[Federal Register Volume 76, Number 227 (Friday, November 25, 2011)]
[Notices]
[Pages 72708-72709]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-30417]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1593-N]


Medicare Program; Renaming and Other Changes to the Advisory 
Panel on Hospital Outpatient Payment Charter (Formerly the Advisory 
Panel on Ambulatory Payment Classification Groups) and Request for 
Nominations

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

ACTION: Notice.

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

SUMMARY: This notice announces the name change of the Advisory Panel on 
Ambulatory Payment Classification Groups to the Advisory Panel on 
Hospital Outpatient Payment (HOP) (the Panel). In addition, it 
announces the renewal and amendments to the charter including changing 
the scope of the Panel to include supervision of outpatient hospital 
services, changing the Panel membership to include Critical Access 
Hospitals (CAH), and the solicitation of six nominations for 
individuals to serve on the Panel in 2012.

DATES: Submission of Nominations: We will consider nominations if they 
are received no later than 5 p.m. (e.s.t.), December 27, 2011.

ADDRESSES: Please email, mail or hand deliver nominations to the 
following address: Centers for Medicare & Medicaid Services; Attn: 
Paula Smith, Advisory Panel on HOP; Center for Medicare, Hospital & 
Ambulatory Policy Group, Division of Outpatient Care; 7500 Security 
Boulevard, Mail Stop C4-05-17; Woodlawn, MD 21244-1850, 
[email protected].

FOR FURTHER INFORMATION CONTACT: For questions or other information 
about the Panel, submit a written request to Paula Smith at the 
addresses provided above or call (410) 786-4709.
    Advisory Committees' Information Lines: You may also refer to the 
CMS Federal Advisory Committee Hotlines at 1-(877) 449-5659 (toll-free) 
or (410) 786-9379 (local) for additional information.
    Web site: For additional information on the Panel, the revised 
charter and updates to the Panel's activities, please access our Web 
site: http://www.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp#TopOfPage. 
(Note: There is an UNDERSCORE after FACA/05--; there is no space.)
    News Media: Representatives should contact the CMS Press Office at 
(202) 690-6145.
    Copies of the Charter: Copies of the Charter are available on the 
Internet at: http://www.cms.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp#TopOfPage. 
(Note: There is an UNDERSCORE after FACA/05--; there is no space.)

SUPPLEMENTARY INFORMATION:

I. Background

    The Secretary of the Department of Health and Human Services (the 
Secretary) is required by section 1833(t)(9)(A) of the Social Security 
Act (the Act) and section 222 of the Public Health Service Act (PHS 
Act) to consult with an expert outside advisory panel regarding the 
clinical integrity of the Ambulatory Payment Classification (APC) 
groups and relative payment weights. The Advisory Panel on Hospital 
Outpatient Payment (HOP) (the Panel, which was formerly known as the 
Advisory Panel on Ambulatory Payment Classification Groups) is governed 
by the provisions of the Federal Advisory Committee Act (FACA) (Pub. L. 
92-463), as amended (5 U.S.C. Appendix 2), which sets forth standards 
for the formation and use of advisory panels.
    The Charter provides that the Panel shall meet up to 3 times 
annually. We consider the technical advice provided by the Panel as we 
prepare the proposed and final rules to update the outpatient 
prospective payment system (OPPS) for the next calendar year.
    The Panel shall consist of a chair and up to 19 members (previously 
15) who are full-time employees of hospitals, hospital systems, or 
other Medicare providers. For purposes of the Panel, consultants or 
independent contractors are not considered to be full-time employees in 
these organizations.
    The current Panel consists of the following members: (The asterisk 
[*] indicates the Panel member whose term will end on February 29, 
2012.)

 E. L. Hambrick, M.D., J.D., Chair, a CMS Medical Officer.
 Ruth L. Bush, M.D., M.P.H.
 Kari S. Cornicelli, C.P.A., FHFMA.
 Dawn L. Francis, M.D., M.H.S.
 Kathleen Graham, R.N., M.S.H.A.*
 David A. Halsey, M.D.
 Brian D. Kavanagh, M.D., M.P.H.
 Judith T. Kelly, B.S.H.A., RHIT, RHIA, CCS.
 Scott Manaker, M.D., Ph.D.
 John Marshall, CRA, RCC, CIRCC, RT(R), FAHRA.
 Randall A. Oyer, M.D.
 Jacqueline Phillips.
 Daniel J. Pothen, M.S., RHIA, CHPS, CPHIMS, CCS, CCS-P, CHC.
 Gregory J. Przbylski, M.D.
 Marianna V. Spanaki-Varela, M.D., Ph.D., M.B.A.

    Panel members serve without compensation, according to an advance 
written agreement. For the meetings, we reimburse travel, meals, 
lodging, and related expenses in accordance with standard Government 
travel regulations. We have a special interest in attempting to ensure, 
while taking into account the nominee pool, that the Panel is diverse 
in all respects of the following: Geography, rural or urban practice, 
points of view, medical or technical specialty, type of hospital, 
hospital health system, or other Medicare provider.
    Based upon either self-nominations or nominations submitted by 
providers or interested organizations, the Secretary, or her designee, 
appoints new members to the Panel from among those candidates 
determined to have the required expertise. New appointments are made in 
a manner that ensures a balanced membership under the FACA guidelines.
    The Secretary signed the original charter establishing the Panel on 
November 21, 2000, and approved the renewal, renaming, and amendment of 
the Panel charter on November 15, 2011. The charter will terminate on 
November 15, 2013, unless renewed or amended by appropriate actions.

