Volume V, Number 3; December
1999
Contents
The Health Care Financing Administration (HCFA) recently proposed
rules for a new Medicare payment system to help ensure appropriate
reimbursements for quality, efficient home-health care.
The proposal continues the efforts of the Clinton Administration
and Congress to protect the home-health benefit while curtailing the
unsustainable costs and inappropriate payments that began in the
early 1990s.
On October 1, 2000, Medicare will begin paying all home-health
agencies under a prospective payment system, as mandated by the
Balanced Budget Act of 1997 (BBA) and amended by the Omnibus
Consolidated and Emergency Supple-mental Appropriations Act of 1998.
The new system will complete the transition from the pre-BBA
cost-based system, which encouraged inefficiency, waste and abuse.
It will replace the BBA-mandated interim payment system that has
been in effect since October 1997.
Under the proposed system:
• Medicare would pay home-health agencies for each covered
60-day episode of care. Beneficiaries could receive an unlimited
number of episodes of care.
• Medicare would pay home-health agencies at a higher rate to
care for those beneficiaries with greater needs. Nurses and other
clinical workers at Medicare-certified agencies already use a
comprehensive, standardized tool to assess the needs of patients.
Payment rates would bebased on relevant data from the assessment.
• Agencies would receive additional payments for an individual
beneficiary if the costs of that care were significantly higher than
the specified payment rate. Such “outlier” payments would account
for the unusual needs of specific beneficiaries.
• The payment system would use national payment rates, with
adjustments to reflect area wage differences and the intensity of
care required by each beneficiary.
• The payments would encompass Medicare-covered home-health
services for a 60-day episode of care, including skilled-nursing and
home-health aide visits, covered therapy, medical social services
and supplies.
• Medicare would pay home-health agencies separately for
medically necessary durable medical equipment provided under the
home-health plan of care.
• Payment rates would be adjusted to reflect significant changes
in a patient’s condition during each Medicare-covered episode of
care.
• Medicare would require agencies to provide at least five visits
to beneficiaries to receive the full payment for each
Medicare-covered episode of care. For fewer visits, Medicare would
rely on a different methodology to ensure appropriate payments.
HCFA published a proposed rule on October 28 , 1999, in the
Federal Register that details the proposed payment system.
The agency will publish a final rule next year after reviewing and
responding to the public’s comments.
Medicare has paid hospitals under a prospective payment system
since 1983. Medicare began to pay nursing homes under a prospective
payment system in 1998. The BBA also requires HCFA to implement
prospective payment systems for hospital outpatient services and for
rehabilitation hospitals.
During early fall 1999, the Oakland (California) Public Library
served as the host site for twin celebrities Marian and Vivian Brown
(seated) for a Medicare & You media event. The vivacious and
energetic Brown twins have appeared in numerous events and regional
commercials throughout the San Francisco Bay area. The Oakland event
was designed to demonstrate to the news media how easy it is to surf
the Web for Medicare information. The event also coincided with the
rollout of a massive nationwide mailing of approximately 32 million
copies of the Medicare & You 2000 handbook. Julie Odosin
, director of the Oakland Public Library, listens as Henry Tyson,
manager of the Customer Relations Branch of HCFA’s San Francisco
Regional Office noted the important partnership with the National
Library Association, which is helping seniors to access Medicare
information via computer throughout the country. “Medicare is
committed to helping seniors learn about Medicare coverage and the
options that are available to them,” Tyson said. Counselors with the
Alemeda County State Hospital Insurance Program were also on hand to
demonstrate the use of the Medicare Web site www.medicare.gov.
Mark Manfredi, a health insurance specialist
in the San Francisco Regional Office, contributed the
cutline.
AS WE APPROACH the holiday season, I want to assure the millions
of Medicare beneficiaries across the nation that we are ready to pay
their Medicare-covered health bills in the next year. We are ready
for Y2K. The Health Care Financing Administration has worked hard to
make sure its computers and those at the insurance companies that
process Medicare claims will function properly when the calendar
flips over to the year 2000.
America moved into the computer age not many years after
President Johnson signed Medicare into law, on July 30, 1965 -- or
07/30/65 in computer talk.
