Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2003 and inclusion of registered nurses in the personnel provision of the critical access hospital emergency services requirement for frontier areas and remote locations. Final rule with comment period

This final rule with comment period refines the resource-based practice expense relative value units (RVUs) and makes other changes to Medicare Part B payment policy. In addition, as required by statute, we are announcing the physician fee schedule update for CY 2003. The update to the physician fee schedule occurs as a result of a calculation methodology specified by law. That law required the Department to set annual updates based in part on estimates of several factors. Although subsequent after-the-fact data indicate that actual increases were different to some degree from earlier estimates, the law does not permit those estimates to be revised. A subsequent law required estimates to be revised for FY 2000 and beyond. Although we have exhaustively examined opportunities for a different interpretation of law that would allow us to correct the flaw in the formula administratively, current law does not permit such an interpretation. Accordingly, without Congressional action to address the current legal framework, the Department is compelled to announce herein a physician fee schedule update for CY 2003 of -4.4 percent. Because the Department would adopt a change in the formula that determines the physician update if the law permitted it, we have examined how proper adjustments to past data could result in a positive update. The Department believes that revisions of estimates used to establish the sustainable growth rates (SGR) for fiscal years (FY) 1998 and 1999 and Medicare volume performance standards (MVPS) for 1990-1996 would, under present calculations, result in a positive update. The Department intends to work closely with Congress to develop legislation that could permit a positive update, and hopes that such legislation can be passed before the negative update takes effect. Because the Department wishes to change the update promptly in the event that Congress provides the Department legal authority to do so, we are requesting comments regarding how physician fee schedule rates could and should be recalculated prospectively in the event that Congress provides the Department with legal authority to revise estimates used to establish the sustainable growth rates (SGR) and for 1998 and 1999 and the NVPS for 1990-1996. The other policy changes concern: the pricing of the technical component for positron emission tomography (PET) scans, Medicare qualifications for clinical nurse specialists, a process to add or delete services to the definition of telehealth, the definition for ZZZ global periods, global period for surface radiation, and an endoscopic base for urology codes. In addition, this rule updates the codes subject to physician self-referral prohibitions. We are expanding the definition of a screening fecal-occult blood test and are modifying our regulations to expand coverage for additional colorectal cancer screening tests through our national coverage determination process. We also make revisions to the sustainable growth rate, the anesthesia conversion factor, and the work values for some gastroenterologic services. 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 clarifies the enrollment of physical and occupational therapists as therapists in private practice and clarifies the policy regarding services and supplies incident to a physician's professional services. In addition, this final rule discusses physical and occupational therapy payment caps and makes technical changes to the definition of outpatient rehabilitation services. In addition, we are finalizing the calendar year (CY) 2002 interim RVUs and are issuing interim RVUs for new and revised procedure codes for calendar year (CY) 2003. As required by the statute, we are announcing that the physician fee schedule update for CY 2003 is -4.4 percent, the initial estimate of the sustainable growth rate for CY 2003 is 7.6 percent, and the conversion factor for CY 2003 is $34.5920. This final rule will also allow registered nurses (RNs) to provide emergency care in certain critical access hospitals (CAHs) in frontier areas (an area with fewer than six residents per square mile) or remote locations (locations designated in a State's rural health plan that we have approved.) This policy applies if the State, following consultation with the State Boards of Medicine and Nursing, and in accordance with State law, requests that RNs be included, along with a doctor of medicine or osteopathy, a physician's assistant, or a nurse practitioner with training or experience in emergency care, as personnel authorized to provide emergency services in CAHs in frontier areas or remote locations.     

Health insurance reform: standard unique employer indentifier. Final rule

This final rule establishes a standard for a unique employer identifier and requirements concerning its use by health plans, health care clearinghouses, and health care providers. The health plans, health care clearinghouses, and health care providers must use the identifier, among other uses, in connection with certain electronic transactions. The use of this identifier will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It will implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.     

