View Rule

View EO 12866 Meetings

Printer-Friendly Version     Download RIN Data in XML

---

HHS/CMS

RIN: 0938-AI56

Publication ID: Spring 1998

Title: ●Medicare Program; Prospective Payment System for Hospital Outpatient (HCFA-1005-P)
Abstract: As required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, this proposed rule would eliminate 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), effective January 1, 1999. The prospective payment system would simplify our current payment system and apply to all hospitals, including those that are exempt from the inpatient prospective payment system. However, the Balanced Budget Act delays application of the system to cancer hospitals until January 1, 2000. ^PThis 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 monetary penalty, not to exceed $2,000 against any individual who knowingly and willfully presents a bill in violation of an arrangement. ^PThis proposed rule would also establish in regulations the requirements for designating certain entities as provider-based or as a department of a hospital.
Agency: Department of Health and Human Services(HHS)	Priority: Economically Significant
RIN Status: First time published in the Unified Agenda	Agenda Stage of Rulemaking: Long-Term Actions
Major: Yes	Unfunded Mandates: Private Sector
CFR Citation: 42 CFR 409.10    42 CFR 410.2    42 CFR 410.27    42 CFR 410.28    42 CFR 410.30    42 CFR 411.15    42 CFR 412.50    42 CFR 413.118    42 CFR 413.122    42 CFR 413.124    42 CFR 413.130    42 CFR 413-New subpart L    42 CFR 489.20    42 CFR 1003.101 to 102    42 CFR 1003.105     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: PL 105-33, Sec 4521    PL 105-33, Sec 4522    PL 105-33, Sec 4523    PL 99-509, Sec 9343(c)

Legal Deadline: Action Source Description Date Final  Statutory    11/01/1998

Regulatory Flexibility Analysis Required: Yes	Government Levels Affected: None
Small Entities Affected: Businesses
Included in the Regulatory Plan: No
Agency Contact: Janet Wellham Center for Health Plans and Providers Department of Health and Human Services Centers for Medicare & Medicaid Services 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-4510