[Federal Register Volume 59, Number 100 (Wednesday, May 25, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-12459]
[[Page Unknown]]
[Federal Register: May 25, 1994]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
42 CFR Part 413
[BPD-689-FC]
RIN 0938-AE80
Medicare Program; Uniform Electronic Cost Reporting System for
Hospitals
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This final rule with comment period implements the provisions
of section 4007(b) of the Omnibus Budget Reconciliation Act of 1987, as
amended by section 411(b)(6) of the Medicare Catastrophic Coverage Act
of 1988, which require the Secretary to place into effect a
standardized electronic cost reporting system for all hospitals under
the Medicare program. Under this final rule with comment period, all
hospitals are required to submit their cost reports, for hospital cost
reporting periods beginning on or after October 1, 1989, in a uniform
electronic format. The Secretary may grant a delay or a waiver of this
requirement where implementation could result in financial hardship for
a hospital.
DATES: Effective date: These rules are effective June 24, 1994.
Comment date: Comments will be considered if we receive them at the
appropriate address, as provided below, no later than 5 p.m. on July
25, 1994. We are accepting comments concerning the requirement in
Sec. 413.24(f)(4)(ii), that cost reporting software be able to detect
changes to the electronic cost report made after the provider has
submitted it to the intermediary.
ADDRESSES: Mail written comments (1 original and 3 copies) to the
following address: Health Care Financing Administration, Department of
Health and Human Services, Attention: BPD-689-FC, P.O. Box 7517,
Baltimore, MD 21207.
If you prefer, you may deliver your written comments (1 original
and 3 copies) to one of the following addresses:
Room 309-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201, or
Room 132, East High Rise Building, 6325 Security Boulevard, Baltimore,
MD 21207.
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code BPD-689-FC. Comments received timely will be available for
public inspection as they are received, generally beginning
approximately 3 weeks after publication of a document, in room 309-G of
the Department's offices at 200 Independence Avenue, SW., Washington,
DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m.
(phone: (202) 690-7890).
FOR FURTHER INFORMATION CONTACT: Thomas Talbott (410) 966-4592.
SUPPLEMENTARY INFORMATION:
I. Background
Under Medicare, hospitals are paid for inpatient hospital services
that they furnish to beneficiaries under Part A (Hospital Insurance).
Currently, most hospitals are paid for their inpatient hospital
services under the prospective payment systems for operating and
capital costs in accordance with sections 1886(d) and (g) of the Social
Security Act (the Act) and 42 CFR part 412. Under these systems,
Medicare payment is made at a predetermined, specific rate for each
hospital discharge based on the information contained on actual bills
submitted.
Section 1886(f)(1)(A) of the Act provides that the Secretary will
maintain a system for reporting costs of hospitals paid under the
prospective payment systems. Section 412.52 requires all hospitals
participating in the prospective payment systems to meet the
recordkeeping and cost reporting requirements of Secs. 413.20 and
413.24, which include submitting a cost report for each 12-month
period.
The hospitals and hospital units that are excluded from the
prospective payment systems are generally paid an amount based on the
reasonable cost of services furnished to beneficiaries. The inpatient
operating costs of these hospitals and hospital units are subject to
the ceiling on the rate of hospital cost increases in accordance with
section 1886(b) of the Act and Sec. 413.40.
Sections 1815(a) and 1833(e) of the Act provide that no payments
will be made to a hospital unless it has furnished the information,
requested by the Secretary, needed to determine the amount of payments
due the hospital under the Medicare program. In general, hospitals
submit this information through cost reports that cover a 12-month
period.
All hospitals participating in the Medicare program, whether they
are paid on a reasonable cost basis or under the prospective payment
systems, are required under Sec. 413.20(a) to ``maintain sufficient
financial records and statistical data for proper determination of
costs payable under the program.'' In addition, hospitals must use
standardized definitions and follow accepted accounting, statistical,
and reporting practices. Under the provisions of Secs. 413.20(b) and
413.24(f), hospitals are required to submit cost reports annually, with
the reporting period based on the hospital's accounting year.