TRICARE; Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); bonus payments in medically underserved areas. Final rule

This final rule implements a bonus payment, in addition to the amount normally paid under the allowable charge methodology, to physicians in medically underserved areas. For purposes of this rule, medically underserved areas are the same as those determined by the Secretary of Health and Human Services for the Medicare program. Such bonus payments shall be equal to the bonus payments authorized by Medicare, except as necessary to recognize any unique or distinct characteristics or requirements of the TRICARE program, and as described in instructions issued by the Executive Director, TRICARE Management Activity. This rule promotes a reimbursement enhancement to a limited number of physicians designed to increase TRICARE beneficiary access to care.     

努力构建农村公共文化服务体系，满足农民群众精神需求

不断加强农村文化建设, 努力构建农村公共文化服务体系, 是落实科学发展观的内在要求,对于积极推进城乡统筹发展、构建和谐社会,实现农村物质文明、政治文明和精神文明协调发展具有重大而深远的意义。     

从某市公安警力配置情况看基层公安机关警力不足的表现及其原因和对策

基层公安机关警力不足不仅制约了公安职能的充分发挥,影响了公安机关的整体形象,而且损害了公安民警的身心健康,队伍凝聚力与吸引力受到挑战。公安机关任务量成倍增长,警力总量增长与之不相适应,侦查办案和治安管理的难度不断加大,执法要求越来越高,公安工作科技含量还不高,部分民警素质还不适应现代警务要求,警力资源内部配置不尽科学合理等,是造成当前基层公安机关警力不足的主要原因。而要解决基层公安机关警力不足的问题,一是增加公安专项编制,使基层公安机关警力与所承担任务尽可能相匹配;二是深化管理和改革,努力发挥现有警力资源的最大效能;三是以各种辅助力量为依托,实现向民力要警力;四是坚持科技强警,提升公安工作信息、技术和装备水平。     

浙江检察研究与检察改革情况报告

一、检察研究的总体情况 近年来,浙江省检察机关紧紧围绕党和国家大局、检察工作主题,着眼于检察工作的创新发展,积极开展检察理论研究,迎难而上,锐意拼博,不懈进取,取得了明显成效.     

论帮助犯罪分子逃避处罚罪之应然主体

对帮助犯罪分子逃避处罚罪主体范围的理解和适用,见仁见智。以罪刑法定为指导对本罪主体进行法条解析：本罪之应然主体以“身份说”为主,兼采“职权说”,皆以负有查禁犯罪的职责为前提。查禁犯罪活动是从调查、发现犯罪人或犯罪事实开始,到立案侦查、审查起诉这一过程的活动。负有查禁犯罪活动职责的各级党委机关中的政法委工作人员,不能成为本罪之主体。     

论警察勤务的规范化管理

警察勤务的规范化建设是新生事物,涉及公安机关各警种的方方面面,既有传统观念的改变,又有内部运作和体制的调整。要革除警务工作中的积弊,从不规范到规范,从不明确到明确,从运行无序到规范操作,需要我们结合工作实际大胆探索、改革,寻求适合我国国情的有中国特色的警务规范化道路。     

以"三个代表"重要思想为指导繁荣云南哲学社会科学事业

在建立社会主义市场经济、建设有中国特色社会主义的过程中 ,必须以“三个代表”的重要思想为指导 ,充分重视哲学社会科学研究的重大意义。云南省哲学社会科学研究在全省的经济社会发展中发挥了重要作用。进入 2 1世纪 ,新时期对云南省哲学社会科学研究提出了更高的要求 ,坚持“与时俱进” ,推进理论创新 ,才能使哲学社会科学研究更好地为党和政府决策服务 ,为建设云南民族文化大省服务     

32例无心外原因猝死者传导系统病理学观察

在对32例无心外原因猝死者传导系统(CCS)组织学观察中,发现31例 CCS 有异常和病变,其中11例可致猝死。这些病变包括有急性炎症、出血、脂肪浸润和结内外神经病变,且与猝死有关。