United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 1998_register executive 2010-09-24 article Part II Proposed Rules D09002ee1bdff11ad D09002ee1bdff1280 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Health Care Financing Administration originator org United States Government Agency or Subagency United States Office of Inspector General originator org United States Government Agency or Subagency As required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, this proposed rule would eliminate the formula- driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage). The prospective payment system would simplify our current payment system and apply to all hospitals, including those that are excluded from the inpatient prospective payment system. The Balanced Budget Act provides for implementation of the prospective payment system effective January 1, 1999, but delays application of the system to cancer hospitals until January 1, 2000. The hospital outpatient prospective payment system would also apply to partial hospitalization services furnished by community mental health centers. Although the statutory effective date for the outpatient prospective payment system is January 1, 1999, implementation of the new system will have to be delayed because of year 2000 systems concerns. The demands on intermediary bill processing systems and HCFA internal systems to become compliant for the year 2000 preclude making the major systems changes that are required to implement the prospective payment system. The outpatient prospective payment system will be implemented for all hospitals and community mental health centers as soon as possible after January 1, 2000, and a notice of the anticipated implementation date will be published in the Federal Register at least 90 days in advance. This document also proposes new requirements for provider departments and provider-based entities. These proposed changes, as revised based on our consideration of public comments, will be effective 30 days after publication of a final rule. This proposed rule would also implement section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital, unless the services are furnished under an arrangement with the hospital. This section also authorizes the Department of Health and Human Services' Office of Inspector General to impose a civil money penalty, not to exceed $10,000, against any individual or entity who knowingly and willfully presents a bill for non-physician or other bundled services not provided directly or under such an arrangement. This proposed rule also addresses the requirements for designating certain entities as provider-based or as a department of a hospital. 63 FR 47552 https://www.govinfo.gov/app/details/FR-1998-09-08/98-23383 98-23383 fr08se98-34 RIN 0938-AI56 4120-01-P HCFA-1005-P https://www.govinfo.gov/app/details/FR-1998-09-08/98-23383 https://www.govinfo.gov/content/pkg/FR-1998-09-08/html/98-23383.htm https://www.govinfo.gov/content/pkg/FR-1998-09-08/pdf/98-23383.pdf 485 p. 47552 48036 63 FR 47552 Title 42 Part 42 CFR Part Title 42 Part 1003 42 CFR Part 1003 Title 42 Part 409 42 CFR Part 409 Title 42 Part 410 42 CFR Part 410 Title 42 Part 411 42 CFR Part 411 Title 42 Part 412 42 CFR Part 412 Title 42 Part 413 42 CFR Part 413 Title 42 Part 419 42 CFR Part 419 Title 42 Part 489 42 CFR Part 489 Title 42 Part 498 42 CFR Part 498 RIN 0938-AI56 Medicare Program; Prospective Payment System for Hospital Outpatient Services; Federal Register Vol. 63, Issue PRORULE 98-23383 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Care Financing Administration Office of Inspector General 1998-11-09 HCFA-1005-P 4120-01-P 98-23383 Proposed rule.

As required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, this proposed rule would eliminate the formula- driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage). The prospective payment system would simplify our current payment system and apply to all hospitals, including those that are excluded from the inpatient prospective payment system. The Balanced Budget Act provides for implementation of the prospective payment system effective January 1, 1999, but delays application of the system to cancer hospitals until January 1, 2000. The hospital outpatient prospective payment system would also apply to partial hospitalization services furnished by community mental health centers. Although the statutory effective date for the outpatient prospective payment system is January 1, 1999, implementation of the new system will have to be delayed because of year 2000 systems concerns. The demands on intermediary bill processing systems and HCFA internal systems to become compliant for the year 2000 preclude making the major systems changes that are required to implement the prospective payment system. The outpatient prospective payment system will be implemented for all hospitals and community mental health centers as soon as possible after January 1, 2000, and a notice of the anticipated implementation date will be published in the Federal Register at least 90 days in advance. This document also proposes new requirements for provider departments and provider-based entities. These proposed changes, as revised based on our consideration of public comments, will be effective 30 days after publication of a final rule. This proposed rule would also implement section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital, unless the services are furnished under an arrangement with the hospital. This section also authorizes the Department of Health and Human Services' Office of Inspector General to impose a civil money penalty, not to exceed $10,000, against any individual or entity who knowingly and willfully presents a bill for non-physician or other bundled services not provided directly or under such an arrangement. This proposed rule also addresses the requirements for designating certain entities as provider-based or as a department of a hospital.

Comments will be considered if we receive them at the appropriate address, as provided below, no later than 5 p.m. on November 9, 1998. Janet Wellham, (410) 786-4510 (for general information). Joel Schaer (OIG), (202) 619-0089 (for information concerning civil money penalties). Kitty Ahern, (410) 786-4515 (for information related to the classification of services into ambulatory payment classification (APC) groups). Suzanne Letsch (410) 786-4558 (for information related to volume control measures and updates). George Morey (410) 786-4653 (for information related to the determination of provider-based status). Janet Samen (410) 786-9161 (for information on the application of APCs to community mental health centers). Vol. 63, no. 173 Office of the Federal Register, National Archives and Records Administration 1998-09-08 continuing daily deposited born digital 674 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-1998-09-08 P0b002ee180a55cfb 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr08se98 https://www.govinfo.gov/app/details/FR-1998-09-08 https://www.govinfo.gov/content/pkg/FR-1998-09-08/pdf/FR-1998-09-08.pdf fdlp 47419 48080 DGPO 2010-09-24 2023-05-06 FR-1998-09-08 machine generated eng FR FR-1998-09-08 63 173