II. Criteria for Nominees

    The Panel must be fairly balanced in its membership in terms of the 
points of

[[Page 72709]]

view represented and the functions to be performed. The Panel shall 
consist of up to 19 total members (previously 15) representing 
providers. The Secretary or the Administrator of the Centers for 
Medicare & Medicaid Services (the Administrator) selects the member 
based upon their technical expertise in hospital payment systems; 
hospital medical care delivery systems; provider billing and accounting 
systems; APC grouping; Current Procedural Terminology codes and 
Healthcare Common Procedure Coding System coding experts; the use of, 
and payment for, drugs and medical devices, and other services in the 
hospital outpatient setting; and other forms of relevant expertise. For 
supervision deliberations, the Panel shall have members that represent 
the interests of Critical Access Hospitals (CAHs), who advise CMS only 
regarding the level of supervision for hospital outpatient services.
    All members shall have a minimum of 5 years experience in their 
areas of expertise, but it is not necessary that any member be an 
expert in all of the areas listed above. Panel members are full-time 
employees of hospitals, hospital systems, or other Medicare providers.
    For purposes of this Panel, consultants or independent contractors 
are not considered to be representatives of providers. All members 
shall serve on a voluntary basis, without compensation, pursuant to 
advance written agreement. Members of the Panel shall be entitled to 
receive reimbursement for travel expenses and per diem in lieu of 
subsistence, in accordance with standard government travel regulations. 
Panel members may serve for up to 4-year terms. A member may serve 
after the expiration of his or her term until a successor has been 
sworn in.
    Any interested person or organization may nominate one or more 
qualified individuals. Self-nominations will also be accepted. Each 
nomination must include the following:
     Letter of Nomination stating the reasons why the nominee 
should be considered,
     Curriculum vitae or resume of the nominee,
     Written and signed statement from the nominee that the 
nominee is willing to serve on the Panel under the conditions described 
in this notice and further specified in the Charter, and
     The hospital or hospital system name and address, or CAH 
name and address, as well as all Medicare hospital and or Medicare CAH 
billing numbers of the facility where the nominee is employed.

III. Provisions of the Notice

A. Renaming, Renewal, and Amendment of the Charter

    Over the last decade, the role of the Panel in assisting CMS in 
decisions about the clinical integrity of the APC groups and their 
associated weights, which are major elements of the OPPS, has led to 
the overall improved functioning of the OPPS.
    As previously stated, this notice renames the Advisory Panel on APC 
Groups (APC Panel), which is now called the Advisory Panel on Hospital 
Outpatient Payment (HOP Panel) and referred to as ``the Panel.'' The 
Panel advises the Secretary and Administrator on developing and 
implementing national practices that support consistent implementation 
of supervision for hospital outpatient services by determining the 
appropriate supervision level for hospital outpatient services, in 
addition to its current role of advising on clinical integrity of the 
APC groups and their associated weights.

B. Increasing the Panel Membership From 15 to 19 Members

    We are also increasing the number of members on the Panel from 15 
to 19, some of which will represent CAHs for the deliberation of 
supervision of outpatient hospital services.

C. Changing the Scope of the Panel To Include Supervision

    The Panel may advise the Secretary and the Administrator on the 
following:
     The clinical integrity of the APC groups and their 
associated weights, which are major elements of the OPPS; and
     The appropriate supervision level for hospital outpatient 
services. With respect to supervision, the Panel may recommend a 
supervision level (general, direct, or personal) to ensure an 
appropriate level of quality and safety for delivery of a given 
service, as described by a Healthcare Common Procedure Code System 
(HCPCS) code.

D. Description of Duties of Panel Members

    The Panel is technical in nature, and may consider the following 
issues:
     Addressing whether procedures within an APC group are 
similar both clinically and in terms of resource use.
     Reconfiguring APCs (for example, separating a single APC 
into two APCs, moving HCPCS codes from one APC to another, and moving 
HCPCS codes from new technology APCs to clinical APCs).
     Evaluating APC group weights.
     Reviewing packaging the cost of items and services, 
including drugs and devices, into procedures and services, including 
the methodology for packaging and the impact of packaging the cost of 
those items and services on APC group structure and payment.
     Removing procedures from the inpatient list for payment 
under the OPPS.
     Using claims and cost report data for CMS determination of 
APC group costs.
     Addressing other technical issues concerning APC group 
structure.
     Evaluating the required level of supervision for hospital 
outpatient services.
    The subject matter before the Panel shall be limited to these and 
related topics. Unrelated topics are not subjects for discussion. 
Unrelated topics include, but are not limited to, the conversion 
factor, charge compression, revisions to the cost report, pass-through 
payments, correct code usage, new technology applications (including 
supporting information/documentation), provider payment adjustments, 
and which types of practitioners are permitted to supervise hospital 
outpatient services.

E. Requests for Nominations

    We are soliciting six nominees to add to the Panel. With this 
expansion, we are particularly interested in adding representatives who 
have experience in working with issues related to CAHs and rural 
hospitals.

IV. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 35).

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

    Dated: November 17, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-30417 Filed 11-23-11; 8:45 am]
BILLING CODE 4120-01-P