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Regulatory Information
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2010-09-24
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Medicare Program; Prospective Payment System for Hospital Outpatient Services
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
Code of Federal Regulations
Title 42 Part
42 CFR Part
Code of Federal Regulations
Title 42 Part 1003
42 CFR Part 1003
Code of Federal Regulations
Title 42 Part 409
42 CFR Part 409
Code of Federal Regulations
Title 42 Part 410
42 CFR Part 410
Code of Federal Regulations
Title 42 Part 411
42 CFR Part 411
Code of Federal Regulations
Title 42 Part 412
42 CFR Part 412
Code of Federal Regulations
Title 42 Part 413
42 CFR Part 413
Code of Federal Regulations
Title 42 Part 419
42 CFR Part 419
Code of Federal Regulations
Title 42 Part 489
42 CFR Part 489
Code of Federal Regulations
Title 42 Part 498
42 CFR Part 498
Regulation Identification Number 0938-AI56
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).
Federal Register
Vol. 63, no. 173
Office of the Federal Register, National Archives and Records Administration
1998-09-08
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674 p.
Table of Contents:
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https://www.govinfo.gov/app/details/FR-1998-09-08
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https://www.govinfo.gov/content/pkg/FR-1998-09-08/pdf/FR-1998-09-08.pdf
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