Using only two digits to denote years saved computer space at the
time, but it also created problems that became apparent as the year
2000 neared. For example, some Medicare beneficiaries who were born
in 1900 will need health care services in 2000. Without Y2K
compliance, both years would show up as 00 on the claims submitted
by providers who have treated them.
For us to process Medicare claims and certify coverage in the
future, our computers must be able to read years in four digits.
This required us to rewrite 50 million lines of computer code. We
updated, tested, and retested our systems, and had our work
certified by an independent verification and validation contractor.
All 25 of our mission critical systems will recognize 01/01/2000
when they read it.
And we had to make sure that the private insurance companies that
process and pay Medicare claims for us were ready. The 75 systems
they use for this work also have been updated, tested, and
certified.
We are confident that when we get a bill from a doctor or other
health care provider, we will be able to pay it. Even in the
unlikely event that something goes wrong in one of our systems, we
do have backups in place.
Of course, it is up to the doctors, hospitals, HMOs, supplemental
insurance carriers, and others who serve our beneficiaries, as well
as the states, which operate Medicaid and the State Child Health
Insurance Program, to get their own computers in order.
We have gone to great lengths to help them with their work. We
provided technical assistance, hands-on counseling, free or low-cost
software, or whatever else it took.
The most important thing for beneficiaries to remember is that
Medicare will cover them, no matter what the calendar says. No
computer can make their coverage go away. The best precaution
beneficiaries can take is to stay informed. They should talk to
their physician or other health care provider and ask them how they
are preparing for Y2K.
If problems arise, we will help. Beneficiaries getting a bill
that they think should have been submitted to Medicare, or with any
other question, need only call our Medicare hotline
1-800-MEDICARE (1-800-633-4227).
Come January 1 and beyond, Medicare will be there
for them.
To live is so startling it leaves little time for
anything else.
-- Emily Dickinson
More than 2,000 people took part in Avon’s Breast-Cancer
Three-Day Walk in Atlanta recently. Included were two HCFA Atlanta
Regional Office staff, Patricia Bellamy and Vernell Britton, who
walked with the others to raise funds for Avon’s Breast-Cancer
Awareness Crusade. They walked 56 miles from Lake Lanier to Atlanta,
sleeping in tents at nightfall for a great cause.
Breast-Cancer Three-Day Walks were initiated by the Avon Company
and have been held in several cities. The millions of dollars raised
by the walkers will be used to provide education, screening, and
direct care to medically needy women throughout the United States.
This year, more than 200,000 women in the United States have been
diagnosed with breast cancer; another one million have breast
cancer. But not knowing that potentially life-threatening fact, they
are likely to remain undiagnosed for five to eight years. Breast
cancer is the second leading cause of deaths in women between the
ages of 40 and 55. As these walks progressed, more than 40,000 women
had died from breast cancer. The best way to “beat” breast cancer is
through early detection, regular mammograms for women over 40 years
of age, annual clinical exams, and monthly self-exams. The five-year
survival rate after treatment for early-stage breast cancer is 97
percent. About two million breast-cancer survivors are alive in
America today.
We walked in memory of those who had lost their lives to breast
cancer and to breast-cancer survivors, including those currently in
treatment.
Vernell Britton, a manager in the Division of
Medicaid and State Operations, Atlanta Regional Office, contributed
this article.
www.access.gpo.gov/su_docs/fedreg/a990914c.html
Pharmacy Redesign Demonstration Project
Medicare-eligible military health system (MHS) beneficiaries‘
access to pharmacy benefits outside this demonstration project is
limited to the facility in which the beneficiary is being treated.
This demonstration project will incorporate private sector “best
practices” in providing pharmacy services to aged MHS beneficiaries.
This URL takes you to the Table of Contents for the Federal
Register, Vol. 64, No. 177, Tuesday, September 14, 1999. There
is one link for this subject (text or PDF) under “Civil Health and
Medical Program of the Uniformed Services (CHAMPUS); TRICARE Program
-- Pharmacy Redesign Demonstration, 49775-49776 [FR Doc. 99-23818].”
www.access.gpo.gov/su_docs/fedreg/a990920c.html
Lists of Designated Primary Medical Care, Mental Health, and
Dental Health Professional Shortage Areas (HPSAs)
Public or private nonprofit entities are eligible to apply for
assignment to the National Health Service Corps (NHSC) personnel in
order to provide primary health services in these HPSAs. This URL
takesyou to the Table of Contents for the Federal Register,
Vol. 64, No. 181, Monday, September 20, 1999. There are four
links for this subject (text or PDF) under the Health Resources and
Services Administration. The links will take you to the various
lists of health professional shortage areas around the country.