II. Legislation Concerning Electronic Reporting
On December 22, 1987, the Omnibus Budget Reconciliation Act of
1987, Public Law 100-203, was enacted. Section 4007 of Public Law 100-
203, which was subsequently amended by section 411(b)(6) of the
Medicare Catastrophic Coverage Act of 1988, Public Law 100-360, added
section 1886(f)(1)(B) of the Act, which sets forth several provisions
concerning the reporting of hospital information under the Medicare
program. Section 1886(f)(1)(B) of the Act applies to hospital cost
reporting periods beginning on or after October 1, 1989.
Section 1886(f)(1)(B)(i) of the Act provides that the Secretary
will place into effect a standardized electronic cost reporting format
for hospitals under Medicare. This standardized electronic cost
reporting format does not require any additional data from hospitals.
Section 1886(f)(1)(B)(ii) of the Act provides that the Secretary may
delay or waive the implementation of the electronic format in instances
where such implementation would result in financial hardship for a
hospital. As an example of a financial hardship situation, this section
of the Act specifically mentions hospitals with a small percentage of
inpatients entitled to Medicare benefits.
III. Provisions of the Proposed Regulations
On August 19, 1991, we published a proposed rule (56 FR 41110) to
implement sections 1886(f)(1)(B) (i) and (ii) of the Act. We proposed
that cost reports be submitted in a standardized electronic format. The
hospital's cost report software must be able to produce a standardized
output file in American Standard Code for Information Interchange
(ASCII) format. All intermediaries have the ability to read this
standardized file and produce an accurate cost report. The proposed
rule did not require the reporting of any additional information.
If a hospital refuses to submit the cost reports electronically,
Medicare payments to that hospital may be suspended under the
provisions of sections 1815(a) and 1833(e) of the Act. As explained
above, sections 1815(a) and 1833(e) of the Act provide that no Medicare
payments will be made to a hospital unless it has furnished the
information, requested by the Secretary, needed to determine the amount
of payments due the hospital under the Medicare program. Section
405.371(d) provides for suspension of Medicare payments to a hospital
by the intermediary if the hospital has failed to submit information
requested by the intermediary that is needed to determine the amount
due the hospital under Medicare. The general procedures that are
followed when Medicare payment to a hospital is suspended for failure
to submit information that is needed by the intermediary to determine
Medicare payment (that is, when a hospital fails to furnish a cost
report, furnishes an incomplete cost report, fails to furnish other
needed information, or fails to submit a cost report electronically)
are located in section 2231 of the Intermediary Manual (HCFA Pub. 13).
These procedures include timeframes for ``demand letters'' to
hospitals, which in addition to reminding hospitals to file timely and
complete cost reports, explain possible adjustments of Medicare
payments to a hospital and the right to request a 30-day extension of
the due date. If a hospital believes that implementation of the
electronic submission requirement would cause a financial hardship, the
hospital should submit a written request for a waiver or a delay of
these requirements, with supporting documentation, to the hospital's
intermediary.
IV. Discussion of Public Comments
In response to the proposed rule, we received six timely items of
correspondence. We have summarized the comments and are presenting them
below with our responses.
A. Requirements for Electronic Submission
Comment: A few commenters requested clarification concerning the
format for electronic reporting.
Response: HCFA provided approved vendors of cost reporting software
with a uniform standardized format for the creation of the required
ASCII file. This format shows how each unique record must be displayed
in the electronic file in terms of worksheet, line, and column
position. The specifications required to complete a computerized
Medicare Cost Report have been in effect since the inception of the
Automated Desk Review (ADR) program in 1983. There are presently three
vendors approved by HCFA for the ADR system. Eight other commercial
vendors are approved by HCFA for electronic compilation of the Medicare
cost report. A hospital may use any of the 11 vendors for purposes of
filing an electronically prepared cost report. Each of the 11 vendors
must undergo periodic testing in which it develops and submits to HCFA
a completed cost report to demonstrate its system's ability to conform
to HCFA's display standards. No hospital may file its cost report
electronically unless the commercial software system it uses has
completed the testing process and been approved by HCFA.
