[Federal Register Volume 73, Number 41 (Friday, February 29, 2008)]
[Rules and Regulations]
[Page 11043]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-3861]



[[Page 11043]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 401 and 405

[CMS-4064-RCN]
RIN 0938-AM73


Medicare Program; Changes to the Medicare Claims Appeal 
Procedures; Continuation of Effectiveness and Extension of Timeline for 
Publication of Final Rule

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

ACTION: Interim final rule; continuation of effectiveness and extension 
of timeline for publication of final rule.

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SUMMARY: This notice announces the continuation of effectiveness of a 
Medicare interim final and the extension of the timeline for 
publication of the final rule. This notice is issued in accordance with 
section 1871(a)(3)(C) of the Social Security Act (the Act), which 
allows an interim final rule to remain in effect after the expiration 
of the timeline specified in section 1871(a)(3)(B) of the Act if prior 
to the expiration of the timeline, the Secretary publishes in the 
Federal Register a notice of continuation and explains the exceptional 
circumstances justifying the extension of the timeline for publishing a 
final rule.

DATES: Effective Date: February 29, 2008.

FOR FURTHER INFORMATION CONTACT: David Danek, (617) 565-2682, or Arrah 
Tabe-Bedward, (410) 786-7129.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 1871(a)(3)(A) of the Social Security Act (the Act) requires 
the Secretary, in consultation with the Director of the Office of 
Management and Budget (OMB), to establish and publish a regular 
timeline for the publication of a final rule based on the previous 
publication of a proposed rule or an interim final rule. In accordance 
with section 1871(a)(3)(B) of the Act, such regular timeline may vary 
among different regulations, based on the complexity of the rule, the 
number and scope of the comments received, and other relevant factors. 
The timeline for publishing the final regulation; however, cannot 
exceed 3 years from the date of publication of the proposed or interim 
final rule, unless there are exceptional circumstances. After 
consultation with the Director of OMB, we published a notice in the 
Federal Register on December 30, 2004 (69 FR 78442) establishing a 
general 3-year timeline for finalizing a Medicare proposed and an 
interim final rule.
    Section 1871(a)(3)(C) of the Act states that a Medicare interim 
final rule shall not continue in effect if the final rule is not 
published before the expiration of the regular timeline, unless the 
Secretary publishes at the end of the regular timeline a notice of 
continuation that includes an explanation of why the regular timeline 
was not met. Upon publication of such a notice, the timeline for 
publishing the final rule is extended for 1 year.

II. Notice of Continuation

    Section 521 of the Medicare, Medicaid, and State Children's Health 
Insurance Program (SCHIP) Benefits Improvement and Protection Act of 
2000 (BIPA), amended section 1869 of the Act to provide for significant 
changes to the Medicare claims appeal procedures. On November 15, 2002, 
we published in the Federal Register a proposed rule (67 FR 69312) 
consistent with Section 521 of BIPA. An interim final rule with comment 
implementing the BIPA provisions as well as further changes to the 
claim appeals procedures enacted in Title IX of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) 
appeared in the Federal Register in March 2005 (70 FR 11420). Under the 
previously established regular timeline for publication of a final 
rule, we must publish a final rule responding to public comments on the 
interim final rule with comment period no later than March 1, 2008.
    This notice announces an extension of the timeline for publication 
of the final rule and the continuation of effectiveness of the interim 
final rule with comment period. We are not able to meet the 3-year 
timeline for publication of the final rule due to the complexity of the 
rule and the need to ensure coordination with other government 
agencies. Specifically, the development of the final rule requires 
collaboration among other HHS agencies (that is, the Office of Medicare 
Hearings and Appeals (OMHA), and the Departmental Appeals Board (DAB), 
as well as extensive involvement from the HHS Office of the General 
Counsel). Although OMHA was not in existence when the interim final 
rule with comment period was published, OMHA is now a key component of 
the Medicare claims appeal process. We note that extensive coordination 
is needed to ensure that there is a mutual understanding of these 
provisions among all three affected administrative agencies. In 
addition, the development of the final rule requires significant 
coordination with other HHS policy related regulations (that is, the 
Provider Reimbursement Determinations and Appeals final rule and the 
Medicare Prescription Drug Appeals Process proposed rule (Part D 
proposed rule,)) which are currently under development.
    We believe that an extension of the publication timeline is 
necessary and appropriate to ensure that we are able to address all of 
the issues raised in response to the interim final.
    Therefore, this notice extends the timeline for publication of the 
final rule until March 1, 2009. In accordance with section 
1871(a)(3)(C) of the Act, interim final rule shall remain in effect 
through March 1, 2009 (unless the final rule is published and becomes 
effective before March 1, 2009).

(Catalog of Federal Domestic Assistance Program No. 93.773 
Medicare--Hospital Insurance Program; and No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: February 25, 2008.
Ann Agnew,
Executive Secretary to the Department.
 [FR Doc. E8-3861 Filed 2-28-08; 8:45 am]
BILLING CODE 4120-01-P