Medical facility construction and modernization; requirements for uncompensated services for persons unable to pay--PHS. Final rule

The rules below revise the rules currently governing how certain health care facilities, assisted under Titles VI and XVI of the Public Health Service Act, fulfill the assurance given in their applications for assistance that they would provide a reasonable volume of services to persons unable to pay for such services. The revisions below amend the rules to permit facilities that provide substantial free or below cost medical services but nonetheless cannot receive credit for such services under current requirements with an alternative method of compliance that will enable them to fulfill their uncompensated services obligations.     

Evaluation of the impact and effectiveness of Title XVI uncompensated services assurance--Health Resources and Services Administration. Rule related notice

The purpose of this notice is to solicit comments on an evaluation plan which has been developed to examine the impact and effectiveness of the regulations [42 CFR 124.501 et seq.) governing the provision of uncompensated services by health facilities obligated under Titles VI and XVI of the Public Health Service Act to provide a reasonable volume of services to persons unable to pay.     

Evaluation of the administrative compliance costs and the impact of the inflation factor for Titles VI and XVI assisted facilities--Health Resources and Services Administration. Rule related notice; request for comments

The purpose of this notice is to solicit comments on an evaluation plan which has been developed to examine the impact of the administrative compliance costs and the inflation factor on health facilities obligated under Titles VI and XVI of the Public Health Service Act to provide a reasonable volume of services to persons unable to pay.     

Child support enforcement program; extension of services to Medicaid recipients and to former AFDC recipients--Office of Child Support Enforcement, HHS. Final rule

These final rules implement sections 9141 and 9142 of Public Law 100-203, the Omnibus Budget Reconciliation Act of 1987, which amended title IV-D of the Social Security Act (the Act). Section 9141, effective December 22, 1987, amended section 457(c) of the Act to require State child support enforcement (IV-D) agencies to provide appropriate notice and to continue to provide IV-D services to persons no longer eligible for Aid to Families with Dependent Children (AFDC) under title IV-A of the Act. The IV-D agency must continue to provide services and pay any amount of support collected to the family on the same basis and under the same conditions as pertain to other non-AFDC families, except that no application, other request to continue services or any application fee for services may be required. Section 9142, effective July 1, 1988, amended section 454 of the Act to require State IV-D agencies to provide IV-D services to families who receive Medicaid and have assigned to the State, under section 1912 of the Act, their rights to medical support and to payment of medical care from any third party, and to provide for distribution by the State of medical support collections under section 1912 of the Act.     

Availability of funds for grants to provide for the delivery of AIDS/HIV services within community health facilities--HRSA. Notice of available funds

The Health Resources and Services Administration (HRSA) announces the availability of approximately $10.9 million in Fiscal Year (FY) 1990 for grants to community health facilities, including Community and Migrant Health Centers and local public hospitals and clinics, to provide comprehensive primary care services to persons with human immunodeficiency virus (HIV) infection. These grants will be awarded under the provisions of the Department of Health and Human Services Appropriations Act, FY 1990, Public Law 101-166.     

Quality mammography standards--FDA. Final rule

The Food and Drug Administration (FDA) is amending its regulations governing mammography. Amendments are being made to the requirements for accreditation bodies; procedures for facility certification; and quality standards for mammography personnel, equipment and practices, including quality assurance. This action is being taken to provide increased assurance of adequate and consistent evaluation of mammography facilities on a nationwide level and compliance of the facilities with quality standards. It also carries out the intent of Congress that FDA replace the existing interim rules with more comprehensive final regulations.     

Medicare and Medicaid programs; advance directives--HCFA. Interim final rule with comment period

This interim final rule amends the Medicare and Medicaid regulations governing provider agreements and contracts to establish requirements for States, hospitals, nursing facilities, skilled nursing facilities, providers of home health care or personal care services, hospice programs and prepaid health plans concerning advance directives. An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under State law, relating to the provision of health care when an individual's condition makes him or her unable to express his or her wishes. The intent of these provisions is to enhance an individual's control over medical treatment decisions. This rule implements sections 4206 and 4751 of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), Public Law 101-508.     