In addition, when the provider files the cost report with the
intermediary, the cost report must pass edits specified in the Provider
Reimbursement Manual, Part II, before the intermediary can accept it.
If the cost report fails to pass these edits the intermediary will
immediately reject the cost report and return it to the provider for
correction. The cost report will be considered late if the provider
fails to correct it before the due date. The provider will be subject
to withholding of interim payments until the intermediary receives the
corrected cost report.
Comment: Several commenters questioned the need to file a hard copy
cost report in addition to submitting the electronic cost report.
Additionally, commenters were concerned with the lack of a written
statement certifying the accuracy of the electronic cost report. One
commenter suggested that HCFA require providers to submit a written
certification with the electronic cost report.
Response: We agree with the commenters concerns regarding the need
to file a hard copy cost report and the lack of a statement certifying
the accuracy of the electronic file. Therefore, effective for cost
reporting periods ending on or after October 1, 1994, we are
eliminating the requirement that providers file a hard copy of the cost
report in addition to the electronic file. In new
Sec. 413.24(f)(4)(iii), we specify that instead of a hard copy cost
report, providers must submit a hard copy of the certification
statement, settlement summary, and a statement of certain worksheet
totals found within the cost report file. We note that the
certification statement provides that in signing the statement, the
provider's administrator or chief financial officer is certifying the
accuracy of the data contained in the electronic cost report or, if the
provider has filed a manually prepared report, in the hard copy cost
report.
We believe that these changes will reduce the burden on providers
and ensure the accuracy of the data contained in the electronic file.
However, we also need to ensure that the electronic cost report is not
altered once it leaves the provider. Thus, in conjunction with the
changes made based on public comment, we are implementing a series of
changes designed to preserve the integrity of the electronic cost
report once the provider files it with the intermediary. First, we are
specifying in new Sec. 413.24(f)(4)(ii) that the provider's software
must be capable of disclosing that changes have been made to the cost
report file after the provider has submitted it to the intermediary.
Specifically, electronic cost reporting software will be modified so
that the cost report will calculate a ``hash total'', that is, a number
representing the sum of the worksheet totals (mentioned above)
contained in the provider's as filed cost report. If any data in the
electronic file is changed after the hash total is calculated, the
electronic file will disclose that a change has been made. We will
instruct all automated data reporting vendors to develop the capability
to calculate hash totals and disclose changes for all their provider
clients. Second, we are specifying in regulations that an intermediary
may not alter a cost report once it has been filed by a hospital and
must reject any cost report that does not pass all specified edits and
return it to the provider for correction. Third, HCFA will make
periodic checks to ensure that the totals in the electronic file agree
with those totals certified by the provider's administrator or chief
financial officer.
Because providers may not have anticipated such substantial changes
as a result of this rule, we are soliciting comments concerning the
requirement in new Sec. 413.24(f)(4)(ii) that cost report software be
able to disclose changes to the electronic file made after the provider
has submitted it to the intermediary.
Comment: One commenter requested that the intermediary be required
to report back to the provider in electronic cost reporting format the
audit adjustments made to the provider's cost report. This would allow
providers to readily add the audit adjustments to the electronic cost
report for future reference.
Response: We recognize the merit of this suggestion and will
consider implementing this process in the future. The intermediaries
would need additional computer programming to be able to provide
hospitals with an electronic file of audit adjustments. We will discuss
the commenter's suggestion with the 11 approved vendors of cost report
software to determine the extent of additional programming needed and
the financial implications.
B. Waiver Process
Comment: Several commenters requested guidance concerning the
process for seeking a delay in or waiver from the electronic submission
requirement. The commenters also wanted to know under what
circumstances HCFA would grant a delay or waiver. Commenters suggested
that HCFA define the term ``financial hardship'' as used in the
proposed rule.
Response: The Provider Reimbursement Manual, part II, section 130,
provides the guidelines for requesting a waiver. Basically, the
provider must make a written request to the intermediary at least 120
days before the close of the provider's cost reporting period. The
intermediary reviews the request and forwards it, with a recommendation
for approval or denial, to HCFA's central office within 30 days of
receipt of the request. The central office informs the intermediary
whether the waiver is approved or denied within 60 days of receipt of
the request in the central office.
