[Federal Register Volume 60, Number 1 (Tuesday, January 3, 1995)]
[Notices]
[Pages 132-141]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-32295]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[BPO-129-N]
Medicare and Medicaid Programs; Quarterly Listing of Program
Issuances and Coverage Decisions--Third Quarter 1994
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice.
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SUMMARY: This notice lists HCFA manual instructions, substantive and
interpretive regulations and other Federal Register notices, and
statements of policy that were published during July, August, and
September of 1994 that relate to the Medicare and Medicaid programs.
Section 1871(c) of the Social Security Act requires that we publish a
list of Medicare issuances in the Federal Register at least every 3
months. Although we are not mandated to do so by statute, for the sake
of completeness of the listing, we are including all Medicaid issuances
and Medicare and Medicaid substantive and interpretive regulations
(proposed and final) published during this timeframe.
We are also providing the content of revisions to the Medicare
Coverage Issues Manual published between July 1 and September 30, 1994.
On August 21, 1989, we published the content of the Manual (54 FR
34555) and indicated that we will publish quarterly any updates. Adding
to this listing the complete text of the changes to the Medicare
Coverage Issues Manual allows us to fulfill this requirement in a
manner that facilitates identification of coverage and other changes in
our manuals.
FOR FURTHER INFORMATION CONTACT:
Margaret Cotton, (410) 966-5255 (For Medicare instruction information)
Walter Rutemueller, (410) 966-5395 (For Medicare coverage information)
Pat Prete, (410) 966-3246 (For Medicaid instruction information)
Michael Robinson, (410) 966-5633 (For all other information)
SUPPLEMENTARY INFORMATION:
I. Program Issuances
The Health Care Financing Administration (HCFA) is responsible for
administering the Medicare and Medicaid programs, which pay for health
care and related services for 36 million Medicare beneficiaries and 33
million Medicaid recipients. Administration of these programs involves
(1) Providing information to Medicare beneficiaries and Medicaid
recipients, health care providers, and the public; and (2) effective
communications with regional offices, State governments, State Medicaid
Agencies, State Survey Agencies, various providers of health care,
fiscal intermediaries and carriers who process claims and pay bills,
and others. To implement the various statutes on which the programs are
based, we issue regulations under authority granted the Secretary under
sections 1102, l871, and 1902 and related provisions of the Social
Security Act (the Act) and also issue various manuals, memoranda, and
statements necessary to administer the programs efficiently.
Section 1871(c)(1) of the Act requires that we publish in the
Federal Register at least every 3 months a list of all Medicare manual
instructions, interpretive rules, statements of policy, and guidelines
of general applicability not issued as regulations. We published our
first notice June 9, 1988 (53 FR 21730). Although we are not mandated
to do so by statute, for the sake of completeness of the listing of
operational and policy statements, we are continuing our practice of
including Medicare substantive and interpretive regulations (proposed
and final) published during the 3-month timeframe. Since the
publication of our [[Page 133]] quarterly listing on June 12, 1992 (57
FR 24797), we decided to add Medicaid issuances to our quarterly
listings. Accordingly, we are listing in this notice Medicaid issuances
and Medicaid substantive and interpretive regulations published from
July 1 through September 30, 1994.
II. Medicare Coverage Issues
We receive numerous inquiries from the general public about whether
specific items or services are covered under Medicare. Providers,
carriers, and intermediaries have copies of the Medicare Coverage
Issues Manual, which identifies those medical items, services,
technologies, or treatment procedures that can be paid for under
Medicare. On August 21, 1989, we published a notice in the Federal
Register (54 FR 34555) that contained all the Medicare coverage
decisions issued in that manual.
In that notice, we indicated that revisions to the Coverage Issues
Manual will be published at least quarterly in the Federal Register. We
also sometimes issue proposed or final national coverage decision
changes in separate Federal Register notices. Readers should find this
an easy way to identify both issuance changes to all our manuals and
the text of changes to the Coverage Issues Manual.
Revisions to the Coverage Issues Manual are not published on a
regular basis but on an as-needed basis. We publish revisions as a
result of technological changes, medical practice changes, responses to
inquiries we receive seeking clarifications, or the resolution of
coverage issues under Medicare. If no Coverage Issues Manual revisions
were published during a particular quarter, our listing will reflect
that fact.
Not all revisions to the Coverage Issues Manual contain major
changes. As with any instruction, sometimes minor clarifications or
revisions are made within the text. We have reprinted manual revisions
as transmitted to manual holders. The new text is shown in italics. We
will not reprint the table of contents, since the table of contents
serves primarily as a finding aid for the user of the manual and does
not identify items as covered or not.
