97-10138. Medicare and Medicaid Programs; Quarterly Listing of Program IssuancesThird Quarter 1996  

  • [Federal Register Volume 62, Number 76 (Monday, April 21, 1997)]
    [Notices]
    [Pages 19328-19337]
    From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
    [FR Doc No: 97-10138]
    
    
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    DEPARTMENT OF HEALTH AND HUMAN SERVICES
    
    Health Care Financing Administration
    [BPO-141-N]
    
    
    Medicare and Medicaid Programs; Quarterly Listing of Program 
    Issuances--Third Quarter 1996
    
    AGENCY: Health Care Financing Administration (HCFA), HHS.
    
    ACTION: Notice.
    
    -----------------------------------------------------------------------
    
    SUMMARY: This notice lists HCFA manual instructions, substantive and 
    interpretive regulations, and other Federal Register notices that were 
    published during July, August, and September of 1996 that relate to the 
    Medicare and Medicaid programs. It also identifies certain devices with 
    investigational device exemption numbers approved by the Food and Drug 
    Administration that may be potentially covered under Medicare.
        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 time frame.
    
    FOR FURTHER INFORMATION CONTACT:
    
    Bridget Wilhite, (410) 786-5248 (For Medicare instruction information).
    Pat Prete, (410) 786-3246 (For Medicaid instruction information).
    Sharon Hippler, (410) 786-4633 (For Food and Drug Administration-
    approved investigational device exemption information).
    Cathy Johnson, (410) 786-5241 (For all other information).
    
    [[Page 19329]]
    
    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 38 million Medicare beneficiaries and 36 
    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 that process claims and pay bills, 
    and others. To implement the various statutes on which the programs are 
    based, we issue regulations under the authority granted the Secretary 
    under sections 1102, 1871, 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, and guidelines of general 
    applicability not issued as regulations. We published our first notice 
    June 9, 1988 (53 FR 21730).
        Since the publication of our quarterly listing on June 12, 1992 (57 
    FR 24797), we decided to add Medicaid issuances to our quarterly 
    listings. Accordingly, we list in this notice Medicaid issuances and 
    Medicaid substantive and interpretive regulations published during July 
    through September 1996.
        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 time frame and are initiating the inclusion of HCFA Rulings.
    
    II. 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 Food and Drug Administration-approved investigational 
    device exemptions published during the time frame 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 six addenda. Addendum I lists the publication dates of the 
    most recent quarterly listing of program issuances.
        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 parts of 
    the Code of Federal Regulations (CFR) that have changed (if 
    applicable), the agency file code number, the title of the regulation, 
    the ending date of the comment period (if applicable), and the 
    effective date (if applicable).
        Addendum V lists a HCFA Ruling that was issued during the period 
    covered by this notice. A HCFA ruling which is a statement of policy or 
    interpretation that has not been published in the Federal Register as 
    part of a regulation or of a notice implementing regulations, but which 
    has been adopted by HCFA as having precedent.
        On September 19, 1995, we published a final rule (60 FR 48417) 
    establishing in regulations that certain devices with an 
    investigational device exemption approved by the Food and Drug 
    Administration and certain services related to those devices may be 
    covered under Medicare. That final rule states that we will announce in 
    this quarterly notice all investigational device exemption 
    categorizations, using the investigational device exemption numbers the 
    Food and Drug Administration assigns. Addendum VI includes listings of 
    the Food and Drug Administration-approved investigational device 
    exemption numbers that have been approved during the quarter covered by 
    this notice. The listings are organized according to the categories to 
    which the device numbers are assigned (that is, Category A or Category 
    B, and identified by the investigational device exemption number). 
    Future notices will announce investigational device exemption 
    categorizations and the numbers assigned by the Food and Drug 
    Administration for the quarter covered by the notice.
    
    III. 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, Government Printing Office, A TTN: New 
    Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 
    512-1800, 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. 
    Additionally, all manuals are available at the following Internet 
    address: http//www.hcfa.gov/pubforms/progman.htm.
    