Because of the varying financial circumstances of hospitals and
other health care providers that participate in the Medicare program,
we believe that it would be inappropriate to establish a definition of
``financial hardship'' or a set of specific criteria that a provider
would need to meet to qualify for a waiver of the electronic cost
reporting requirement. We believe that the best method for determining
whether a provider qualifies for a waiver is to consider requests on a
case by case basis.
To date, we have received only eight requests for waiver. We
believe that the small number of requests indicates that the majority
of providers will not experience financial hardship as a result of
electronic cost reporting. In addition, in an effort to minimize the
number of providers that need a waiver, we developed a software package
that will enable the hospital to file an electronic data set to its
fiscal intermediary in order to generate an electronic cost report. We
are providing the software package to hospitals free of charge.
Therefore, we believe that with the availability of the free software,
it will be difficult for a provider to demonstrate financial hardship.
Comment: A commenter recommended that HCFA provide an automatic
waiver of electronic cost report filing in each instance in which a
waiver of standard or full cost reporting has been granted, including
those cases where full cost reporting has been waived because of a low
percentage of Medicare inpatients.
Response: HCFA will grant an automatic waiver of electronic cost
reporting if a provider is exempt from full or standard cost reporting.
To qualify for an automatic waiver of electronic cost reporting, the
provider must apply and qualify for an exemption from full or standard
cost reporting in accordance with the rules that provide for the
exemption. For example, a provider that does not furnish any covered
services to Medicare beneficiaries is exempt from filing a full cost
report and instead must submit an abbreviated report under
Sec. 413.24(g). Additionally, a provider with low program utilization
may obtain a waiver from filing a full cost report in accordance with
Sec. 413.24(h). When the intermediary notifies a provider that it
qualifies for an exemption from filing a full cost report, the provider
also will be notified of the exemption from electronic filing.
Providers must apply for a waiver of full cost reporting for each new
cost reporting period. Providers that are not exempt from full cost
reporting must file for a waiver according to the procedure set forth
in section 130 of the Provider Reimbursement Manual, part II, as
discussed above.
C. Sanctions
Comment: Commenters requested HCFA's position regarding the
penalties assessed against a provider for failing to file its cost
report electronically.
Response: Sections 1815(a) and 1833(e) of the Act provide that no
payments will be made to a hospital unless it has furnished the
information requested by the Secretary needed to determine the amount
of payments due the hospital under the Medicare program. Section
405.371(d) provides for suspension of Medicare payments to a hospital
by the intermediary if the hospital fails to submit a cost report,
submits an incomplete cost report, or fails to furnish other needed
information. Section 2409.1(A)(1) of the Provider Reimbursement Manual
(PRM 15-I) addresses the procedures an intermediary will follow when a
provider fails to submit a cost report or when the cost report is
overdue. Unless the provider has received a waiver from electronic cost
reporting, the intermediary will consider a timely filed cost report
that is not filed electronically as an overdue cost report for purposes
of section 2409.1(A)(1). We will update this section of the manual to
reflect our position regarding sanctions for failure to file cost
reports electronically.
D. Cost of Implementation
Comment: A commenter disagreed with our statement in the impact
analysis of the proposed rule that hospitals would not be significantly
affected by electronic cost reporting. The commenter stated that some
hospitals had to make expensive changes in personnel or software to
comply with the regulations and that the cost of maintaining the
required software was an additional burden on providers. The commenter
suggested that HCFA pay providers for the cost of implementing the
electronic cost reporting requirement including the cost of equipment,
software, additional personnel, external consultants, and any related
overhead costs.
Response: Section 1886(f)(1)(B) of the Act does not authorize HCFA
to subsidize any of the costs hospitals incur in implementing
electronic cost reporting. However, it does authorize the waiver or
delay of the implementation of the electronic format in cases of
financial hardship. As discussed above, if computer support required
for electronic cost reporting will cause financial hardship, the
hospital may request a waiver from electronic filing.
