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HHS/CMS

RIN: 0938-AI56

Publication ID: Spring 1999

Title: Medicare Program; Prospective Payment System for Hospital Outpatient Services (HCFA-1005-P)
Abstract: The Balanced Budget Act of 1997 (BBA) (Public Law 105-33), enacted on August 5, 1997, provides for implementation of a Prospective Payment System (PPS) for hospital outpatient services (and for part B services furnished to inpatients who have no Part A coverage) furnished on or after January 1, 1999. This system will also apply to partial hospitalization services furnished by community mental health centers. The BBA also requires a new method for calculating beneficiary copayments for the hospital outpatient services included under the PPS. The PPS will consist of about 340 groups of services, called "Ambulatory Payment Classifications" or APCs, that are related clinically and in terms of their resource use. We will assign a group weight to each group, based on the median cost (operating and capital) of the services included in the group. We will convert the weights for each group to payment rates using a national conversion factor, taking into account group weights and the projected volume of services for each group. In addition, this proposed rule would 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: Previously published in the Unified Agenda	Agenda Stage of Rulemaking: Completed 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 42 CFR 489.20 42 CFR 1003.101 to 102 42 CFR 1003.105
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

Timetable:

Action	Date	FR Cite
NPRM	09/08/1998	63 FR 47551
Final Action	09/08/1998	63 FR 47552
NPRM Comment Period End	11/09/1998

Regulatory Flexibility Analysis Required: No	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