    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 
    given above. When ordering individual copies, it is necessary to cite 
    either the date of publication or the volume number and page number.
        The Federal Register is also available on 24 x  microfiche and as 
    an online database through GPO Access. The online database is updated 
    by 6 a.m. each day the Federal Register is published. The database 
    includes both text and graphics from Volume 59, Number 1 (January 2, 
    1994) forward. Free public access is available on a Wide Area 
    Information Server (WAIS)
    
    [[Page 19330]]
    
    through the Internet and via asynchronous dial-in. Internet users can 
    access the database by using the World Wide Web; the Superintendent of 
    Documents home page address is http://www.access.gpo.gov/su__docs/, by 
    using local WAIS client software, or by telnet to swais.access.gpo.gov, 
    then log in as guest (no password required). Dial-in users should use 
    communications software and modem to call (202) 512-1661; type swais, 
    then log in as guest (no password required).
    
    C. Rulings
    
        We publish Rulings on an infrequent basis. 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)
    
        Our laws, regulations, and manuals are also 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 on the CD-
    ROM disk:
         Titles XI, XVIII, and XIX of the Act.
         HCFA-related regulations.
         HCFA manuals and monthly revisions.
         HCFA program memoranda.
        The titles of the Compilation of the Social Security Laws are 
    current as of January 1, 1995. The remaining portions of CD-ROM are 
    updated on a monthly basis.
        Because of complaints about the unreadability of the Appendices 
    (Interpretive Guidelines) in the State Operations Manual (SOM), as of 
    March 1995, we deleted these appendices from CD-ROM. We intend to re-
    visit this issue in the near future, and, with the aid of newer 
    technology, we may again be able to include the appendices on CD-ROM.
        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.
    
    IV. How To Review Listed Material
    
        Transmittals or Program Memoranda can be reviewed at a local 
    Federal Depository Library (FDL). Under the FDL program, government 
    publications are sent to approximately 1,400 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, 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 Intermediary Manual, Part 
    1--Fiscal Administration (HCFA Pub. 13-1) transmittal entitled 
    ``Electronic Remittance Advice,'' use the Superintendent of Documents 
    No. HE 22.8/6-3 and the HCFA transmittal number 127.
    
    V. 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 Addendum III may be 
    addressed to Bridget Wilhite, Bureau of Program Operations, Issuances 
    Staff, Health Care Financing Administration, N2-05-03, 7500 Security 
    Boulevard, Baltimore, 21244-1850, Telephone (410) 786-5248.
        Questions concerning Medicaid items in Addendum III may be 
    addressed to Pat Prete, Medicaid Bureau, Office of Medicaid Policy, 
    Health Care Financing Administration, C4-25-02, 7500 Security 
    Boulevard, Baltimore, MD 21244-1850, Telephone (410) 786-3246.
        Questions concerning Food and Drug Administration-approved 
    investigational device exemptions may be addressed to Sharon Hippler, 
    Bureau of Policy Development, Office of Chronic Care and Insurance 
    Policy, Health Care Financing Administration, C4-11-04, 7500 Security 
    Boulevard, Baltimore, MD 21244-1850, Telephone (410) 786-4633.
        Questions concerning all other information may be addressed to 
    Cathy Johnson, Bureau of Policy Development, Office of Regulations, 
    Health Care Financing Administration, C5-12-16, 7500 Security 
    Boulevard, Baltimore, MD 21244-1850, Telephone (410) 786-5241.
    
    (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: April 10, 1997.
    Gary Kavanagh,
    Acting Director, Bureau of Program Operations.
    
    Addendum I
    
        This addendum lists the publication dates of the most recent 
    quarterly listings of program issuances.
    
    July 26, 1995 (60 FR 38344)
    November 15, 1995 (60 FR 57435)
    April 8, 1996 (61 FR 15491)
    June 26, 1996 (61 FR 33119)
    December 18, 1996 (61 FR 66676)
    
    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.
    