V. Provisions of the Final Regulations
In this final rule with comment, we are revising the provisions set
forth in the proposed rule. Based on public comment, we are eliminating
the requirement that providers file a hard copy cost report in addition
to the electronic file. Also based on public comment, we are adding a
new paragraph (iii) to Sec. 413.24(f)(4) to provide that in addition to
the electronic file, a hospital must submit hard copies of a settlement
summary, a statement of certain worksheet totals found in the
electronic file, and a signed statement certifying the accuracy of the
electronic file or the manually prepared cost report.
In addition to the changes made based on public comment, we are
adding a new paragraph (ii) to Sec. 413.24(f)(4) to provide the
following:
All cost reporting software must be able to disclose that
changes have been made to the electronic file after the provider has
submitted its cost report to the intermediary.
The intermediary may not alter the cost report once it has
been filed by the provider.
The intermediary rejects any cost report that does not
pass all specified edits and returns it to the provider for correction.
As a result of the above changes to the regulations text, proposed
Sec. 413.24(f)(4)(ii) has been redesignated as Sec. 413.24(f)(4)(iv).
VI. Collection of Information Requirements
Section 413.24 of this final rule with comment contains information
collection and recordkeeping requirements that are subject to review by
the Office of Management and Budget (OMB) under the Paperwork Reduction
Act of 1980 (44 U.S.C. 3501 et seq.). These information collection and
recordkeeping requirements are not effective until they have been
approved by OMB. We have submitted a copy of this final rule with
comment to OMB for review of the information collection requirements.
Approximately 90 percent of hospitals participating in Medicare
have filed electronic cost reports before the effective date of this
regulation, that is with cost reporting periods beginning on or after
October 1, 1989. These providers will now have to file a diskette
containing the required cost report data in a standard format. This
diskette will contain input data only. We believe that minimal time
would be needed for hospitals to become familiar with the revised
software furnished by their cost reporting vendor. The remaining 10
percent of the hospitals previously filed manually prepared cost
reports. While these hospitals will initially experience an additional
reporting burden, we believe that once they are familiar with
electronic reporting, there will no longer be an additional burden and
there may even be a decrease in burden since the time needed to compute
the cost report will no longer be required.
VII. Response to Comments
Because of the number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. We will consider
comments we receive by the date and time specified in the ``DATES''
section of this preamble, and, if we proceed with a final rule, we will
respond to comments in the preamble to that document. Specifically, we
are soliciting comments concerning the requirement in new
Sec. 413.24(f)(4)(ii) that cost reporting software be able to detect
changes made to the electronic file after the provider has submitted it
to the intermediary. We will not consider comments concerning
provisions that remain unchanged from the August 19, 1991 proposed rule
or provisions that were changed based on public comment.
VIII. Impact Statement
Unless the Secretary certifies that a final rule will not have a
significant economic impact on a substantial number of small entities,
we generally prepare a regulatory flexibility analysis that is
consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601
through 612). For purposes of the RFA, all hospitals and small
businesses that distribute cost-report software to hospitals are
considered to be small entities. Intermediaries are not included in the
definition of a small entity.
Section 1102(b) of the Act requires the Secretary to prepare a
regulatory impact analysis if a final rule may have a significant
impact on the operations of a substantial number of small rural
hospitals. Such an analysis must conform to the provisions of section
603 of the RFA. For purposes of section 1102(b) of the Act, we define a
small rural hospital as a hospital that has fewer than 50 beds and is
located outside of a Metropolitan Statistical Area.
Under the provisions of Secs. 413.20(b) and 413.24(f), hospitals
are required to submit cost reports annually, with reporting periods
based on the hospital's accounting year. This is generally a
consecutive 12-month period. Section 1886(f)(1)(B)(i) of the Act now
requires the use of a standardized electronic cost reporting format for
hospitals. There are approximately 11 national software suppliers that
distribute cost report software packages to hospitals. In addition,
HCFA offers a cost reporting software package that is available at no
expense to any hospital that requests it.
