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HHS/CMS | RIN: 0938-AI56 | Publication ID: Fall 2000 |
Title: Medicare Program; Prospective Payment System for Hospital Outpatient Services (HCFA-1005-F) | |
Abstract: The Balanced Budget Act of 1997 (BBA) (Pub. L. 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. In the proposed rule published on September 8, 1998, HCFA indicated that implementation of the system would be delayed because of systems concerns. 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 rule would establish 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: Final Rule Stage |
Major: Yes | Unfunded Mandates: Private Sector |
CFR Citation: 42 CFR 409.10 42 CFR 413.124 42 CFR 413.130 42 CFR 413 42 CFR 489.20 42 CFR 1003.105 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 1003.101 42 CFR 1003.102 | |
Legal Authority: PL 105-33, sec 4521 PL 105-33, sec 4522 PL 105-33, sec 4523 PL 99-509, sec 9343(c) |
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Regulatory Flexibility Analysis Required: Yes | Government Levels Affected: None |
Small Entities Affected: Businesses | Federalism: No |
Included in the Regulatory Plan: No | |
Agency Contact: Chuck Braver Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Health Plans and Providers, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-6719 |