    [[Page 19331]]
    
    
    
                                 Addendum III--Medicare and Medicaid Manual Instructions                            
                                              [July through September 1996]                                         
    ----------------------------------------------------------------------------------------------------------------
              Trans. No.                                      Manual/Subject/Publication Number                     
    ----------------------------------------------------------------------------------------------------------------
                                                   Intermediary Manual                                              
                                     Part 1--Fiscal Administration (HCFA Pub. 13-1)                                 
                                      (Superintendent of Documents No. HE 22.8/6-3)                                 
    ----------------------------------------------------------------------------------------------------------------
    127                             http://www.hcfa.gov/pubforms/pub6/
    pub6toc.htm.
    Transmittal No. 88
        Clarification--Effective Date: Not Applicable.
        Section 50-41, Human Tumor Stem Cell Drug Sensitivity Assays, 
    clarifies that while the fluorescent cytoprint assay (FCA) is not based 
    upon the same or a similar procedure as the human tumor stem cell drug 
    sensitivity assay, it is sufficiently alike that it is included under 
    this subject. The basic difference is that the FCA incorporates the use 
    of microorgan systems and a fluorescent dye. The test is performed as 
    an in vitro chemosensitivity test for the effectiveness of drugs for 
    cancer treatment. Medicare considers the clinical application of this 
    procedure as experimental and not covered by the program at this time.
    Transmittal No. 89
        Changed Implementing Instructions--Effective Date: For services 
    furnished on or after 10/07/96.
    
    [[Page 19335]]
    
        Section 65-9, Incontinence Control Devices, is revised to reflect 
    that in female patients the Abdominal Leak Point Pressure (ALPP) 
    measurement is amended from less than 65 cm H20 to an ALPP of less 
    than 100 cm HH20, if the diagnosis of intrinsic sphincter 
    deficiency (ISD) is established. HCFA is amending the leak point 
    pressure measurement in female patients without urethral hypermobility 
    and with abdominal leak point pressures of 65 cm H20 to 100 cm 
    H20.
        For patients whose incontinence showed no improvement after the 
    initial five treatments, no further treatments are covered. HCFA is 
    amending the lifetime limitation of five treatment sessions for 
    patients who have received successful treatments in the past to allow 
    latitude for the treating physician to decide whether additional 
    sessions of collagen injection may be beneficial. For these patients, 
    medical documentation must accompany claims for additional treatments 
    beyond five. HCFA is deleting the requirement that patients must have 
    shown no improvement in their incontinence for at least 12 months prior 
    to collagen therapy in order to be eligible for coverage.
        In addition, the coverage guidelines for pelvic floor stimulators 
    that were previously in Sec. 65-11 under the bladder stimulators policy 
    are being moved to Sec. 65-9 since pelvic floor stimulators are more 
    appropriately identified as incontinence control devices. Section 65-9 
    is also revised to indicate that pelvic floor stimulators are not 
    covered for the reason that the effectiveness of these devices is 
    unproven. The previous policy in Sec. 65-11 indicated that both the 
    safety and effectiveness of pelvic floor stimulators were unproven.
        Section 65-11, Bladder Stimulators, is revised to eliminate the use 
    of name brand products. HCFA now identifies devices according to a 
    general categorization of products rather than by specific brand names. 
    In addition, the coverage guidelines for pelvic floor stimulators have 
    been moved to Sec. 65-9.
    
