Schedule for rating disabilities; hemic and lymphatic systems--VA. Final rule

This document amends the Department of Veterans Affairs' (VA) Schedule for Rating Disabilities of the Hemic and Lymphatic Systems. The effect of this action is to update the hemic and lymphatic portion of the rating schedule to ensure that it uses current medical terminology and unambiguous criteria, and that it reflects medical advances that have occurred since the last review.     

Schedule for rating disabilities; diseases of the ear and other sense organs. Department of Veterans Affairs. Final rule

This document amends that portion of the Department of Veterans Affairs (VA) Schedule for Rating Disabilities that addresses the ear and other sense organs. The intended effect of this action is to update this portion of the rating schedule to ensure that it uses current medical terminology and unambiguous criteria, and that it reflects medical advances that have occurred since the last review.     

Medicare program; refinements to geographic adjustment factor values, revisions to payment policies, adjustments to the relative value units (RVUs) under the physician fee schedule for calendar year 1995, and the 5-year refinement of RVUs--HCFA. Final rule with comment period

This final rule revises the geographic adjustment factor values and fee schedule payment areas, various payment policies for specific physician services, the relative value units (RVUs) for certain existing procedure codes, and establishes interim RVUs for new and revised procedure codes. It implements section 13518 of the Omnibus Budget Reconciliation Act of 1993 that requires payment for antigens under the physician fee schedule. This final rule also discusses the process for periodic review and adjustment of RVUs not less frequently than every 5 years as required by section 1848(c)(2)(B)(i) of the Social Security Act.     

Medicare program; fee schedule for physicians' services for calendar year 1993--HCFA. Final notice with comment period

This final notice with comment period announces the final relative value units (RVUs) for Medicare payment for existing procedure codes under the physician fee schedule and interim RVUs for new and revised codes. Section 6102(a) of the Omnibus Budget Reconciliation Act of 1989, as amended by section 4118 of the Omnibus Budget Reconciliation Act of 1990, requires establishment of the physician fee schedule and periodic review and adjustment of the RVUs.     

Medicare program; payment for durable medical equipment and orthotic, and prosthetic devices--HCFA. Interim final rule with comment period

This interim final rule implements section 4062(b) of the Omnibus Budget Reconciliation Act of 1987 which specifies that payment under the Medicare program for durable medical equipment, orthotics, and prosthetics furnished on or after January 1, 1989 is limited to the lower of the actual charge for the equipment or the fee schedule established by the carrier. We are setting forth the methods for computing fee schedules for six classes of these items. We are also describing how the fee schedules are updated in subsequent years.     

Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after July 1, 1991--HCFA. Notice with comment period

This notice sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program. This revised schedule of limits applies to cost reporting periods beginning on or after July 1, 1991. As required by section 4207(d) of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101-508), this revised schedule of limits incorporates a blended hospital wage index.     

Medicare program; model fee schedule for physicians' services--HCFA. Notice with comment period

This notice announces and invites comments on a model fee schedule for physicians' services that is required by section 6102 of the Omnibus Budget Reconciliation Act of 1989. The model fee schedule provides very preliminary estimates for some, but not all, services to illustrate the effects of the Medicare physician payment fee schedule that will begin to take effect in January 1992. In accordance with section 6102(f)(11), we are making the model fee schedule available to the public through publication of this notice. Any comments received from the public will be considered carefully, but not specifically addressed in a subsequent proposed rule.     

Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after July 1, 1992--HCFA. Notice with comment period

This notice sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program. This revised schedule of limits applies to cost reporting periods beginning on or after July 1, 1992. As required by section 4207(d)(3)(B) of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101-508), this revised schedule of limits incorporates a blended hospital wage index.     

Physician fee schedule update for calendar year 1995 and physician volume performance standard rates of increase for federal fiscal year 1995--HCFA. Final notice

This final notice announces the calendar year (CY) 1995 updates to the Medicare physician fee schedule and the Federal fiscal year (FY) 1995 volume performance standard rates of increase for expenditures for physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848(d) and (f), respectively, of the Social Security Act. The fee schedule update for CY 1995 is 12.2 percent for surgical services, 7.9 percent for primary care services, and 5.2 percent for other nonsurgical services. While it does not affect payment, there was a 7.7 percent increase in the update for all physicians' services for 1995. The physician volume performance standard rates of increase for Federal FY 1995 are 9.2 percent for surgical services, 13.8 percent for primary care services, 4.4 percent for other nonsurgical services, and a weighted average of 7.5 percent for all physicians' services. In our December 2, 1993 notice announcing the CY 1994 update to the Medicare physician fee schedule and FY 1994 volume performance standard rates of increase, we invited public comment on the update indicators for surgical and nonsurgical procedures that were new or revised in 1994. There were no public comments on those indicators. We have decided not to establish a public comment period for the codes that are new and revised in 1995 since, although these codes are initially classified as surgical or nonsurgical based on the clinical judgment of our medical staff, that classification ultimately rests on charge data that we use when they become available to determine whether the codes classified as surgical meet the criteria specified in our December 1993 notice.(ABSTRACT TRUNCATED AT 250 WORDS)     