Health Resources Administration--Hill-Burton "uncompensated services" assurance; priorities for handling complaints. Notice

This notice announces the establishment of priorities for handling complaints of noncompliance by assisted medical facilities with their "uncompensated services" assurances under Titles VI and XVI of the Public Health Service Act. The priorities will determine the allocation of the Department's investigative and decision-making resources to certain complaints where the resources available are insufficient to handle all complaints.     

National guidelines for health planning: Public Health Service, HHS. Notice of proposed rulemaking

This Notice proposes to add national health planning goals to the National Guidelines for Health Planning under section 1501 of the Public Health Service Act. These goals concern health status outcomes, disease prevention and health promotion and personnel resources and systems of care. They supplement Subparts A and C of the Guidelines published as final regulations on March 28, 1978, which addressed standards for nine types of health services and facilities. Later issuances will provide additional goals and standards.     

Quality standards and certification requirements for mammography facilities--FDA. Interim rule; opportunity for public comment

The Food and Drug Administration (FDA) is issuing regulations to implement the Mammography Quality Standards Act of 1992 (MQSA). The MQSA requires the establishment of a Federal certification and inspection program for mammography facilities; regulations and standards for accrediting bodies for mammography facilities; and standards for mammography equipment, personnel, and practices, including quality assurance. This regulation, which amends two previously published interim rules, modifies and adds to the definitions previously set forth. In addition, the interim rule provides a mechanism to request permission to meet alternative requirements, other than those previously set forth, if the proposed alternative requirement is at least as effective as the existing quality standards in achieving quality mammography services for women.     

基本医疗服务法制化研究

获取基本医疗服务是公民保障生命健康的基本权利,应当通过法律加以明确,使之成为"拟制公共产品"。公共卫生服务与基本医疗服务是两种性质不同的服务,不宜用一部法律来统一规定,因此全国人大《基本医疗卫生保障法》的立法模式是不适宜的,应当单独出台《基本医疗服务法》。政府提供基本医疗服务的范围主要包括基本医疗保险、基本医疗救助、基本药物和基本诊疗项目、基本医疗服务体系和基本医疗设施、基本医疗服务人力。公民的医疗服务请求权可以通过诉讼救济,医疗服务请求诉讼的类型属于行政给付之诉。     

Civil monetary penalties, assessments and recommended exclusions. Final rules

These final rules reflect provisions of Public Law 106-169, the Foster Care Independence Act of 1999, and Public Law 108-203, the Social Security Protection Act of 2004, to provide new and amended procedures for SSA's civil monetary penalty cases filed pursuant to sections 1129 and 1140 of the Social Security Act . These final rules implement amendments to section 1129 of the Social Security Act (42 U.S.C. 1320a-8) to provide for the imposition of civil monetary penalties and/or assessments: against representative payees who convert Social Security benefits for a use other than for the use or benefit of the beneficiary; against those who withhold disclosure of material statements to SSA; and, against those who make false or misleading statements or representations or omissions of a material fact with respect to benefits or payments under title VIII of the Social Security Act. These final rules also implement amendments to section 1140 of the Social Security Act (42 U.S.C. 1320b-10) to: Add to the list of enumerated terms that may give rise to a violation of section 1140; and, provide for the imposition of civil monetary penalties against those who charge fees for products or services, otherwise provided free of charge by SSA, unless the offers provide sufficient notice that the product or service can be obtained free of charge from SSA.     

The joint venture alternative to mergers

However, while a joint venture may be "safe" from antitrust challenge, it is not without some practical difficulties, especially with respect to consolidating services at one location or jointly offering services provided at multiple facilities. These practical concerns include: 1. Who will exercise operational management of the joint venture? 2. How will the joint venture deal with different pricing for services that will be provided at multiple locations? 3. What criteria will be used to decide the location at which consolidated tertiary services will be offered? 4. In what circumstances can the joint venture be unwound, either in its entirety or as to discrete functions? When clinical services have been consolidated at one location, there is an appropriate concern by the other hospital that it will be unable to provide or re-enter the market for those services if the joint venture dissolves. These operational concerns, of course, are not addressed in the Consent Decree. Thus, even if a joint venture relationship survives antitrust scrutiny, the parties must still negotiate and resolve these operational issues in order for the joint venture to be viable.     