www.ncqa.org/pages/communications/news/excellentrel.htm
NCQA Recognizes Nation’s Best Health Plans With Introduction
of New ‘Excellent’ Accreditation Status
The National Committee for Quality Assurance (NCQA) recently
released the names of an elite group of health plans from across the
nation that have earned -- by virtue of their commitment to clinical
excellence, customer service and continuous improvement -- NCQA’s
new ‘Excellent’Accreditation status. Massachusetts, Pennsylvania and
New York contain three Medicare managed care plans with the new
rating. Florida, Georgia, Texas, Wisconsin, Colorado, California and
Hawaii each has one. [Note: The list of all NCQA accredited health
plans is available for download from NCQA’s Web site. The list is
updated on or near the 15th of each month. The health plans listed
above had achieved NCQA’s “Excellent” designation as of October 18,
1999.]
HHS Secretary Donna E. Shalala recently released a new report
showing that a growing and increasingly diverse elderly population
in the U.S. is living longer but still faces health challenges as
the next century approaches.
Health, United States, 1999 reveals the annual “report
card” on the nation’s health, which is produced by the Centers for
Disease Control and Prevention’s (CDC) National Center for Health
Statistics (NCHS). The annual report features a special chart book
this year on the aging population in the U.S.
Life expectancy for older Americans has increased over the past
50 years. Based on current mortality rates, a 65-year-old person in
1997 could on average expect to live to be nearly 83 years old; an
85-year-old in 1997 could expect to live to be over 90.
Contributing to longer life expect-ancy is the significant and
long-term decline in mortality, especially from heart disease. Death
rates from heart disease among persons 65-84 have been reduced by
about half since 1970; among those aged 85 and over, death rates
from heart disease have dropped 21 percent over the same time
period.
Examining the quality of those added years of life, the report
shows that most older persons are not severely limited in their
daily activities despite living with chronic conditions. A majority
of noninstitutionalized persons 70 years of age and over reported
they suffered from arthritis, and approximately one-third reported
they had hypertension. Diabetes was reported by 11 percent.
Overall, the report shows that less than 10 percent of
noninstitutionalized persons 70 years of age and over were unable to
perform one or more activities of daily living (e.g., bathing,
dressing, using the toilet) in 1995. However, this disability
increased with age from close to 5 percent among persons 70-74 years
of age to nearly 22 percent among persons 85 years of age and over.
Other findings on the health status of the elderly:
• In 1995, 39 percent of noninstitutinalized persons 70 years
of age and over used assistive devices such as hearing aids,
diabetic and respiratory equipment, and canes and walkers during the
previous 12 months.
• Seven out of 10 non-disabled persons 65 years of age and over
participated in some form of exercise at least once in a recent
two-week period, such as walking, gardening, and stretching. Still,
only about one-third of the persons who exercised achieved
recommended levels.
• Almost all elderly persons have Medicare coverage. However,
non-Hispanic-black and Hispanic elderly persons were less likely
than non-His-panic white persons to have private insurance to
supplement their Medicare coverage.
• Approximately 12 percent of Medicare enrollees 65 years of age
and over were in managed care plans in 1997. For the U.S. population
as a whole, HMO enrollment increased to 29 percent in 1998.
Health, United States, 1999 features more
than a hundred tables showing trends in health status, health risk
factors, use of health care and a variety of other health topics for
the entire U.S. population collected from several federal and
non-federal sources. The National Institute on Aging provided
support for the chart book on aging. Copies of the report are
available from the NCHS at 6525 Belcrest Rd., Hyattsville, MD 20782,
or can be downloaded from the NCHS Web site at
http://www.cdc.gov/nchswww.
The Health Care Financing Administration (HCFA) approved a
request by Regence HMO Oregon and PacifiCare to expand coverage to
Medicare beneficiaries in two Oregon and 13 Oklahoma counties
recently.