Medicare program; payment for durable medical equipment and orthotic and prosthetic devices--HCFA. Final rule

This final rule addresses comments received on an interim final rule with comment period published on December 7, 1992. The interim final rule implemented section 4062(b) of the Omnibus Budget Reconciliation Act of 1987. It specified that payment under the Medicare program for durable medical equipment (DME), prosthetics, and orthotics furnished on or after January 1, 1989 is limited to the lower of the actual charge for the equipment or the fee schedule amount established by the carrier. This final rule describes amendments to the methods for computing fee schedules covering the six classes of DME and how they are updated in subsequent years in accordance with sections 13542 through 13546 of the Omnibus Budget Reconciliation Act of 1993.     

Medicare program; fee schedule for payment of ambulance services and revisions to the physician certification requirements for coverage of nonemergency ambulance services. Final rule with comment period

This final rule establishes a fee schedule for the payment of ambulance services under the Medicare program, implementing section 1834(l) of the Social Security Act. As required by that section, the proposed rule on which this final fee schedule for ambulance services is based was the product of a negotiated rulemaking process that was carried out consistent with the Federal Advisory Committee Act and the Negotiated Rulemaking Act of 1990. The fee schedule described in this final rule will replace the current retrospective reasonable cost payment system for providers and the reasonable charge system for suppliers of ambulance services. In addition, this final rule requires that ambulance suppliers accept Medicare assignment; codifies the establishment of new Health Care Common Procedure Coding System (HCPCS) codes to be reported on claims for ambulance services; establishes increased payment under the fee schedule for ambulance services furnished in rural areas based on the location of the beneficiary at the time the beneficiary is placed on board the ambulance; and revises the certification requirements for coverage of nonemergency ambulance services.     

Professionalism and accountability. Controlling health services in the United States and West Germany

This paper examines the new Professional Standards Review Organizations (PSROs) program in light of a similar program ("Economic Monitoring") that has been used in West Germany for over forty years. In the first section the PSRO program is described as government-mandated peer review by professional organizations, and is compared with that of the West Germany system. The second section argues that the PSROs are likely to strengthen the organization of established medicine, to increase the bargaining power of professional organizations, and to further insulate professional behavior from public scrutiny. The third section describes some of the effects of bureaucratic rigidities in peer review on the practice of medicine: the preservation of old technologies, the development of fixed patterns of practice, and the strengthening of the technical and interventionist biases in medical care. The final section evaluates the PSRO program as a complete delegation of congressional authority and a failure of Congress to set any rules for the development and application of norms and standards. The lack of any mechanism for accountability of the PSROs to public and choices is emphasized.     

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2001. Health Care Financing Administration (HCFA), HHS. Final rule with comment period

This final rule with comment period makes several changes affecting Medicare Part B payment. The changes include: refinement of resource-based practice expense relative value units (RVUs); the geographic practice cost indices; resource-based malpractice RVUs; critical care RVUs; care plan oversight and physician certification and recertification for home health services; observation care codes; ocular photodynamic therapy and other ophthalmological treatments; electrical bioimpedance; antigen supply; and the implantation of ventricular assist devices. This rule also addresses the comments received on the May 3, 2000 interim final rule on the supplemental survey criteria and makes modifications to the criteria for data submitted in 2001. Based on public comments we are withdrawing our proposals related to the global period for insertion, removal, and replacement of pacemakers and cardioverter defibrillators and low intensity ultrasound. This final rule also discusses or clarifies the payment policy for incomplete medical direction, pulse oximetry services, outpatient therapy supervision, outpatient therapy caps, HCPCS "G" Codes, and the second 5-year refinement of work RVUs for services furnished beginning January 1, 2002. In addition, we are finalizing the calendar year (CY) 2000 interim physician work RVUs and are issuing interim RVUs for new and revised codes for CY 2001. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule also announces the CY 2001 Medicare physician fee schedule conversion factor under the Medicare Supplementary Medical Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 2001 Medicare physician fee schedule conversion factor is $38.2581.     

