[Federal Register Volume 60, Number 201 (Wednesday, October 18, 1995)]
[Rules and Regulations]
[Pages 53876-53877]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-25840]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 411
[BPD-482-CN]
RIN 0938-AD73
Medicare Program; Medicare Secondary Payer for Individuals
Entitled to Medicare and Also Covered Under Group Health Plans;
Correction
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule with comment period; Correcting amendments.
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SUMMARY: This document makes corrections to the final rule with comment
period entitled ``medicare program; medicare secondary payer for
individuals entitled to medicare and also covered under group health
plans'' that was published in the Federal Register on Thursday, August
31, 1995 (60 FR 45344).
EFFECTIVE DATE: September 29, 1995.
FOR FURTHER INFORMATION CONTACT: Roya D. Lotfi, (410) 786-1898
SUPPLEMENTARY INFORMATION:
Background
In the August 31, 1995 issue, we amended the rules to implement
certain provisions of section 1862(b) of the Social Security Act, as
amended by the Omnibus Budget Reconciliation Acts of 1986, 1989, 1990,
and 1993 and the Social Security Act Amendments of 1994 that affected
the Medicare secondary payer rules for individuals who are entitled to
Medicare on the basis of age or who are eligible or entitled on the
basis of end stage renal disease, and who are also covered under group
health plans. We also established limits on Medicare payment for
services furnished to individuals who are entitled to Medicare on the
basis of disability and who are covered under large group health plans
by virtue of their own or a family member's current employment status
with an employer; and prohibit large group health plans from taking
into account that those individuals are entitled to Medicare on the
basis of disability.
The final rule with comment period that is the subject of these
corrections was necessary because of the statutory changes referenced
above. Those changes required a new subpart for the provisions that now
apply generally to all group health plans and Medicare secondary payer
situations. We also needed to make room for incorporating in logical
order any additional regulations that may be required by future
amendments to the Act.
Correction of Publication
As published, the final rule with comment period contains errors.
Accordingly, the publication on August 31, 1995 of the final rule with
comment that was the subject of FR Doc. 95-21265, is corrected as
follows (see also correction published September 20, 1995 at 60 FR
48749):
In the preamble, we correct typographical errors on page 45358,
first column, last paragraph. As corrected the first sentence reads:
``In contrast, a plan that is paying primary benefits takes into
account ESRD-based eligibility if it attempts to shift that primary
payment responsibility to Medicare when an individual becomes eligible
for Medicare based on ESRD, or when an individual is already eligible
for Medicare based on ESRD but has not completed the 18-month
coordination period.''
Also in the preamble, on page 45360, third column, first paragraph,
several words were inadvertently omitted from the third sentence. As
corrected the sentence reads:
``However, section 13561(c)(2) and (3) of OBRA '93 provides that
there will be an 18-month coordination period during which employer
sponsored primary insurance plans must continue to pay primary benefits
even if an individual who is eligible for or entitled to Medicare based
on ESRD is also entitled to Medicare on another basis.''
In the regulations text of Sec. 411.108(a)(8) on page 46364, we
correct drafting errors by removing the words ``no more than the
Medicare payment rate'' and adding the word ``less''; by removing the
words ``but making payments at a higher rate'' and adding the word
``than''; and by adding the word ``furnished'' after the word
``services'' the second place it appears. As written, a group health
plan could pay one dollar more than the Medicare rate, but less than
the rate it pays for non-Medicare enrollees, and not be in violation of
this paragraph. Paragraph (8) presents an example as the rule, when it
should simply state that where the group health plan pays less for the
same services for a Medicare beneficiary than for others, the group
health plan has taken Medicare entitlement into account. (See
Sec. 411.161(b)(2)(iv).)
Also in the text, we are making a conforming change in the second
sentence of Secs. 411.163 (b)(2) and (b)(3) on page 45369 by removing
the word ``If'' and adding the words ``Except as provided in paragraph
(b)(4) of this section, if'' so that paragraphs (2) and (3) cannot be
misconstrued to conflict with paragraph (4).
Finally in the text, we are making a change in the first sentence
of Sec. 411.172(b) to conform this section to Sec. 411.170(a)(2) and
the statutory provisions of section 1862(b) by adding ``and of
subparagraph (iii) of Sec. 411.170(a)(2)'' after the word ``section''.
List of Subjects in 42 CFR Part 411
Exclusions from Medicare, Limitations on Medicare payments,
Medicare, Recovery against third parties, Reporting and recordkeeping
requirements.
PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE
PAYMENT
42 CFR Part 411 is corrected by making the following correcting
amendments:
1. The authority citation for Part 411 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Sec. 411.108 [Corrected]
2. In Sec. 411.108, paragraph (a)(8) is revised to read as follows:
(a) Examples of actions that constitute ``taking into account''. *
* *
(8) Paying providers and suppliers less for services furnished to a
Medicare beneficiary than for the same services furnished to an
enrollee who is not entitled to Medicare.
* * * * *
Sec. 411.163 [Corrected]
3. In Sec. 411.163, paragraphs (b)(2) and (b)(3) are revised to
read as follows:
* * * * *
(b) * * *
(2) First month of ESRD-based eligibility or entitlement and first
month
[[Page 53877]]
of dual eligibility/entitlement after February 1992 and before August
10, 1993. Except as provided in paragraph (b)(4) of this section, if
the first month of ESRD-based eligibility or entitlement and first
month of dual eligibility/entitlement were after February 1992 and
before August 10, 1993, Medicare--
(i) Is primary payer from the first month of dual eligibility/
entitlement through August 9, 1993;
(ii) Is secondary payer from August 10, 1993, through the 18th
month of ESRD-based eligibility or entitlement; and
(iii) Again becomes primary payer after the 18th month of ESRD-
based eligibility or entitlement.
(3) First month of ESRD-based eligibility or entitlement after
February 1992 and first month of dual eligibility/entitlement after
August 9, 1993. Except as provided in paragraph (b)(4) of this section,
if the first month of ESRD-based eligibility or entitlement is after
February 1992, and the first month of dual eligibility/entitlement is
after August 9, 1993, the rules of Sec. 411.162(b) and (c) apply; that
is, Medicare--
(i) Is secondary payer during the first 18 months of ESRD-based
eligibility or entitlement; and
(ii) Becomes primary after the 18th month of ESRD-based eligibility
or entitlement.
* * * * *
Sec. 411.172 [Corrected]
4. In Sec. 411.172, paragraph (b) is revised to read as follows:
* * * * *
(b) Special rule for multi-employer plans. The requirements and
limitations of paragraph (a) of this section and of (a)(2)(iii) of
Sec. 411.170 do not apply with respect to individuals enrolled in a
multi-employer plan if--
(1) The individuals are covered by virtue of current employment
status with an employer that has fewer than 20 employees; and
(2) The plan requests an exception and identifies the individuals
for whom it requests the exception as meeting the conditions specified
in paragraph (b)(1) of this section.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: October 13, 1995.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 95-25840 Filed 10-17-95; 8:45 am]
BILLING CODE 4120-01-P
