[Federal Register Volume 62, Number 1 (Thursday, January 2, 1997)]
[Rules and Regulations]
[Pages 26-31]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-33093]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 413
[BPD-788-F]
RIN 0938-AH12
Medicare Program; Electronic Cost Reporting for Skilled Nursing
Facilities and Home Health Agencies
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule adds the requirement that, for cost reporting
periods ending on or after February 1, 1997, most skilled nursing
facilities and home health agencies must submit cost reports currently
required under the Medicare regulations in a standardized electronic
format. This rule also allows a delay or waiver of this requirement
where implementation would result in financial hardship for a provider.
The provisions of this rule allow for more accurate preparation and
more efficient processing of cost reports.
DATES: This final rule is effective February 1, 1997. This rule is
applicable for cost reporting periods ending on or after February 1,
1997.
FOR FURTHER INFORMATION CONTACT: Tom Talbott, (410) 786-4592.
SUPPLEMENTARY INFORMATION:
I. Background
Generally, under the Medicare program, skilled nursing facilities
(SNFs) and home health agencies (HHAs) are paid for the reasonable
costs of the covered items and services they furnish to Medicare
beneficiaries. Sections 1815(a) and 1833(e) of the Social Security Act
(the Act) provide that no payments will be made to a provider unless it
has furnished the
[[Page 27]]
information, requested by the Secretary, needed to determine the amount
of payments due the provider. In general, providers submit this
information through cost reports that cover a 12-month period. Rules
governing the submission of cost reports are set forth in Federal
regulations at 42 CFR 413.20 and 42 CFR 413.24.
Under Sec. 413.20(a), all providers participating in the Medicare
program are required to maintain sufficient financial records and
statistical data for proper determination of costs payable under the
program. In addition, providers must use standardized definitions and
follow accounting, statistical, and reporting practices that are widely
accepted in the health care industry and related fields. Under
Secs. 413.20(b) and 413.24(f), providers are required to submit cost
reports annually, with the reporting period based on the provider's
accounting year. Additionally, under Sec. 412.52, all hospitals
participating in the prospective payment system must meet cost
reporting requirements set forth at Secs. 413.20 and 413.24.
Section 1886(f)(1)(B)(i) of the Act required the Secretary to place
into effect a standardized electronic cost reporting system for all
hospitals participating in the Medicare program. This provision was
effective for hospital cost reporting periods beginning on or after
October 1, 1989. On May 25, 1994, we published a final rule with
comment period in the Federal Register implementing the electronic cost
reporting requirement for hospitals (59 FR 26960). On June 27, 1995, we
published a final rule that responded to comments on the May 25, 1994
final rule with comment period (60 FR 33123).
II. Provisions of the Proposed Regulations
On December 5, 1995, we published a proposed rule in the Federal
Register (60 FR 62237) that proposed to require SNFs and HHAs to submit
cost reports in a standardized electronic format for cost reporting
periods beginning on or after October 1, 1995. We also proposed that if
a SNF or HHA believes that implementation of the electronic submission
requirement would cause a financial hardship, it may submit a written
request for a waiver or a delay of these requirements.
We stated that we essentially would apply the current hospital
electronic cost reporting requirements to SNFs and HHAs. Hospitals
participating in Medicare must submit cost reports in a uniform
electronic format for cost reporting periods beginning on or after
October 1, 1989. These hospital cost reports must be electronically
transmitted to the intermediary in American Standard Code for
Information Interchange (ASCII) format. In addition to the electronic
file, hospitals were initially required to submit a hard copy of the
full cost report, which was later changed to a hard copy of a one-page
settlement summary, a statement of certain worksheet totals found in
the electronic file, and a statement signed by the hospital's
administrator or chief financial officer certifying the accuracy of the
electronic file (Sec. 413.24(f)(4)(iii)). Further, to preserve the
integrity of the electronic file, we specified procedures regarding the
processing of the electronic cost report once it is submitted to the
intermediary. In addition, the provider's electronic program must be
able to disclose that changes have been made to the provider's as-filed
cost report. We proposed to apply these same hospital electronic cost
reporting requirements to SNFs and HHAs.