Regence HMO Oregon, based in Portland, began enrollment in
October to serve Medicare beneficiaries starting January 1, 2000, in
Marion and Polk counties in northwestern Oregon. In the same area,
the plan currently serves beneficiaries in Clackamas, Columbia,
Multnomah and Washington counties including Portland. About 38,000
beneficiaries live in the plan’s newly approved service area. The
plan does business as First Choice 65.
PacifiCare, based in Tulsa, began enrollment in October to
serve Medi-care beneficiaries starting January 1,
2000. The managed care plan will be offered for the first time to
beneficiaries in Cherokee, Lincoln, Mayes and Nowata counties. The
plan also will serve beneficiaries throughout nine other counties --
Canadian, Creek, Cleveland, Logan, McClain, Okfuskee, Rogers, Tulsa
and Wagoner -- now partially covered by PacifiCare.
PacifiCare will continue to serve beneficiaries in all of
Oklahoma County, including Oklahoma City, and parts of Grady, Osage,
Pottawatomie and Washington counties in central and northeastern
Oklahoma. About 158,000 beneficiaries live in the plan’s newly
approved service area. The plan does business as Secure Horizons.
Currently, about 6.5 million Medicare beneficiaries -- out of a
total of nearly 40 million aged and disabled Americans -- have
enrolled in Medicare HMOs. HCFA, which administers the Medicare
program, has approved 25 applications this year for new or expanded
service areas and has an additional 17 applications from managed
care organizations seeking to serve beneficiaries in new or expanded
service areas. Managed care and other new health care options, known
as Medicare+Choice, are available where private companies choose to
offer them. Original fee-for-service Medicare, currently chosen by
more than 33 million beneficiaries, is available to all
beneficiaries.
Congress created Medicare+Choice in the Balanced Budget Act of
1997 to expand the types of health care options available to
Medicare beneficiaries. As part of Medicare+Choice, Medicare now
offers new preventive benefits and patient protections, as well as a
far-reaching information program that includes a national toll-free
phone number -- 1-800-MEDICARE (1-800-633-4227) -- a new Internet
site -- http://www.medicare.gov.
-- and a coalition of more than 200 national and local organizations
to provide seniors with more information.
The Department of Health and Human Services (HHS) announced
recently that the Part B premium paid by Medicare beneficiaries next
year will remain unchanged for the second time in three years.
“The Clinton Administration’s efforts to protect Medicare are
ensuring this essential program will be preserved for the future,
and also helping beneficiaries save money,” said HHS Secretary Donna
E. Shalala.
The Part B premium covers physician services, hospital outpatient
care, durable medical equipment and other services outside
hospitals. The Part B premium will stay at the 1999 rate of $45.50.
Last year, it rose by $1.70.
“This is welcome news for the millions of senior and older
Americans who rely on Medicare,” said HCFA Administrator Nancy-Ann
Min DeParle.
The Medicare Part A deductible for inpatient hospital care is
rising by $8, only about one percent, to $776. The small increase
largely reflects savings from reductions in Medicare hospital
payments and other program changes signed into law in the Balanced
Budget Act to help protect and preserve the Medicare Hospital
Insurance Trust Fund. Last year, the deductible rose by $4.
The Part A deductible is a beneficiary’s only cost for up to 60
days of inpatient care. The cost to beneficiaries for hospital stays
longer than 60 days is rising by $2, to $194 per day, and by $4, to
$388 per day, for stays longer than 90 days. The skilled-nursing
facility deductible, which must be paid after the first 20 days of
such care, is rising by $1, to $97 per day.
The vast majority of Medicare beneficiaries do not pay premiums
for Part A coverage. However, these premiums are actually dropping
in 2000 for the 365,000 beneficiaries who do not pay them. The full
monthly Part A premium is dropping by $8, to $301. It is paid by
seniors with less than 30 quarters of Medicare-covered employment
and by disabled individuals under 65 who lost disability benefits
because of work and earnings. Seniors with 30 to 40 quarters of
Medicare-covered employment are entitled to reduced premiums that
are dropping by $4, to $166.
After reviewing the scientific evidence of the insulin-infusion
pump’s effectiveness in treating Type I diabetes, HCFA announced a
national coverage decision to cover insulin-infusion pumps in late
September 1999. Under the new coverage policy, Medicare will pay for
the pump when prescribed for beneficiaries who have Type I diabetes.
