Medicare program; special payment limits for home blood glucose monitors--HCFA. Final notice

This notice establishes special payment limits for standard home blood glucose monitors, identified as code E0607 of the HCFA Common Procedure Coding System (HCPCS). This final notice is intended to prevent excessive payment for these items. Currently, payment under the Medicare program for home blood glucose monitors and other items of durable medical equipment (DME) is equal to 80 percent of the lesser of the actual charge for the item or the fee schedule amount for the item. This notice requires that payment for standard home blood glucose monitors be equal to 80 percent of the lesser of the actual charge or a special payment limit.     

Medicare program; criteria for Medicare coverage of adult liver transplants--HCFA. Proposed notice

This notice proposes Medicare coverage of liver transplantations in adults under certain circumstances. We would provide coverage for adult liver transplants based on the results of an assessment conducted by the Office of Health Technology Assessment of the Public Health Service and our subsequent determination that liver transplants are a medically reasonable and necessary service when furnished to adult patients with certain conditions and when furnished by participating facilities that meet specific criteria, including patient selection criteria.     

Medicare program; adjustments to cost limits for skilled nursing facility inpatient routine service costs--HCFA. Proposed notice

This notice proposes to eliminate an adjustment that we make to the Medicare cost limits for skilled nursing facility (SNF) routine services if the final rate of change in the market basket index for a calendar year that we use to set the limits differs from the estimated rate of change in the index by at least 0.3 percentage points. Elsewhere in this issue of the Federal Register is a separate final notice with comment period that explains the methodology we use to develop the cost limits and sets forth the cost limits applicable to cost reporting periods occurring on or after October 1, 1997.     

Medicare program; payment change for home dialysis--HCFA. Final rule

This final rule implements section 6203(b) of the Omnibus Budget Reconciliation Act of 1989, which limits Medicare payment for home dialysis equipment, supplies, and support services. Also, in accordance with section 6203(b), we are requiring that, for Medicare payments to be made to a supplier of home dialysis supplies and equipment when the patient's self-care home dialysis is not under the direct supervision of a Medicare approved renal dialysis facility, the patient must certify that the supplier is the sole supplier of his or her dialysis supplies and equipment. In addition, the supplier must agree to receive payment on an assignment basis only and must certify that it has entered into a written agreement with an approved dialysis facility, under which the facility agrees to furnish the patient with all home dialysis services. We are also providing a one-time-only opportunity for certain home dialysis patients to immediately change their current method of payment.     

Medicare program; prospective payment system for hospital outpatient services--HCFA. 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 nonphysician 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.     

Medicare program; revision of ambulatory surgical center payment rate methodology--HCFA. Final notice of payment rates

This final notice sets forth the revised payment rates for ambulatory surgical center services. We are refining the methodology used to determine the payment rates and have based the rates on the most recent survey data collected from participating ambulatory surgical centers. In addition, we have computed the payment rates using the HCFA hospital wage index. We are also incorporating the payment for intraocular lens inserted during cataract surgery into the facility rate as required by section 4063(b) of the Omnibus Budget Reconciliation Act of 1987. Finally, we are changing the payment policy for surgical procedures that are terminated due to medical complications that increase the surgical risk to the patient. As a result of the refinements to our ratesetting methodology, this final notice establishes eight payment groups rather than the six proposed groups. Of these eight groups, two groups (Group 6 and Group 8) contain only cataract procedures.     

Medicare program; payment for teleconsultations in rural health professional shortage areas--HCFA. Proposed rule

This proposed rule would implement parts of section 4206 of the Balanced Budget Act of 1997 by amending our regulations to provide for payment for professional consultation by a physician and certain other practitioners via interactive telecommunication systems. Payment may be made if the physician or other practitioner is furnishing a service for which payment may be made under Medicare to a beneficiary residing in a rural area that is designated as a health professional shortage area. This proposed rule would also establish a methodology for determining the amount of payments made for the consultation.     

Medicare program; adjustment in payment amounts for new technology intraocular lenses--HCFA. Proposed rule

This proposed rule would establish in regulations a process under which interested parties may request, with respect to a class of new technology intraocular lenses (IOLs), a review of the appropriateness of the current payment amount for IOLs furnished by Medicare-participating ambulatory surgical centers. The rule implements section 141(b) of the Social Security Act Amendments of 1994, which requires us to develop and implement this process.     