Medicare program; fee schedule for physicians' services--HCFA. Final rule

This final rule sets forth a fee schedule for payment for physicians' services beginning January 1, 1992. Establishment of this fee schedule is required by section 6102(a) of the Omnibus Budget Reconciliation Act of 1989, as amended by the Omnibus Budget Reconciliation Act of 1990. This final rule explains which services will be included in the fee schedule and sets forth the formula for computing payment amounts. Application of transition rules during 1992 through 1995 is also described, as well as other adjustments to fee schedule payment amounts.     

Do resemblance ratings measure the accuracy of facial approximations?

Since forensic facial approximations are used to promote recognition of a deceased person, an accurate forensic facial approximation (FFA) should be easily recognized as the person to whom the skull belonged (target individual). However, the accuracy of FFAs has been previously assessed by the direct comparison of an FFA to the corresponding target individual for similarity (i.e., a resemblance rating). Resemblance ratings may not indicate a facial approximation's accuracy since the resemblance of non-target individuals is not accounted for. This experiment tests the validity of using resemblance ratings to assess the accuracy of FFAs. The study indicates that there is no statistically significant difference between: (a) resemblance ratings of FFAs to target individuals and (b) resemblance ratings of FFAs to individuals incorrectly identified as the target individual. It is concluded that it is not possible from resemblance ratings to determine the accuracy and/or quality of a facial approximation since a non-target individual may receive a resemblance rating equal to, or higher than, the target individual.     

Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after July 1, 1989--HCFA. Final notice

This final notice sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program. This revised schedule of limits applies to cost reporting periods beginning on or after July 1, 1989 and before July 1, 1991. As required by section 6222 of the Omnibus Budget Reconciliation Act of 1989 (Pub. L. 101-239), the revised schedule of limits incorporates the hospital wage index in effect for cost reporting periods beginning prior to July 1, 1989.     

Medicare program; revisions to payment policies and adjustments to the relative value units under the physician fee schedule for calendar year 1994--HCFA. Final rule with comment period

This final rule revises the payment policy for specific physician services and supplies, revises the relative value units (RVUs) assigned to certain existing procedure codes, and establishes interim RVUs for new and revised procedure codes. Section 6102(a) of the Omnibus Budget Reconciliation Act of 1989, as amended by section 4118 of the Omnibus Budget Reconciliation Act of 1990, requires establishment of the physician fee schedule and periodic review and adjustment of the RVUs. Further changes concerning payment for certain physician services are required by sections 13513 through 13517 of the Omnibus Budget Reconciliation Act of 1993.     

Medicare program; revisions to payment policies and adjustments to the relative value units under the physician fee schedule for calendar year 1999--HCFA. Final rule with comment period

This final rule makes several policy changes affecting Medicare Part B payment. The changes that relate to physicians' services include: resource-based practice expense relative value units (RVUs), medical direction rules for anesthesia services, and payment for abnormal Pap smears. Also, we are rebasing the Medicare Economic Index from a 1989 base year to a 1996 base year. Under the law, we are required to develop a resource-based system for determining practice expense RVUs. The Balanced Budget Act of 1997 (BBA) delayed, for 1 year, implementation of the resource-based practice expense RVUs until January 1, 1999. Also, BBA revised our payment policy for nonphysician practitioners, for outpatient rehabilitation services, and for drugs and biologicals not paid on a cost or prospective payment basis. In addition, BBA permits certain physicians and practitioners to opt out of Medicare and furnish covered services to Medicare beneficiaries through private contracts and permits payment for professional consultations via interactive telecommunication systems. Furthermore, we are finalizing the 1998 interim RVUs and are issuing interim RVUs for new and revised codes for 1999. This final rule also announces the calendar year 1999 Medicare physician fee schedule conversion factor under the Medicare Supplementary Medical Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 1999 Medicare physician fee schedule conversion factor is $34.7315.     

Medicare program; establishment of an expedited review process for Medicare beneficiaries enrolled in health maintenance organizations, competitive medical plans, and health care prepayment plans--HCFA. Final rule with comment period

This final rule with comment period establishes a new administrative review requirement for Medicare beneficiaries enrolled in health maintenance organizations (HMOs), competitive medical plans (CMPs), and health care prepayment plans (HCPPs). This rule implements section 1876(c)(5) of the Social Security Act, which specifies the appeal and grievance rights for Medicare enrollees in HMOs and CMPs. This rule requires that an HMO, CMP, or HCPP establish and maintain, as part of the health plan's appeals procedures, an expedited process for making organization determinations and reconsidered determinations when an adverse determination could seriously jeopardize the life or health of the enrollee or the enrollee's ability to regain maximum function. This rule also revises the definition of appealable determinations to clarify that it includes a decision to discontinue services.     

Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after July 1, 1993--HCFA. Notice with comment period

This notice sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program. As required by section 1861(v)(1)(L)(iii) of the Social Security Act (the Act), these limits are based on the current hospital wage index.