In Type I diabetes the pancreas fails to produce insulin, the
hormone necessary for the metabolism of blood glucose.
The decision to expand Medicare benefits to include
insulin-infusion pumps was made within the 90-day deadline HCFA
established when it announced a new Medicare administrative process
in April 1999. Medicare’s new coverage process is designed to be
open, understandable and predictable. The process relies on medical
and scientific evidence to make national coverage decisions
including medical literature and data, discussions with medical
experts and technology assessment.
Medicare already covers diabetes self-management training
provided in outpatient settings. Blood glucose monitors and testing
strips are covered for all diabetic patients as durable medical
equipment.
HCFA next will issue a coverage instruction, including coding and
billing information, to all of its contractors that will specify the
effective date for payment for insulin-infusion pumps for Type I
diabetes.
Type I diabetes is less common than Type II diabetes which is
more prevalent in the Medicare population. Type I diabetes accounts
for 5 to 10 percent of all diabetes in the United States. Type II, a
disorder resulting from the body’s inability to make enough insulin,
accounts for 90 to 95 percent of diabetes. Infusion pumps have not
yet been shown to be effective for Type II diabetic patients.
On September 10, 1999, the Health Care Financing Administration
(HCFA) named the remaining members of the Medicare Coverage Advisory
Committee, who will advise Medicare on coverage policy decisions.
Previously, on August 5, HCFA named members of the Laboratory and
Diagnostic Services Panel, Drugs, Biologics and Therapeutics Panel,
and Medical and Surgical Procedures Panel. [The combined
October-November issue of Health Watch lists members’ names
for those panels.]
Additional members of the Executive Committee and members of the
Diagnostic Imaging Panel, Durable Medical Equipment Panel, and
Medical Devices and Prosthetics Panel have been selected. These
selections complete the membership of the new panels, whose
expertise will assist Medicare in making timely, science-based
coverage decisions using a new administrative process that is easily
understood and open to the public.
The coverage committee serves as an advisory body to HCFA on
national coverage decisions to ensure Medicare beneficiaries have
access to the latest effective, evidencebased treatment. To make
national coverage decisions, HCFA relies on medical and scientific
evidence including medical literature and data, discussions with
medical experts and technology evaluations.
The advisory committee and panels will meet at least twice a year
and provide an opportunity for public participation on coverage
issues referred to the committee by HCFA. The committee will review
and evaluate medical literature, analyze technology assessments, and
examine data and information on the effectiveness and
appropriate-ness of medical devices and procedures. Based on the
medical evidence reviewed, the committee will advise and make
recommendations on Medicare decisions, but HCFA makes final Medicare
coverage decisions.
Each of the six advisory panels is organized to roughly parallel
Medicare benefit categories, enabling HCFA to obtain the most
pertinent technical advice. The panels will be asked to evaluate
scientific evidence to assist HCFA in coverage decisions.
The two-year terms of the panel members are staggered with about
one-third expiring in 2001, one-third in 2002 and one-third in 2003.
The panel and Executive Committee meetings and the administrative
record of the coverage decision are public.
In an April 27, 1999 Federal Register notice, HCFA
described the new administrative process for making national
coverage decisions. While building on current procedures, the agency
will take additional steps to ensure that the national coverage
process is more open, predictable and understandable. The April
announcement also outlined how the public may request national
coverage decisions, timelines for reviewing requests and the roles
of HCFA, the advisory committee and technology assessment in
national coverage decisions.
The Medicare law provides for broad coverage of many medical and
health care services, including care provided by physicians,
hospitals, skilled-nursing facilities and home health agencies.
Instead of providing an all-inclusive list of items and services
covered by Medicare, Congress gave the Health and Human Services
Secretary the authority to decide which specific items and services
within these categories can be covered by Medicare.
The law also states that Medicare cannot pay for any items or
services that are not “reasonable and necessary” for the diagnosis
and treatment of illness and injury. For more than 30 years, the
Medicare program has exercised this authority to determine whether
specific services that meet one of the broadly defined benefit
categories should be covered under the program.