III. How to Use the Addenda
This notice is organized so that a reader may review the subjects
of all manual issuances, memoranda, substantive and interpretive
regulations, or coverage decisions published during the timeframe to
determine whether any are of particular interest. We expect it to be
used in concert with previously published notices. Most notably, those
unfamiliar with a description of our Medicare manuals may wish to
review Table I of our first three notices (53 FR 21730, 53 FR 36891,
and 53 FR 50577) and the notice published March 31, 1993 (58 FR 16837),
and those desiring information on the Medicare Coverage Issues Manual
may wish to review the August 21, 1989, publication (54 FR 34555).
To aid the reader, we have organized and divided this current
listing into five addenda. Addendum I identifies updates that changed
the Coverage Issues Manual. We published notices in the Federal
Register that included the text of changes to the Coverage Issues
Manual. These updates, when added to material from the manual published
on August 21, 1989, constitute a complete manual as of September 30,
1994. Parties interested in obtaining a copy of the manual and
revisions should follow the instructions in section IV of this notice.
Addendum II identifies previous Federal Register documents that
contain a description of all previously published HCFA Medicare and
Medicaid manuals and memoranda.
Addendum III of this notice lists, for each of our manuals or
Program Memoranda, a HCFA transmittal number unique to that instruction
and its subject matter. A transmittal may consist of a single
instruction or many. Often it is necessary to use information in a
transmittal in conjunction with information currently in the manuals.
Addendum IV lists all substantive and interpretive Medicare and
Medicaid regulations and general notices published in the Federal
Register during the quarter covered by this notice. For each item, we
list the date published, the Federal Register citation, the title of
the regulation, the Parts of the Code of Federal Regulations (CFR)
which have changed (if applicable), the agency file code number, the
ending date of the comment period (if applicable), and the effective
date (if applicable).
Addendum V sets forth the revisions to the Medicare Coverage Issues
Manual that were published during the quarter covered by this notice.
For the revisions, we give a brief synopsis of the revisions as they
appear on the transmittal sheet, the manual section number, and the
title of the section. We present a complete copy of the revised
material, no matter how minor the revision, and identify the revisions
by printing in italics the text that was changed. If the transmittal
includes material unrelated to the revised section, for example, when
the addition of revised material causes other sections to be
repaginated, we do not reprint the unrelated material.
IV. How to Obtain Listed Material
A. Manuals
An individual or organization interested in routinely receiving any
manual and revisions to it may purchase a subscription to that manual.
Those wishing to subscribe should contact either the Government
Printing Office (GPO) or the National Technical Information Service
(NTIS) at the following addresses:
Superintendent of Documents, U.S. Government Printing Office, Attn: New
Order, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 783-
3238, Fax number (202) 512-2250 (for credit card orders); or
National Technical Information Service, Department of Commerce, 5825
Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.
In addition, individual manual transmittals and Program Memoranda
listed in this notice can be purchased from NTIS. Interested parties
should identify the transmittal(s) they want. GPO or NTIS can give
complete details on how to obtain the publications they sell.
B. Regulations and Notices
Regulations and notices are published in the daily Federal
Register. Interested individuals may purchase individual copies or
subscribe to the Federal Register by contacting the GPO at the address
indicated above. When ordering individual copies, it is necessary to
cite either the date of publication or the volume number and page
number.
C. Rulings
Rulings are published on an infrequent basis by HCFA. Interested
individuals can obtain copies from the nearest HCFA Regional Office or
review them at the nearest regional depository library. We also
sometimes publish Rulings in the Federal Register.
D. HCFA's Compact Disk-Read Only Memory (CD-ROM)
HCFA's laws, regulations, and manuals are now available on CD-ROM,
which may be purchased from GPO or NTIS on a subscription or single
copy basis. The Superintendent of Documents list ID is HCLRM, and the
stock number is 717-139-00000-3. The following material is contained on
the CD-ROM disk:
Titles XI, XVIII, and XIX of the Act.
HCFA-related regulations.
HCFA manuals and monthly revisions. [[Page 134]]
HCFA program memoranda.
The titles of the Compilation of the Social Security Laws are current
as of January 1, 1993. The remaining portions of CD-ROM are updated on
a monthly basis.
The CD-ROM disk does not contain Appendix M (Interpretative
Guidelines for Hospices). Copies of this appendix may be reviewed at a
Federal Depository Library (FDL).
Any cost report forms incorporated in the manuals are included on
the CD-ROM disk as LOTUS files. LOTUS software is needed to view the
reports once the files have been copied to a personal computer disk.