Medicare program; schedules of limits and prospectively determined payment rates for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period

This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility (SNF) routine service costs for which payment may be made under the Medicare program and sets forth an updated schedule of payment rates for low Medicare volume SNFs that elect to receive prospectively determined payment rates for routine service costs. Section 1888(a) of the Social Security Act (the Act) requires that the Secretary update the per diem cost limits for SNF routine service costs for cost reporting periods beginning on or after October 1, 1995, and every 2 years thereafter. In addition, section 1888(d)(4) of the Act requires the Secretary to establish and publish prospectively determined payment rates at least 90 days prior to the beginning of the Federal fiscal year (FY) to which such rates are to be applied.     

Medicare program; list of covered surgical procedures for ambulatory surgical centers--HCFA. Proposed notice and request for comment

HCFA is seeking suggestions for possible additions or revisions to the current list of ambulatory surgical center (ASC) procedures covered under Medicare. Our current list of covered ASC procedures was published in the Federal Register on August 5, 1982 (47 FR 34099). In this notice we are also soliciting comments on additional ASC procedures that have been suggested by the public since publication of our current list.     

Medicare program: schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period

This final notice with comment period provides that there will be no changes in the skilled nursing facility (SNF) cost limits for cost reporting periods beginning during Federal fiscal years 1994 and 1995 and that the add-on for administrative and general costs of hospital-based SNFs is eliminated. This notice announces provisions of the Omnibus Budget Reconciliation Act of 1993 that affect the schedule of limits on SNF routine service costs for which payment may be made under the Medicare program and explains the effects of these provisions on the methodology used in calculating the SNF cost limits.     

Medicare program; home health prospective payment system rate update for calendar year 2012. Final rule

This final rule sets forth updates to the home health prospective payment system (HH PPS) rates, including: the national standardized 60-day episode rates; the national per-visit rates; and the low utilization payment amount (LUPA) under the Medicare PPS for home health agencies effective January 1, 2012. This rule applies a 1.4 percent update factor to the episode rates, which reflects a 1 percent reduction applied to the 2.4 percent market basket update factor, as mandated by the Affordable Care Act. This rule also updates the wage index used under the HH PPS, and further reduces home health payments to account for continued nominal growth in case-mix which is unrelated to changes in patient health status. This rule removes two hypertension codes from the HH PPS case-mix system, thereby requiring recalibration of the case-mix weights. In addition, the rule implements two structural changes designed to decrease incentives to upcode and provide unneeded therapy services. Finally, this rule incorporates additional flexibility regarding face-to-face encounters with providers related to home health care.     

Medicare program; criteria for Medicare coverage of adult liver transplants--HCFA. Final notice

This notice provides for Medicare coverage of liver transplantations in adults under certain circumstances. We are providing coverage for adult liver transplants based on our determination that liver transplants are medically reasonable and necessary services if furnished to adult patients with certain conditions and if furnished by participating facilities that meet specific criteria, including patient selection criteria.     

Medicare program; payment for customized wheelchairs--HCFA. Final rule

This final rule responds to comments we received on an interim final rule relating to payment for customized wheelchairs that was published on December 20, 1991 (56 FR 65995). The interim rule set forth the Secretary's criteria that a wheelchair must meet to be considered a customized item and allowed for a payment for the purchase of customized items based on the carrier's case-by-case determination. This rule establishes the interim rule as a final regulation with one change. The change is based on our review and consideration of the public comments. EFFECTIVE DATE: This final rule is effective on July 30, 1993.     

Medicare program; Medicare secondary payer for disabled active individuals--HCFA. Proposed rule

This proposal sets forth the rules that limit Medicare payment for services furnished to disabled "active individuals" who are covered under a large group health plan (LGHP), and prohibit discrimination by an LGHP against such individuals. These rules are necessary to implement section 1862(b)(1)(B) of the Social Security Act (the Act), and related provisions, which make Medicare benefits secondary to LGHP benefits.     

Medicare program; home health prospective payment system rate update for calendar year 2006. Final rule

This final rule sets forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health agencies. This final rule is the first update of the home health prospective payment system (HH PPS) rates that uses the revised area labor market Metropolitan Statistical Area designations for calendar year 2006. In implementing the new area labor market designations, we are allowing for a one-year transition period. This transition consists of a blend of 50 percent of the new area labor market designations' wage index and 50 percent of the previous area labor market designations' wage index. In addition, we are revising the fixed dollar loss ratio, which is used in the calculation of outlier payments.     

Medicare program; payment for preadmission services--HCFA. Final rule

This final rule responds to public comments on the January 12, 1994, interim final rule with comment period that provided that inpatient hospital operating costs include certain preadmission services furnished by the hospital (or by an entity that is wholly owned or operated by the hospital) to the patient up to 3 days before the date of the patient's admission to that hospital. These provisions implement amendments made to section 1886(a)(4) of the Social Security Act by section 4003 of the Omnibus Budget Reconciliation Act of 1990.