Most Medicare coverage and policy decisions are made locally by
HCFA contractors -- the private companies that by law process and
pay Medicare claims -- HCFA also makes coverage policies that apply
nationwide and are binding on all contractors and administrative law
judges. Under the new administrative process, HCFA will initiate
coverage reviews when appropriate and accept formal requests from
external parties for coverage decisions. The agency will typically
initiate a national coverage review when there are conflicting local
contractor coverage policies, a service represents a significant
medical advance and no similar service is covered by Medicare, there
is substantial disagreement among medical experts about a service’s
efficacy or medical effectiveness, or the service is currently
covered but is widely considered ineffective or obsolete.
The current membership and affiliations of the three panels and
Executive Committee announced on September 10 are as follows.
Executive Committee of the Medicare Coverage
Advisory Committee (MCAC)
DIAGNOSTIC IMAGING PANEL -- David M. Eddy, M.D., Ph.D.,
Senior Advisor, Health Policy and Management, Kaiser Permanente
Southern California, Washington, D.C.; Frank J. Papatheofanis,
M.D., Ph.D., Assistant Professor of Radiology, Department of
Radiology, University of California San Diego, San Diego, Calif.
MEDICAL DEVICES AND PROSTHETICS PANEL -- Harold C. Sox,
M.D., Professor and Chair, Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, N.H.; Ronald M.
Davis,
DURABLE MEDICAL EQUIPMENT -- Daisy Alford-Smith, Ph.D.,
Director, Summit County Department of Health, Akron, Ohio; Joe W.
Johnson, D.C., Private Chiropractor, Paxton, Fla.;
Member-at-Large Robert H. Brook, M.D., Sc.D., Vice
President and Director, RAND Health and Corporate Fellow, The RAND
Corporation, Santa Monica, Calif; Consumer Representative
Linda A. Berthold, Ph.D., Consultant and Researcher,
Stanford, Calif.; Industry Representative Randel E.
Richner, M.P.H., Director, Reimbursement and Outcomes Planning,
Boston Scientific Corporation, Natick, Mass.
DIAGNOSTIC IMAGING PAENL OF THE MEDICARE COVERAGE ADVISORY
COMMITTEE -- Chairperson: Donald M. Eddy, M.D., Ph.D.;
Vice-Chairperson, Frank J. Papatheofanis, M.D., Ph.D.
Voting Members: Carole R. Flamm, M.D., M.P.H., Senior
Consultant, Blue Cross and Blue Shield Association, Technology
Evaluation Center, Chicago, Ill.; Jeffrey C. Lerner, Ph.D.,
Vice President, Strategic Planning, ECRI, Plymouth Meeting, Pa.;
Michael Manyak, M.D., Professor and Chairman, Department of
Urology, George Washington University Medical Center, Washington,
D..C.; Donna Novak, B.A., Senior Manager, Deloitte and
Touche, LC, Chicago, Ill.; Manuel D. Cerqueira, M.D.,
Associate Chief, Clinical Cardiology, Georgetown Hospital University
Medical Center, Washington, D.C.; Kim J. Burcheil, M.D., Vice
Chair for Hospital Affairs, Department of Surgery, Oregon Health
Sciences University, Portland, Ore.; Steven Guyton, M.D.,
M.P.H., Surgeon, Cardiology and Thoracic Surgical Service, Virginia
Mason Medical Center, Seattle, Wash.; Consumer Representative,
Sally Hart, J.D., Consulting Attorney, Center for
Medi-care Advocacy, Tucson, Ariz.; Industry Representative:
Michael S. Klein, M.B.A., Senior Vice President,
Marketing and Sales, Varian Oncology Systems, Palo Alto, Calif.