                                              Addendum IV.--Regulation Documents Published in the Federal Register                                          
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                       End of               
        Publication date     FR vol. 61 page          CFR part(s)                   File code*               Regulation title         comment     Effective 
                                                                                                                                       period        date   
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    07/01/96...............      33928-33936  ...........................  BPD-847-CN                   Medicare Program; Changes   ...........  ...........
                                                                                                         to the Hospital Inpatient                          
                                                                                                         Prospective Payment                                
                                                                                                         Systems and Fiscal Year                            
                                                                                                         1997 Rates; Correction.                            
    07/01/96...............      34344-34365  ...........................  BPD-867-NC                   Medicare Program; Schedule     08/30/96       070196
                                                                                                         of Limits on Home Health                           
                                                                                                         Agency Costs Per Visit                             
                                                                                                         for Cost Reporting                                 
                                                                                                         Periods Beginning on or                            
                                                                                                         After July 1, 1996.                                
    07/02/96...............      34614-34662  405, 410, 415                BPD-852-P                    Medicare Program;              09/03/96  ...........
                                                                                                         Revisions to Payment                               
                                                                                                         Policies Under the                                 
                                                                                                         Physician Fee Schedule                             
                                                                                                         for Calendar Year 1997.                            
    07/05/96...............            35307  405, 417, 431, 473, 498      BPD-704-FC                   Medicare and Medicaid       ...........     07/24/96
                                                                                                         Programs; Provider                                 
                                                                                                         Appeals; Technical                                 
                                                                                                         Amendments; Correction.                            
    07/16/96...............      37011-37015  413                          BPD-647-F                    Medicare Program;           ...........     08/15/96
                                                                                                         Reporting of Interest                              
                                                                                                         From Zero Coupon Bonds.                            
    07/23/96...............      38207-38212  ...........................  BPD-849-PN                   Medicare Program;              08/22/96  ...........
                                                                                                         Recognition of the                                 
                                                                                                         Ambulatory Surgical                                
                                                                                                         Center Standards of the                            
                                                                                                         Joint Commission on the                            
                                                                                                         Accreditation of                                   
                                                                                                         Healthcare Organizations                           
                                                                                                         and the Accreditation                              
                                                                                                         Association for                                    
                                                                                                         Ambulatory Health Care.                            
    07/24/96...............      38395-38399  ...........................  MB-099-F                     Medicaid Program; Medicaid  ...........     08/23/96
                                                                                                         Eligibility Quality                                
                                                                                                         Control, Progressive                               
                                                                                                         Reductions in Federal                              
                                                                                                         Financial Participation                            
                                                                                                         for FYs 1982-1984,                                 
                                                                                                         Payment for Physician                              
                                                                                                         Billing for Clinical                               
                                                                                                         Laboratory Services, and                           
                                                                                                         Utilization Control of                             
                                                                                                         Skilled Nursing Facility                           
                                                                                                         Services: Removal of                               
                                                                                                         Obsolete Requirements.                             
    07/24/96...............            38395  417                          OMC-009-FC                   Medicare Program;           ...........     10/01/95
                                                                                                         Qualified Health                                   
                                                                                                         Maintenance                                        
                                                                                                         Organizations; Correction.                         
    08/01/96...............      40236-40242  ...........................  BPO-139-N                    Medicare and Medicaid       ...........  ...........
                                                                                                         Programs; Quarterly                                
                                                                                                         Listing of Program                                 
                                                                                                         Issuances and Coverage                             
                                                                                                         Decisions-First Quarter                            
                                                                                                         1996.                                              
    08/02/96...............      40343-40347  406, 407, 408, 416           BPD-752-FC                   Medicare Program; Special      10/01/96     09/03/96
                                                                                                         Enrollment Periods and                             
                                                                                                         Waiting Period.                                    
    08/15/96...............      42385-42386  417, 473, 498                BPD-704-CN                   Medicare and Medicaid       ...........     07/24/96
                                                                                                         Programs: Provider                                 
                                                                                                         Appeals; Technical                                 
                                                                                                         Amendments; Corrections.                           
    08/15/96...............            42385  415                          BPD-827-CN                   Medicare Program;           ...........   \1\ 01/01/
                                                                                                         Revisions to Payment                             96
                                                                                                         Policies and Adjustments                           
                                                                                                         to the Relative Value                              
                                                                                                         Units Under the Physician                          
                                                                                                         Fee Schedule for Calendar                          
                                                                                                         Year 1996; Correction.                             
    
    [[Page 19336]]
    