In the proposed rule, we discussed in detail the benefits of
requiring electronic cost reports for SNFs and HHAs. The use of
electronically prepared cost reports will be beneficial for SNFs and
HHAs because the cost reporting software for these reports will
virtually eliminate computational errors and substantially reduce
preparation time. The use of cost reporting software will also save
time when the provider discovers that it needs to change individual
entries in the cost report.
III. Discussion of Public Comments
We received six timely comments in response to the proposed rule.
The majority of the commenters supported our proposal but had some
questions and concerns regarding its implementation. A summary of these
comments and our responses follow:
Waivers and Exclusions
Comment. Several commenters requested clarification of the
requirement for granting a waiver of electronic filing due to financial
hardship. While some commenters suggested that we develop a defined set
of criteria for determining when the requirement for electronic filing
would impose a financial hardship on a provider, others supported our
proposal of a case-by-case review of waiver requests. One commenter
suggested that, in addition to financial hardship, waivers should be
automatically granted for providers with low Medicare utilization.
Commenters supporting case-by-case review advised us to remain
flexible in making determinations of financial hardship until we have
the experience and data to determine whether set criteria are
necessary. Another commenter supporting our proposal noted that most
providers have, or have access to, a computer and recommended that as
part of a waiver request, a provider should be required to include a
statement certifying that it does not own, rent, or have access to a
computer.
Commenters opposing case-by-case review were concerned that, based
on hospitals' experiences with electronic filing, few waivers would be
granted. These commenters asserted that it would be best to establish
specific criteria for the waiver process.
Response. We do not believe that the development of specific
criteria for waiver requests is appropriate. For example, a
characteristic such as a provider's size alone may not necessarily be a
reliable indicator that electronic cost reporting would impose a
financial hardship since even the smallest SNFs and HHAs are quite
likely to already be using computer equipment. Thus, we believe that an
individualized review of each waiver request based on the totality of
the provider's financial situation would be the most effective method
for making determinations. Factors that we may consider in determining
whether to grant a waiver include whether the provider has access to a
computer, the provider's size, level of Medicare utilization, and
financial status.
Regarding the commenters concern that, like hospitals, few waivers
will be granted for SNFs and HHAs, we wish to point out that the small
number of electronic reporting waivers granted to hospitals is
attributed to the small number of hospitals that have requested them.
We have received only 10 waiver electronic reporting requests from
hospitals (of approximately 7,000 hospitals required to file
electronically) since we implemented electronic reporting. All 10
hospitals have been granted waivers. We note that hospitals must
request the waiver every year. We anticipate receiving numerous
requests from SNFs and HHAs. There are large differences in the
financial structure between hospitals and long-term care providers.
Hospitals provide many services that are not provided by SNFs and HHAs.
Additionally, virtually all hospitals have, or have access to, computer
equipment, which may or may not be the case for SNFs and HHAs. As we
did with hospitals, we anticipate granting hardship waivers for
providers with low Medicare utilization and
[[Page 28]]
providers with reimbursement systems that would be too costly to
program (for example, all inclusive rate providers who are not required
to file electronically). Each waiver request will be handled on a case-
by-case basis and waivers will be granted when a provider has
documented appropriately its financial hardship.
We note that if a provider subject to the requirements and not
granted a hardship exemption does not submit its cost report
electronically, Medicare payments to that provider may be suspended
under the provisions of sections 1815(a) and 1833(e) of the Act. These
sections of the Act provide that no Medicare payments will be made to a
provider unless it has furnished the information, requested by the
Secretary, that is needed to determine the amount of payments due the
provider under the Medicare program. Section 405.371(d) provides for
suspension of Medicare payments to a provider by the intermediary if
the provider fails to submit information requested by the intermediary
that is needed to determine the amount due the provider under the
Medicare program. The general procedures that are followed when
Medicare payment to a provider is suspended for failure to submit
information needed by the intermediary to determine Medicare payment
are located in section 2231 of the Medicare Intermediary Manual (HCFA
Pub. 13). Those procedures include timeframes for ``demand letters'' to
providers. Demand letters remind providers to file timely and complete
cost reports and explain possible adjustments of Medicare payments to a
provider and the right to request a 30-day extension of the due date.