As discussed in the proposed rule, computer software suppliers and
hospitals that purchased their software will not be significantly
affected by these provisions. Suppliers will not need to develop new
software and hospitals will not need to purchase new software but only
revise the software or have the cost report portion of the software
revised based on standard format requirements set by HCFA. Although the
cost report portion of software packages will be exactly the same,
competition among suppliers will not be adversely affected since each
offers other features that make its product unique.
Hospitals that will be most affected by this final rule with
comment period are those that may be unable to afford the equipment to
submit electronically. These hospitals might include hospitals that
have very few Medicare beneficiaries and small rural hospitals.
Hospitals that have access to computer equipment can utilize and
benefit from HCFA's free software if they are unable to afford the
software that is available from suppliers. However, as stated above, we
have received only eight requests for waiver of electronic cost
reporting. We believe that the small number of requests indicates that
the vast majority of hospitals will not experience financial hardship
due to the requirements of this final rule with comment period.
In conclusion, this final rule with comment period will not have a
significant effect on hospital costs since hospitals will not be
required to collect any additional data beyond that which the
regulations currently specify; cost-report software is available at no
cost from HCFA to any hospital that requests it; and most hospitals
have some type of computer equipment through which they are currently
submitting electronically prepared cost reports. Hospitals will only be
affected to the extent that all would be required to submit cost
reports in a standardized electronic format to their respective
intermediary. A hospital 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 hospital unless it has furnished the information requested by
the Secretary that is needed to determine the amount of payments due
the hospital under Medicare.
This final rule with comment period will not have a significant
effect on a substantial number of Medicare participating hospitals or
software suppliers. Therefore, a regulatory flexibility analysis is not
required. We are not preparing a rural impact statement since the
Secretary certifies that this final rule with comment period will not
have a significant economic impact on the operation of a substantial
number of small rural hospitals. In accordance with the provisions of
Executive Order 12866, this regulation was not reviewed by the Office
of Management and Budget.
List of Subjects 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
A. The authority citation for part 413 is revised to read as
follows:
Authority: Sec. 1102, 1814(b), 1815, 1833(a), (i), and (n),
1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act (42
U.S.C. 1302, 1395f(b), 1395g, 13951(a), (i), and (n), 1395x(v),
1395hh, 1395rr, 1395tt, and 1395ww) and sec. 104(c) of Pub. L. 100-
360 as amended by sec. 608(d)(3) of Pub. L. 100-485 (42 U.S.C.
1395ww (note)); and sec 101(c) of Pub. L. 101-234 (42 U.S.C. 1395ww
(note)).
B. A new paragraph (f)(4) is added to Sec. 413.24 to read as
follows:
Sec. 413.24 Adequate cost data and cost finding.
* * * * *
(f) Cost reports. * * *
(4) Electronic submission of cost reports. (i) Effective for cost
reporting periods beginning on or after October 1, 1989, a hospital is
required to submit its cost reports in a standardized electronic
format. The hospital's electronic program must be capable of producing
the HCFA standardized output file in a form that can be read by
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.
(ii) The fiscal intermediary may not alter the cost report once it
has been filed by the hospital. If a cost report does not pass all
specified edits, the fiscal intermediary rejects the cost report and
returns it to the hospital for correction. The hospital's electronic
program must be able to disclose that changes have been made to the
electronic cost report after the provider has submitted it to the
intermediary.
(iii) Effective for cost reporting periods ending on or after
October 1, 1994, a hospital 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. The following statement must immediately
precede the dated signature of the hospital'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.
(iv) A hospital may request a delay or waiver of the electronic
submission requirement in paragraph (f)(4)(i) of this section if this
requirement would cause a financial hardship. The hospital must submit
a written request for delay or waiver with necessary supporting
documentation to its intermediary at least 120 days prior to 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: August 25, 1993.
Bruce C. Vladeck
Administrator, Health Care Financing Administration.
Approved: May 6, 1994.
Donna E. Shalala,
Secretary.
[FR Doc. 94-12459 Filed 5-24-94; 8:45 am]
BILLING CODE 4120-01-P