                                                                                                                                                            
    08/16/96...............      42637-42638  ...........................  ORD-090-N                    New and Pending             ...........  ...........
                                                                                                         Demonstration Project                              
                                                                                                         Proposals Submitted                                
                                                                                                         Pursuant to Section                                
                                                                                                         1115(a) of the Social                              
                                                                                                         Security Act: June 1996.                           
    08/30/96...............      46166-46328  412, 413, 489                BPD-847-F                    Medicare Program; Changes   ...........     10/01/96
                                                                                                         to the Hospital Inpatient                          
                                                                                                         Prospective Payment                                
                                                                                                         Systems and Fiscal Year                            
                                                                                                         1997 Rates.                                        
    09/03/96...............      46466-46478  ...........................  BPD-842-NC                   Medicare Program; Schedule     11/04/96     10/01/96
                                                                                                         of Prospectively                                   
                                                                                                         Determined Payment Rates                           
                                                                                                         for Skilled Nursing                                
                                                                                                         Facility Inpatient                                 
                                                                                                         Routine Service Costs.                             
    09/03/96...............      46384-46385  417                          OMC-010-FC                   Medicare and Medicaid          11/04/96     09/03/96
                                                                                                         Programs; Requirements                             
                                                                                                         for Physician Incentive                            
                                                                                                         Plans in Prepaid Health                            
                                                                                                         Care Organizations;                                
                                                                                                         Correction.                                        
    09/04/96...............      46579-46603  418                          BPD-820-P                    Medicare Program; Hospice      11/04/96  ...........
                                                                                                         Wage Index.                                        
    09/09/96...............      47423-47434  482                          BPD-633-F                    Medicare and Medicaid       ...........     11/08/96
                                                                                                         Program; Hospital                                  
                                                                                                         Standard for Potentially                           
                                                                                                         HIV Infectious Blood and                           
                                                                                                         Blood Products.                                    
    09/11/96...............      47946-47950  ORD-091-N                    New and Pending              ..........................  ...........             
                                                                            Demonstration Project                                                           
                                                                            Proposals Submitted                                                             
                                                                            Pursuant to Section                                                             
                                                                            1115(a) of the Social                                                           
                                                                            Security Act                                                                    
    09/11/96...............      47950-47951  ...........................  OPL-011-N                    Medicare Program;           ...........  ...........
                                                                                                         September 30, 1996                                 
                                                                                                         Meeting of the Practicing                          
                                                                                                         Physicians Advisory                                
                                                                                                         Council.                                           
    09/19/96...............      49269-49271  401, 405                     BPD-869-F                    Medicare Program; Waiver    ...........     10/21/96
                                                                                                         of Recovery of                                     
                                                                                                         Overpayments.                                      
    09/19/96...............      49271-49276  421                          BPO-105-F                    Medicare Program; Part B    ...........     10/21/96
                                                                                                         Advance Payments to                                
                                                                                                         Suppliers Furnishing                               
                                                                                                         Items or Services Under                            
                                                                                                         Medicare Part B.                                   
    09/23/96...............      49781-49785  ...........................  MB-100-N                     Medicaid Program; Final     ...........  ...........
                                                                                                         Limitations on Aggregate                           
                                                                                                         Payments to                                        
                                                                                                         Disproportionate Share                             
                                                                                                         Hospitals; Federal Fiscal                          
                                                                                                         Year 1996.                                         
    09/26/96...............            50493  ...........................  ORD-092-N                    New and Pending                                     
                                                                                                         Demonstration Project                              
                                                                                                         Proposals Submitted                                
                                                                                                         Pursuant to Section                                
                                                                                                         1115(a) of the Social                              
                                                                                                         Security Act: August 1996.                         
    09/30/96...............            51021  ...........................  BPD-704-CN                   Medicare and Medicaid       ...........     07/24/96
                                                                                                         Programs; Provider                                 
                                                                                                         Appeals: Technical                                 
                                                                                                         Amendments; Correction.                            
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    \1\ And 07/01/96 (part 415 only).                                                                                                                       
    
    Addendum V.--HCFA Ruling
    
        HCFAR-96-1 Medicare Program; Medicare Supplementary Medical 
    Insurance (Part B); Clarification of the Terms ``Orthotics,'' 
    ``Braces,'' and ``Durable Medical Equipment'' under Medicare Part B. 
    Issued September 18, 1996.
    
    Addendum VI.--Categorization of Food and Drug Administration-Approved 
    Investigational Device Exemptions
    
        Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c), devices 
    fall into one of three classes:
        Class I--Devices for which the general controls of the Food, Drug, 
    and Cosmetic Act, such as adherence to good manufacturing practice 
    regulations, are sufficient to provide a reasonable assurance of safety 
    and effectiveness.
        Class II--Devices that, in addition to general controls, require 
    special controls, such as performance standards or postmarket 
    surveillance, to provide a reasonable assurance of safety and 
    effectiveness.
        Class III--Devices that cannot be classified into Class I or Class 
    II because insufficient information exists to determine that either 
    special or general controls would provide reasonable assurance of 
    safety and effectiveness. Class III devices require premarket approval.
        Under the new categorization process to assist HCFA, the Food and 
    Drug Administration assigns each device with a Food and Drug 
    Administration-approved investigational device exemption to one of two 
    categories:
        Experimental/Investigational (Category A) Devices, or Non-
    Experimental/Investigational (Category B) Devices. Under this 
    categorization process, an experimental/investigational
    