Comment. One commenter suggested that, to avoid unnecessary
administrative costs and delays, the fiscal intermediary instead of
HCFA should have responsibility for granting waiver requests.
Response. We believe that our process for making waiver
determinations is the most efficient and will allow each provider
seeking a waiver to receive an individualized review of its request. As
explained later, we have extended the deadline for filing waiver
requests. The revised process specifies that the waiver request,
including supporting documentation, must be submitted to a provider's
intermediary no later than 30 days after the end of the provider's cost
reporting period. The intermediary will review the request and forward
it, with a recommendation for approval or denial, to the HCFA central
office within 30 days of its receipt of the request. HCFA central
office will either approve or deny the request by response to the
intermediary within 60 days of receipt of the request from the
intermediary.
Comment. Some commenters expressed concern with the proposed
deadline for filing waiver requests of 120 days before the end of the
provider's cost reporting period. One commenter noted that the deadline
should not be set before the end of the reporting period because the
level of Medicare utilization can vary from month to month. Another
commenter suggested that the time limits be modified to be more
accommodating until HCFA has further experience with the impact of
electronic cost reporting on SNFs and HHAs.
Response. We have reconsidered our proposed policy in light of
these comments and the fact that we have decided to extend the due date
for filing electronic cost reports in this final rule (as discussed
under the section on ``Implementation Date''). We agree with the
commenters that it is appropriate to allow providers a longer time
period within which to submit waiver requests. We have revised
Sec. 413.24(f)(4)(v) to provide that a provider may submit a written
request for delay or waiver with necessary supporting documentation to
its intermediary no later than 30 days after the end of its cost
reporting period.
Comment. One commenter suggested that in lieu of a waiver, we
should allow the hardware and software costs as ``below the line'' cost
expenses by modifying the Medicare cost report to allow the provider to
enter the software costs directly into reimbursable costs and to treat
the hardware similarly, as a capital expense.
Response. The use of electronic cost reporting software and the
costs associated with it is similar to a provider hiring an accounting
firm to complete its cost report. We do not make separate payments for
these types of costs; rather we include the costs as administrative and
general costs. Similarly, for those providers that have to purchase
computer equipment, in accordance with existing regulations governing
payment of provider costs, Medicare will pay for the cost of the
equipment as an overhead cost.
Comment. One commenter inquired about the effect of the rule on
hospital-based HHAs. The commenter asked if hospital-based facilities
will be required to submit a separate cost report. Another commenter
requested clarification as to whether providers under the prospective
payment system would be required to file electronically. Specifically,
the commenter asked that we clarify our statement in the proposed rule
that a SNF that furnishes fewer than 1,500 Medicare covered days in a
cost reporting period would not be subject to the electronic cost
reporting requirement (60 FR 62238).
Response. The electronic cost reporting provision will only apply
to those providers that are required to file a full Medicare cost
report. Providers that are required to file less than a full cost
report (that is, low or no Medicare utilization) will not file
electronically but will be required to request a waiver of the
requirement to file electronically. Hospital-based SNFs and HHAs file
electronically through the hospital, would continue to do so, and would
not file separately as a result of this regulation. We did not intend
to exclude SNFs that are paid prospectively and that file their cost
reports on Form 2540S. While Sec. 413.321 defines the Form 2540S as a
simplified cost reporting form, the form does not meet the definition
of a less than full cost report as discussed above. Absent a waiver,
these SNFs will be required to file their cost reports electronically.
Software will be available from HCFA and from commercial vendors that
meet the requirements for electronic filing.
Implementation Date
Comment. Commenters were concerned that the proposed implementation
date for filing electronic cost reports beginning on or after October
1, 1995, was too aggressive and would not allow sufficient time for
providers with short period cost reports to file electronically.