V. How to Review Listed Material
Transmittals or Program Memoranda can be reviewed at a local FDL.
Under the FDL program, government publications are sent to
approximately 1400 designated libraries throughout the United States.
Interested parties may examine the documents at any one of the FDLs.
Some may have arrangements to transfer material to a local library not
designated as an FDL. To locate the nearest FDL, individuals should
contact any library.
In addition, individuals may contact regional depository libraries,
which receive and retain at least one copy of most Federal government
publications, either in printed or microfilm form, for use by the
general public. These libraries provide reference services and
interlibrary loans; however, they are not sales outlets. Individuals
may obtain information about the location of the nearest regional
depository library from any library.
Superintendent of Documents numbers for each HCFA publication are
shown in Addendum III, along with the HCFA publication and transmittal
numbers. To help FDLs locate the instruction, use the Superintendent of
Documents number, plus the HCFA transmittal number. For example, to
find the Carriers Manual, Part 3--Claims Process (HCFA-Pub. 13-3)
transmittal entitled ``Essential Access Community Hospital and Rural
Primary Care Hospital'', use the Superintendent of Documents No. HE
22.8/6, and the HCFA transmittal number 1626.
VI. General Information
It is possible that an interested party may have a specific
information need and not be able to determine from the listed
information whether the issuance or regulation would fulfill that need.
Consequently, we are providing information contact persons to answer
general questions concerning these items. Copies are not available
through the contact persons. Copies can be purchased or reviewed as
noted above.
Questions concerning Medicare items in Addenda III may be addressed
to Margaret Cotton, Issuances Staff, Health Care Financing
Administration, Room 688 East High Rise, 6325 Security Blvd.,
Baltimore, MD 21207, Telephone (410) 966-5260.
Questions concerning Medicaid items in Addenda III may be addressed
to Pat Prete, Medicaid Bureau, Office of Medicaid Policy, Health Care
Financing Administration, Room 233 East High Rise, 6325 Security Blvd.,
Baltimore, MD 21207, Telephone (410) 966-3246.
Questions concerning items in Addenda V may be addressed to Walter
Rutemueller, Office of Coverage and Eligibility Policy, Health Care
Financing Administration, Room 401 East High Rise, 6325 Security Blvd.,
Baltimore, MD 21207, Telephone (410) 966-5395.
Questions concerning all other information may be addressed to
Michael Robinson, Office of Regulations, Health Care Financing
Administration, Room 132 East High Rise, 6325 Security Blvd.,
Baltimore, MD 21207, Telephone (410) 966-5633.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance, Program No. 93.774, Medicare--
Supplementary Medical Insurance Program, and Program No. 93.714,
Medical Assistance Program)
Dated: December 19, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
Addendum I
This addendum lists the publication dates of the quarterly
listing of program issuances and coverage decision updates to the
Coverage Issues Manual.
March 20, 1990 (55 FR 10290)
February 6, 1991 (56 FR 4830)
July 5, 1991 (56 FR 30752)
November 22, 1991 (56 FR 58913)
January 22, 1992 (57 FR 2558)
March 16, 1992 (57 FR 9127)
June 11, 1992 (57 FR 24797)
October 16, 1992 (57 FR 47468)
January 7, 1993 (58 FR 3028)
March 31, 1993 (58 FR 16837)
July 9, 1993 (58 FR 36967)
September 1, 1993 (58 FR 46200)
December 22, 1993 (58 FR 67796)
March 17, 1994 (59 FR 12610)
August 5, 1994 (59 FR 40038)
November 14, 1994 (59 FR 56501)
Addendum II--Description of Manuals, Memoranda, and HCFA Rulings
An extensive descriptive listing of Medicare manuals and
memoranda was published on June 9, 1988, at 53 FR 21730 and
supplemented on September 22, 1988, at 53 FR 36891 and December 16,
1988, at 53 FR 50577. Also, a complete description of the Medicare
Coverage Issues Manual was published on August 21, 1989, at 54 FR
34555. A brief description of the various Medicaid manuals and
memoranda that we maintain was published on October 16, 1992, at 57
FR 47468.
Medicare End Stage Renal Disease; Network Organizations Manual
This manual presents technical instructions and/or changes in
procedures that pertain to ESRD network organizations in an
understandable format, which can be easily modified. This manual
benefits both HCFA and its customers.
Addendum III.--Medicare and Medicaid Manual Instructions July through September 1994
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Trans. No. Manual/Subject/Publication No.
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Intermediary Manual Part 2--Audits, Reimbursement Program Administration (HCFA-Pub. 13-2) (Superintendent of
Documents No. HE 22.8/6-1)
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