    [[Page 19337]]
    
    (Category A) device is an innovative device in Class III for which 
    ``absolute risk'' of the device type has not been established (that is, 
    initial questions of safety and effectiveness have not been resolved 
    and the Food and Drug Administration is unsure whether the device type 
    can be safe and effective). A non-experimental/investigational 
    (Category B) device is a device believed to be in Class I or Class II, 
    or a device believed to be in Class III for which the incremental risk 
    is the primary risk in question (that is, underlying questions of 
    safety and effectiveness of that device type have been resolved), or it 
    is known that the device type can be safe and effective because, for 
    example, other manufacturers have obtained Food and Drug Administration 
    approval for that device type. The criteria the Food and Drug 
    Administration uses to categorize an investigational device under 
    Category B include the following:
        (1) Devices, regardless of the classification, under investigation 
    to establish substantial equivalence to a predicate device, that is, to 
    establish substantial equivalence to a previously/currently legally 
    marketed device.
        (2) Class III devices whose technological characteristics and 
    indication for use are comparable to a Pre-Market Approval (PMA)-
    approved device.
        (3) Class III devices with technological advances compared to a 
    PMA-approved device, that is, a device with technological changes that 
    represent advances to a device that has already received PMA-approval 
    (generational changes).
        (4) Class III devices that are comparable to a PMA-approved device 
    but are under investigation for a new indication for use. For purposes 
    of studying the new indication, no significant modifications to the 
    device were required.
        (5) Pre-amendments Class III devices that become the subject of an 
    investigational device exemption after the Food and Drug Administration 
    requires premarket approval, that is, no PMA application was submitted 
    or the PMA application was denied.
        (6) Nonsignificant risk device investigations for which the Food 
    and Drug Administration required the submission of an investigational 
    device exemption.
        The following information presents the device number, category (in 
    this case, A), and criterion code.
    
    G960032  A1
    G960055  A
    G960069  A2
    G960125  A1
    G960140  A2
    G960143  A2
    G960154  A2
    G960169  A2
        The following information presents the device number category (in 
    this case,  B), and criterion code.
    
    G940026  B
        G950128  B3
        G960005  B1
        G960022  B2
        G960050  B2
        G960059  B2
        G960077  B3
        G960080  B3
        G960092  B4
        G960114  B4
        G960116  B4
        G960117  B2
        G960120  B1
        G960121  B3
        G960122  B2
        G960123  B1
        G960126  B2
        G960127  B4
        G960128  B1
        G960129  B3
        G960130  B
        G960132  B4
        G960133  B2
        G960135  B1
        G960136  B2
        G960139  B4
        G960141  B
        G960142  B2
        G960148  B
        G960150  B2
        G960151  B4
        G960152  B4
        G960153  B2
        G960155  B1
        G960156  B
        G960157  B
        G960158  B4
        G960159  B
        G960161  B
        G960162  B
        G960165  B
        G960168  B1
        G960170  B4
        G960171  B3
        G960172  B3
        G960173  B
        G960175  B2
        G960176  B1
        G960177  B3
        G960179  B1
        G960180  B4
        G960182  B2
        G960221  B4
        Note: Some investigational devices may exhibit unique 
    characteristics or raise safety concerns that make additional 
    consideration necessary. For these devices, HCFA and the Food and 
    Drug Administration will agree on the additional criteria to be 
    used. The Food and Drug Administration will use these criteria to 
    assign the device(s) to a category. As experience is gained in the 
    categorization process, this addendum may be modified.
    
    [FR Doc. 97-10138 Filed 4-18-97; 8:45 am]
    BILLING CODE 4120-01-P
    
    
    

Document Information

Published:
04/21/1997
Department:
Health Care Finance Administration
Entry Type:
Notice
Action:
Notice.
Document Number:
97-10138
Dates:
Not Applicable.
Pages:
19328-19337 (10 pages)
Docket Numbers:
BPO-141-N
PDF File:
97-10138.pdf