Response. We agree that the proposed implementation date should be
revised. The new effective date will be timed to coincide with the
completion of the installment of and training on the free software and
electronic specifications.__ We anticipate that the software will be
ready for distribution in time for providers to become accustomed to
using it before they submit their cost reports for cost reporting
periods ending on or after February 1, 1997. Thus, we are revising the
implementation date to require SNFs and HHAs to begin filing their cost
reports electronically for cost reporting periods ending on or after
February 1, 1997. We believe that this revised implementation date will
avoid prolonged extensions for short period cost reports. We also
believe that providers with cost reporting periods ending on February
1, 1997 (and who thus must file their cost reports by June 30, 1997),
will have ample time to do what is needed to file an electronic cost
report by June 30, 1997.
[[Page 29]]
Cost Reporting Software
Comment. One commenter inquired about how providers will be paid
for the cost of the electronic cost reporting software. Other
commenters questioned the adequacy of the software offered by HCFA and
its efficiency in performing electronic filing. These commenters'
concerns were based on the difficulties experienced by hospitals in
using the cost reporting software provided by HCFA. Another commenter
suggested that the software be available at least 6 months before the
implementation date for electronic filing to allow providers time to
install the software and train staff. Additionally, one commenter
advised that free software should be available for SNFs under the
prospective payment system. Finally, commenters suggested that we
develop software for billing and for the Provider Cost Report
Reimbursement Questionnaire (Form 339).
Response. HCFA will provide software, free of charge, to any
provider that requests it. Alternatively, providers may purchase the
software from any HCFA-approved software vendor. To obtain the free
software, providers may contact their intermediaries or send a written
request to the following address: Health Care Financing Administration,
Division of Cost Principles and Reporting, Room C5-02-23, Central
Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. We note
that, as with the cost of computer equipment, Medicare will pay for the
cost of the software as an overhead cost through the cost report based
on Medicare utilization.
Regarding commenters' concerns about the adequacy of the cost
reporting software, we note that while there were some difficulties
with application of the free software for hospitals, the hospital cost
report is extremely complex and requires extensive reporting for a
number of Medicare services that are not provided by SNFs and HHAs.
Thus, we do not anticipate having similar types of problems with cost
reporting software for SNFs and HHAs because these providers generally
file less complicated cost reports. The free software will not be
developed to compete with commercial software packages. Rather, the
software offered by HCFA will enable a provider with access to a
computer to meet the requirements by filing an electronic data set to
the fiscal intermediary in order to generate a cost report. We expect
that the software will be a series of input screens that are designed
to assimilate the cost reporting forms. Once the prescribed data are
entered, these same data can be forwarded to the intermediary to
produce a completed cost report. As stated above, we anticipate that
the software will be ready for distribution in time to allow providers
to install the software and train staff.
While we do not currently require that providers submit bills in an
electronic format, we strongly encourage electronic billing. We note
that fiscal intermediaries can accept electronic bills prepared with
commercially available software that meets Medicare specifications.
Fiscal intermediaries also provide free software for submission of
Medicare billing data. Providers should contact their intermediary's
electronic billing department for information about this software.
Additionally, we are currently in the process of developing a software
package for the Form 339.
Audit Adjustments
Comment. One commenter questioned the provision in proposed
Sec. 413.24(f)(4)(iii), which requires that the fiscal intermediary
must return the as-filed cost report to the provider for correction if
it does not pass all specified edits. The commenter believed that
requiring intermediaries to send rejected cost reports back to the
provider would impose a burden because the provider would have to do a
complete review of the cost report in order to identify and correct the
error. The commenter suggested that we allow the intermediary
discretion in determining whether to send a cost report back to the
provider.
Response. This section provides that the intermediary must reject a
cost report that does not pass all specified edits. This provision is
not intended to prohibit the intermediary from making audit adjustments
to the provider's cost report. Rather, an intermediary must reject a
cost report that fails a ``level one'' edit (for example, when the
settlement amount on the hard copy cost report and the amount contained
in the electronic file are different). Cost reports that fail level one
edits result in incorrect settlement data that cannot be corrected by
the intermediary for legal reasons. The cost report is the submission
of the provider and must maintain its originality throughout the cost
report settlement process.