Availability of funds to provide health services in the Pacific Basin--HHS. Notice of availability of funds

The Health Resources and Services Administration (HRSA) announces that up to $331,000 is available under section 301 of the Public Health Service (PHS) ACT 42 U.S.C. 241, for funding public and non-profit private entities for projects to build capacity and improve health services and systems, particularly preventive health services, in the Commonwealth of the Northern Mariana Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau and to provide technical assistance relative to such projects. In recognition of the extent of funding available, these funds will be available only to continue activities currently receiving funds under the section 301 Pacific Initiative grant authority. HRSA will entertain applications from current grantees for supplemental grants to modify project activities, and from eligible organizations for competing continuation grant awards to extend project activities.     

Health maintenance organizations--Public Health Service. Final regulations

These rules amend the Public Health Service (PHS) regulations on health maintenance organizations (HMOs) by implementing certain changes made by the Health Maintenance Organization Amendments of 1981. The provision governing repayment of grant funds under certain circumstances is also amended. In addition, this rule amends the requirements for the award of loans or loan guarantees to qualified HMOs for the acquisition or construction of ambulatory health care facilities and the acquisition of equipment for those facilities (Subpart J). The amendments to Subpart J are made as a result of public comments on the interim regulations published on April 9, 1980.     

Medicare programs: changes to the end-stage renal disease prospective payment system transition budget-neutrality adjustment. Interim final rule with comment period

This interim final rule with comment will revise the end-stage renal disease (ESRD) transition budget-neutrality adjustment finalized in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided on April 1, 2011 through December 31, 2011. We are revising the transition budget-neutrality adjustment to reflect the actual election decision to receive payment under the ESRD PPS for renal dialysis services furnished on or after January 1, 2011 made by ESRD facilities, rather than projected elections using the same methodology as described in the ESRD PPS proposed and final rules. This results in a zero percent adjustment for renal dialysis services furnished April 1, 2011 through December 31, 2011.     

Public Health Service--health maintenance organizations: final regulations

These rules amend the Public Health Service (PHS) regulations by implementing certain changes made by the HMO Amendments of 1978 with respect to grants and loan guarantees for planning and initial development costs (Subpart D) and to loans and loan guarantees for initial costs of operation (Subpart E). These regulations change Subpart D by including projects for the "expansion of services" of an HMO among the projects eligible for initial development assistance. In addition, they change the limits on the amount of assistance permitted for initial development projects. These regulations also change Subpart E by substituting the words "costs of operation" for the words "operating costs," thereby expanding the scope of assistance for initial operations (1) to include costs of certain small capital expenditures for equipment and alterations and renovations of facilities and (2) to incorporate into the regulations a longstanding policy which specifies the amount of preaward balance sheet liabilities which may be paid for with funds under operating loans (whether made directly or guaranteed by the Secretary).     

Availability of funds for home health services and training--HRSA

The Health Resources and Services Administration (HRSA) announces that funds are available for grants and loans for the development and expansion of home health programs and services. Public Law (Pub. L.) 98-139, the Labor, Health and Human Services, and Education Appropriations Act of 1984, signed on October 31, 1983, appropriates $5 million under section 339 of the Public Health Service (PHS) Act (42 U.S.C. 255) to provide home health services and for the training of paraprofessionals to provide home health services. This notice contains information of interest to prospective applicants for such funding.     

Revision of income criteria for eligibility for uncompensated services--HRSA. Notice

This notice announces the applicability of the recent revision of the Poverty Income Guidelines to uncompensated services programs administered by health care facilities pursuant to Titles VI and XVI of the Public Health Service Act.