DURABLE MEDICAL EQUIPMENT PANEL OF THE MEDI-CARE COVERAGE
ADVISORY COMMITTEE -- Chairperson: Daisy Alford-Smith,
Ph.D.; Vice-Chairperson: Joe W. Johnson, D.C.;
Voting Members: Edward A. Eckenhoff, M.A., M.H.A.,
President and CEO, National Rehabilitation Hospital, Washington,
D.C.; Halley S. Faust, M.D., M.P.H., President, Medmax
Ventures, LC, Bloomfield, Conn.; Neil Kahanovitz, M.D.,
Orthopaedic Surgeon, Anderson Orthopaedic Clinic, Arlington, Va.;
Lisa Landy, M.D., Private Practitioner, Tucson, Ariz.;
Kathleen O’Connor, M.A., Executive Director, WHERE, Seattle,
Wash.; Emil Paganini, M.D., Section Head, Dialysis and
Extracorporeal Therapy, The Cleveland Clinic Foundation, Cleveland,
Ohio; Antonio Puente, Ph.D., Professor, Department of
Psychology, University of North Carolina at Wilmington, Wilmington,
N.C.; Mary Margaret Sharp-Pucci, Ed.D., M.P.H., Senior
Consultant, Blue Cross and Blue Shield Association, Technology
Evaluation Center, Chicago, Ill.; Michael J. Strauss, M.D.,
M.P.H., Executive Vice President, Covance, Inc., Washington, D.C.;
Consumer Representative: Marilyn-Lu Webb, Ph.D.,
Director, Manage Incontinence Positively, Fresno, Calif.;
Industry Representative: Jonathan Well, J.D., Ph.D.,
Senior Attorney, Medical Products Group/ Federal Regulations,
Hewlett-Packard Co., Andover, Mass.
MEDICAL DEVICESAND PROSTHETICS PANEL OF THE MEDICARE COVERAGE
ADVISORY COMMITTEE -- Chairperson: Harold C. Sox, M.D.
Vice-Chairperson: Ronald M. Davis, M.D.; Voting
Members: Willarda V. Edwards, M.D., Managing Partner,
Internal Medicine, Baltimore, Md.; John T. Hinton, D.O.,
M.P.H., Vice President, Medical Management, Preferred Physicians
Partners, Cincinnati, Ohio; Anne C. Roberts, M.D., Professor,
Department of Radiology, University of California at San Diego,
Medical Center, Thornton Hospital, La Jolla, Calif.; Karl A.
Matuszweski, M.S., Pharm.D., Director, Technology Assessment
Program, Clinical Practice Advancement Center, University Health
System Consortium, Oak Brook, Ill.; Thomas E. Strax, M.D.,
Professor and Chairman, Department of Physical Medicine and
Rehabilitation, University of Medicine and Dentistry, New Jersey
Robert Wood Johnson Medical School, Edison, N.J.; Wade M. Aubry,
M.D., National Medical Consultant, Health Management Systems,
Blue Cross and Blue Shield Association, Technology and Evaluation
Program, San Francisco, Calif.; Consumer Representative:
Ph.D., Professor and Chairman, Department of Rehabilitation
Science and Technology, University of Pittsburgh, Pittsburgh, Pa.;
Industry Representative: Eileen C. Helzner, M.D., Vice
President, Worldwide Clinical Development and Outcomes Research
Professional Group, Johnson & Johnson, Titusville, N.J.
Medicare Program; Appeals of Carrier Determinations That a
Supplier Fails to Meet the Requirements for Medicare Billing
Privileges [HCFA-6003-P] -- Published 10/25. This proposed rule
would extend appeal rights to all suppliers whose enrollment
applications for Medicare billing privileges are disallowed by a
carrier or whose Medicare billing privileges are revoked, except for
those suppliers covered under other existing appeals provisions of
HCFA regulations. In addition, we propose to revise certain appeal
provisions to correspond with the existing appeal provisions in
those other sections of our regulations. We also would extend appeal
rights to all suppliers not covered by existing regulations to
ensure they have a full and fair opportunity to be heard. Although
we are not required by the Administrative Procedure Act to publish
this rule as a proposed rule, (see 5 U.S.C. Section 553(b)(3)(A), we
are doing so in order to allow interested parties the opportunity
for prior notice and comment. Written comments will be considered if
we receive them at the appropriate address, as provided below no
later than 5 p.m. Eastern time on December 27, 1999. Mail written
comments (1 original and 3 copies) to Health Care Financing
Admin-istration, Department of Health and Human Services, Attention:
HCFA-6003-P, P.O. Box 26688, Baltimore, MD 21207-0488.
Health Insurance Portability [45 CFR Subtitle A, Parts 144 and
146] -- Published 10/25. In response to interim regulations
published on April 8, 1997, the Departments [DOJ, Labor and HHS]
have received comments from the public on a number of issues arising
under the portability, access, and renewability provisions of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The Departments are interested in receiving further comments
reflecting the experience that interested parties have had with the
interim regulations. The Departments have requested that comments be
submitted on or before January 25, 2000. For convenience, written
comments should be submitted with a signed original and 3 copies to
the Health Care Financing Administration (HCFA) at the address
specified below. HCFA will provide copies to each of the Departments
for their consideration. All comments will be available for public
inspection in their entirety. Comments should be sent to: Health
Care Financing Administration, Department of Health and Human
Services, Attention: HCFA-2056-NC, P.O. Box 9013, Baltimore, MD
21244-9013.