Comment. One commenter recommended that intermediaries not require
providers to submit more than one hard copy of the cost report in
addition to the electronic file.
Response. During a transition period, we will require providers to
submit a hard copy of the completed full cost report forms in addition
to the electronic file (as we did for hospitals). Requiring a hard copy
will allow the provider and the intermediary to compare data on the
hard copy cost report to data in the electronic file to ensure accuracy
and proper programming. Once providers and intermediaries become
accustomed to the use of the electronic cost reporting software, we
will no longer require that a hard copy of the full cost report be
filed. After the transition period, SNFs and HHAs subject to the
electronic reporting requirement will be required to file a hard copy
of the one-page settlement sheet, a statement of certain worksheet
totals found in the electronic file, and a statement signed by their
administrator or chief financial officer certifying the accuracy of the
electronic file.
IV. Provisions of the Final Rule
In this final rule we are adopting the provisions as proposed with
three revisions. Specifically, in response to a public comment, we are
revising Sec. 413.24(f)(4) (ii) and (iv) to change the implementation
date. These sections now provide that, effective for cost reporting
periods beginning on or after February 1, 1997, SNFs and HHAs must
submit cost reports in a standardized electronic format. Additionally,
we are revising Sec. 413.24(f)(4)(v) to clarify that providers with low
or no Medicare utilization may request a waiver of electronic cost
reporting. We are making another revision to Sec. 413.24(f)(4)(v) to
specify that a provider may submit a written request for a delay or a
waiver with necessary supporting documentation to its intermediary no
later than 30 days after the end of its cost reporting period.
V. Impact Statement
We generally prepare a regulatory flexibility analysis that is
consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601
through 612) unless we certify that a final rule such as this will not
have a significant economic impact on a substantial number of small
entities. For purposes of the RFA, all providers and small businesses
that distribute cost-report software to providers are considered small
entities. HCFA's intermediaries are not considered small entities for
purposes of the RFA.
In addition, section 1102(b) of the Social Security Act requires us
to prepare a regulatory impact analysis for any final rule that may
have a significant impact on the operation of a substantial number of
small rural hospitals. Such an analysis must conform to the provisions
of section 604
[[Page 30]]
of the RFA. For purposes of section 1102(b) of the Act, we define a
small rural hospital as a hospital that is located outside of a
Metropolitan Statistical Area and has fewer than 50 beds. We are not
preparing a rural impact statement since we have determined, and
certify, that this final rule will not have a significant impact on the
operations of a substantial number of small rural hospitals.
As stated above, under Secs. 413.20(b) and 413.24(f), providers are
required to submit cost reports annually, with reporting periods based
on the provider's accounting year. This final rule will require SNFs
and HHAs, like hospitals, to submit their Medicare cost reports in a
standardized electronic format. We anticipate that this requirement
will take effect for cost reporting periods ending on or after February
1, 1997, meaning that the first electronic cost reports will be due
June 30, 1997.
Currently, approximately 75 percent of all SNFs and HHAs submit a
hard copy of an electronically prepared cost report to the
intermediary. We believe that the provisions of this final rule will
have little or no effect on these providers, except to reduce the time
involved in copying and collating a hard copy of the report for
intermediaries. In addition to the 75 percent of providers that
currently use electronic cost reporting, this rule will not affect
those providers that do not file a full cost report and, as stated
above, will not be required to submit cost reports electronically.
This final rule may have an impact on those providers who do not
prepare electronic cost reports, some of whom may have to purchase
computer equipment, obtain the necessary software, and train staff to
use the software. However, as discussed below, we believe that the
potential impact of this final rule on those providers who do not
prepare electronic cost reports will be insignificant.
First, a small number of providers that do not submit electronic
cost reports may have to purchase computer equipment to comply with the
provisions of this final rule. However, even among the 25 percent of
SNFs and HHAs that do not submit electronically prepared cost reports,
we believe that most providers already have access to computer
equipment, which they are now using for internal record keeping
purposes, as well as for submitting electronically generated bills to
their fiscal intermediaries, for example. Thus, we do not believe that
obtaining computer equipment will be a major obstacle to electronic
cost reporting for most providers. For those providers that will have
to purchase computer equipment, we note that, in accordance with
current regulations governing payment of provider costs, Medicare will
pay for the cost of the equipment as an overhead cost.
