits, must be forwarded to the fiscal intermediary for 
processing through its system.
    (iii) The fiscal intermediary stores the provider's as-filed 
electronic cost report and may not alter that file for any reason. The 
fiscal intermediary makes a ``working copy'' of the as-filed electronic 
cost report to be used, as necessary, throughout the settlement process 
(that is, desk review, processing audit adjustments, and final 
settlement). The provider's electronic program must be able to disclose 
if any changes have been made to the as-filed electronic cost report 
after acceptance by the intermediary. If the as-filed electronic cost 
report does not pass all specified edits, the fiscal intermediary must 
return it to the provider for correction. For purposes of the 
requirements in paragraph (f)(2) of this section concerning due dates, 
an electronic cost report is not considered to be filed until it is 
accepted by the intermediary.
    (iv) Effective for cost reporting periods ending on or after 
September 30, 1994 for hospitals, cost reporting periods ending on or 
after December 31, 1996 for skilled nursing facilities and home health 
agencies, and cost reporting periods ending on or after December 31, 
2004 for hospices, organ procurement organizations, rural health 
clinics, Federally qualified health centers, community mental health 
centers, and end-stage renal disease facilities, a provider must submit 
a hard copy of a settlement summary, a statement of certain worksheet 
totals found within the electronic file, and a statement signed by its 
administrator or chief financial officer certifying the accuracy of the 
electronic file or the manually prepared cost report. During a 
transition period (first two cost-reporting periods on or after 
December 31, 2004), hospices, organ procurement

[[Page 50722]]

organizations, rural health clinics, Federally qualified health 
centers, community mental health centers, and end-stage renal disease 
facilities must submit a hard copy of the completed cost report forms 
in addition to the electronic file. The following statement must 
immediately precede the dated signature of the provider's administrator 
or chief financial officer:

I hereby certify that I have read the above certification statement 
and that I have examined the accompanying electronically filed or 
manually submitted cost report and the Balance Sheet Statement of 
Revenue and Expenses prepared by--------(Provider Name(s) and 
Number(s)) for the cost reporting period beginning ------ and ending 
------ and that to the best of my knowledge and belief, this report 
and statement are true, correct, complete and prepared from the 
books and records of the provider in accordance with applicable 
instructions, except as noted. I further certify that I am familiar 
with the laws and regulations regarding the provision of health care 
services, and that the services identified in this cost report were 
provided in compliance with such laws and regulations.

    (v) A provider may request a delay or waiver of the electronic 
submission requirement in paragraph (f)(4)(ii) of this section if this 
requirement would cause a financial hardship or if the provider 
qualifies as a low or no Medicare utilization provider. The provider 
must submit a written request for delay or waiver with necessary 
supporting documentation to its intermediary no later than 30 days 
after the end of its cost reporting period. The intermediary reviews 
the request and forwards it, with a recommendation for approval or 
denial, to CMS central office within 30 days of receipt of the request. 
CMS central office either approves or denies the request and notifies 
the intermediary within 60 days of receipt of the request.
* * * * *

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
    Dated: February 21, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.

    Approved: April 24, 2003.
Tommy G. Thompson,
Secretary.
[FR Doc. 03-21441 Filed 8-21-03; 8:45 am]
BILLING CODE 4120-01-P