Medicare Program; Revision to Accrual Basis of Accounting
Policy [HCFA-1876-F] -- Published 9/27. Medicare policy provides
that payroll taxes that a provider becomes obligated to remit to
governmental agencies are included in allowable costs only in the
cost reporting period in which payment (upon which the payroll is
based) is actually made to an employee. Therefore, for payroll
accrued in one year, but not paid until the next year, the
associated payroll taxes are not an allowable cost until the next
year. This final rule provides for an exception when payment would
be made to the employee in the current year but for the fact the
regularly scheduled payment date is after the end of the year. In
that case, the rule requires allowance in the current year of
accrued taxes on payroll that is accrued through the end of the year
but not paid until the beginning of the next year, thus allowing
accrued taxes on end-of-the-year payroll is allowable in the current
period rather than in the following period. These regulations are
effective November 25, 1999.
Medicare Program; Telephone Requests for Review of Part B
Initial Claim Determinations [HCFA-4121-FC] -- Published 9/30.
Currently, our regulations allow beneficiaries, providers, and
suppliers, who are entitled to appeal Medicare Part B initial claim
determinations, to request a review of the carrier’s initial
determination in writing. This final rule allows those review
requests to be made by telephone and allows the carrier to conduct
the review by telephone, if possible. The use of telephone requests
supplements, and does not replace, the current written procedures
for initiating appeals. This telephone option also improves carrier
relationships with the beneficiary, provider, and supplier
communities by providing quick and easy success to the appeals
process. Carriers will make accommodations to enable a
hearingimpaired individual access to the telephone review process.
The effective date of these regulations is February 1, 2000.
Medicare Program; Hospice Wage Index; Correction
[HCFA-1039-CN2] -- Published 9/16. On October 5, 1998, HCFA
published a notice in the Federal Register (63 FR 53446)
announcing the annual update to the hospice wage index, which is
used to reflect local differences in wage levels. That update was
effective October 1, 1998, and is in the second year of a 3-year
transition period. The provisions in this correction notice are
effective as if they had been included in the document published in
the Federal Register on October 5, 1998. On November 1, 1998,
HCFA published a notice (63 FR 63326) correcting the October 5
notice. However, HCFA failed to make one typographical correction.
Therefore, in FR Doc. 98-26501 of October 5, 1998, we are now making
the following correction: On page 53448, in Table A, under the MSA
code number 1303 for Burlington, VT, the wage index “1.1037” is
corrected to read “1.0137”.
Medicare Program; Optional Coverage of Certain
Tuberculosis-Related Services to TB-Infected Individuals
[HCFA-2082-P] -- Published 9/10. This proposed rule would amend
the existing Medicaid regulations to incorporate statutory
provisions that allow States to cover a limited Medicaid service
package to an eligibility group of low-income individuals infected
with tuberculosis (TB). The services provided under this optional
coverage are limited to those related to the treatment of TB. This
optional coverage will ensure Medicaid services for the treatment of
TB-infected individuals who would otherwise be unlikely to receive
coverage under Medicaid. This proposed rule would incorporate and
interpret provisions of the OBRA of 1993.
Wishing You Happy Holidays
and GOOD HEALTH In The
Year 2000 |
The HCFA Health Watch
is published monthly, except when two issues are
combined, by the Health Care Financing Administration to provide
timely information on significant program issues and activities to
its external customers.
NANCY-ANN MIN DEPARLE
Administrator
Elizabeth Cusick
Director, Office of
Communications & Operations Support
Robert K. Adams
Acting Director, Communications
Strategies & Standards Group
HEALTH WATCH TEAM
JON
BOOTH............................. 410/786-6577
JUSTIN
DOWLING.................... 617/565-1261
WILLIAM KIDD..........
Relay: 800/735-2258
410/786-8609
MILDRED
REED.................... 202/690-8617
DAVID
WRIGHT..................... 214/767-4460
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