We recognize that a potential cost for providers that do not submit
electronic cost reports will be that of training staff to use the
software. Since most SNFs and HHAs currently use computers, we do not
believe that training staff to use the new software will impose a large
burden on providers. An additional cost will be the cost of the
software offered by commercial vendors. However, providers could
eliminate this cost by obtaining the free software from HCFA.
The requirement that hospitals submit cost reports in a
standardized electronic format has been in place since October 1989.
Since that time, the accuracy of cost reports has increased and we have
received very few requests for waivers. Additionally, we have not
received any comments from the hospital industry indicating that the
use of electronic cost reporting is overly burdensome. We believe that
electronic cost reporting will be equally effective for SNFs and HHAs,
with the benefits (such as increased accuracy and decreased preparation
time) outweighing the costs of implementation for most providers.
In conclusion, we have determined that this final rule will not
have a significant effect on SNF and HHA costs because these providers
will not be required to collect any additional data beyond that which
the regulations currently specify; cost reporting software is available
at no cost from HCFA to any provider that requests it; most SNFs and
HHAs have some type of computer equipment through which they currently
prepare electronic cost reports; and a waiver of the electronic cost
reporting requirement will be available to providers for whom the
requirement will impose a financial hardship. We note that, as with the
cost of computer equipment, Medicare will pay for the cost of the
software as an overhead cost through the cost report based on Medicare
utilization. Therefore, SNFs and HHAs will only be affected to the
extent that, absent a waiver, they will be required to submit cost
reports in a standardized electronic format to their intermediary. A
provider that does not comply with the provisions of this rule, as
specified in the preamble, will be subject to sections 1815(a) and
1833(e) of the Act, which provide that no payments will be made to a
provider unless it has furnished the information requested by the
Secretary that is needed to determine the amount of payments due the
provider under Medicare.
In accordance with the provisions of Executive Order 12866, this
regulation was not reviewed by the Office of Management and Budget
(OMB).
VI. Collection of Information Requirements
The overall information collection and recordkeeping requirements
associated with filing HHA costs reports (HCFA Form 1728) have been
approved by OMB through October 1997 (OMB approval number 0938-0022).
Additionally, OMB has approved the overall information collection and
record keeping requirement associated with filing SNF costs reports
(HCFA Form 2540) through May 1999 (OMB approval number 0938-0463).
This final rule does not require SNFs and HHAs to report any
information on the electronic cost report that is not already required
in the Medicare cost reports currently submitted by these providers.
Although this regulation does not impose any new information collection
requirements per se, the new electronic format requires HCFA to
resubmit the information collection requirements to OMB for approval.
We estimate that the number of hours each provider will save by
submitting an electronically prepared cost report instead of manually
preparing and photocopying the cost report will be about 4.5 hours for
each affected HHA and 9 hours for each affected SNF. Assuming that
approximately 25 percent of all SNFs and HHAs will be affected, that
is, roughly 3,000 SNFs and 2,000 HHAs, we estimate that SNFs will save
approximately 27,000 hours per year completing cost reports and HHAs
will save about 9,000 hours per year.
This final rule does not need to be reviewed by OMB under the
Paperwork Reduction Act of 1995.
List of Subjects in 42 CFR Part 413
Health facilities, Kidney diseases, Medicare, Puerto Rico,
Reporting and recordkeeping requirements.
42 CFR part 413 is amended as set forth below:
PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED
PAYMENT RATES FOR SKILLED NURSING FACILITIES
1. The authority citation for part 413 continues to read as
follows:
[[Page 31]]
Authority: Secs. 1102, 1861(v)(1)(A), and 1871 of the Social
Security Act (42 U.S.C. 1302, 1395x(v)(1)(A), and 1395hh).
2. Section 413.1 is amended by redesignating paragraphs (a)(1)(ii)
(C) through (J) as paragraphs (a)(1)(ii) (D) through (K), respectively,
and adding a new paragraph (a)(1)(ii)(C) to read as follows:
Sec. 413.1 Introduction.
(a) Basis, scope, and applicability.
(1) Statutory basis. * * *
(ii) Additional requirements. * * *
(C) Sections 1815(a) and 1833(e) of the Act provide the Secretary
with authority to request information from providers to determine the
amount of Medicare payment due providers.
* * * * *
3. Section 413.24 is amended by redesignating existing paragraphs
(f)(4)(i) through (f)(4)(iv) as paragraphs (f)(4)(ii) through
(f)(4)(v); adding a new paragraph (f)(4)(i); and revising redesignated
paragraphs (f)(4)(ii) through (f)(4)(v) to read as follows:
Sec. 413.24 Adequate cost data and cost finding.
* * * * *
(f) Cost reports. * * *
(4) Electronic submission of cost reports. (i) As used in this
paragraph, ``provider'' means a hospital, skilled nursing facility, or
home health agency.
(ii) Effective for cost reporting periods beginning on or after
October 1, 1989, for hospitals, and cost reporting periods ending on or
after February 1, 1997, for skilled nursing facilities and home health
agencies, a provider is required to submit cost reports in a
standardized electronic format. The provider's electronic program must
be capable of producing the HCFA standardized output file in a form
that can be read by the fiscal intermediary's automated system. This
electronic file, which must contain the input data required to complete
the cost report and the data required to pass specified edits, is
forwarded to the fiscal intermediary for processing through its system.
(iii) The fiscal intermediary stores the provider's as-filed
electronic cost report and may not alter that file for any reason. The
fiscal intermediary makes a ``working copy'' of the as-filed electronic
cost report to be used, as necessary, throughout the settlement process
(that is, desk review, processing audit adjustments, final settlement,
etc). The provider's electronic program must be able to disclose if any
changes have been made to the as-filed electronic cost report after
acceptance by the intermediary. If the as-filed electronic cost report
does not pass all specified edits, the fiscal intermediary rejects the
cost report and returns it to the provider for correction. For purposes
of the requirements in paragraph (f)(2) of this section concerning due
dates, an electronic cost report is not considered to be filed until it
is accepted by the intermediary.
(iv) Effective for cost reporting periods ending on or after
September 30, 1994, for hospitals, and cost reporting periods ending on
or after, February 1, 1997, for skilled nursing facilities and home
health agencies, a provider must submit a hard copy of a settlement
summary, a statement of certain worksheet totals found within the
electronic file, and a statement signed by its administrator or chief
financial officer certifying the accuracy of the electronic file or the
manually prepared cost report. During a transition period, skilled
nursing facilities and home health agencies must submit a hard copy of
the completed cost report forms in addition to the electronic file. The
following statement must immediately precede the dated signature of the
provider's administrator or chief financial officer:
I hereby certify that I have read the above certification
statement and that I have examined the accompanying electronically
filed or manually submitted cost report and the Balance Sheet
Statement of Revenue and Expenses prepared by ________ (Provider
Name(s) and Number(s)) for the cost reporting period beginning
________ and ending ________ and that to the best of my knowledge
and belief, this report and statement are true, correct, complete
and prepared from the books and records of the provider in
accordance with applicable instructions, except as noted. I further
certify that I am familiar with the laws and regulations regarding
the provision of health care services, and that the services
identified in this cost report were provided in compliance with such
laws and regulations.
(v) A provider may request a delay or waiver of the electronic
submission requirement in paragraph (f)(4)(ii) of this section if this
requirement would cause a financial hardship or if the provider
qualifies as a low or no Medicare utilization provider. The provider
must submit a written request for delay or waiver with necessary
supporting documentation to its intermediary no later than 30 days
after the end of its cost reporting period. The intermediary reviews
the request and forwards it, with a recommendation for approval or
denial, to HCFA central office within 30 days of receipt of the
request. HCFA central office either approves or denies the request and
notifies the intermediary within 60 days of receipt of the request.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: September 27, 1996.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 96-33093 Filed 12-31-96; 8:45 am]
BILLING CODE 4120-01-P
