[Federal Register Volume 60, Number 143 (Wednesday, July 26, 1995)]
[Notices]
[Pages 38344-38352]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-18333]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[BPO-131-N]
Medicare and Medicaid Programs; Quarterly Listing of Program
Issuances and Coverage Decisions--First Quarter 1995
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, and
statements of policy that were published during January, February, and
March of 1995 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 January 1 and March 31, 1995. 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) 786-5255 (For Medicare instruction information).
Pat Prete, (410) 966-3246 (For Medicaid instruction information). After
July 21, 1995, (410) 786-3246. Nancy Ranels, (410) 966-8928 (For all
other information). After August 4, 1995, (410) 786-8928.
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 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, 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, 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 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
January 1 through March 31, 1995.
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 June 9, 1988 (53 FR 21730),
September 22, 1988 (53 FR 36891), December 16, 1988 (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
[[Page 38345]]
Manual. These updates, when added to material from the manual published
on August 21, 1989 constitute a complete manual as of March 31, 1995.
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 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.
Addendum V 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).
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, Government Printing Office, ATTN: New
Order, 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.
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.
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. 14-3) transmittal entitled ``Medical
Review,'' use the Superintendent of Documents No. HE 22.8/7 and the
HCFA transmittal number 1508.
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, Bureau of Program Operations,
Health Care Financing Administration, S1-03-08, 7500 Security Blvd.,
Baltimore, MD 21244-1850, Telephone (410) 786-5255.
Questions concerning Medicaid items in Addenda III may be addressed
to Pat Prete, Medicaid Bureau, Office of Medicaid Policy, Health Care
Financing Administration, (before July 21, 1995) Room 233 East High
Rise, 6325 Security Blvd., Baltimore, MD 21207, Telephone (410) 966-
3246 or (after July 21, 1995) C4-25-02, 7500 Security Boulevard,
[[Page 38346]]
Baltimore, MD 21244-1850, Telephone (410) 786-3246.
Questions concerning all other information may be addressed to
Nancy Ranels, Office of Regulations, Bureau of Policy Development,
Health Care Financing Administration, (before August 4, 1995) Room 132
East High Rise 6325 Security Blvd., Baltimore, MD 21207, Telephone
(410) 966-8928 or (after August 4, 1995) C5-14-22, 7500 Security
Boulevard, Baltimore, MD 21244-1850, Telephone (410) 786-8928.
(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: July 19, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
Addendum I
This addendum lists the publication dates of the most recent
quarterly listing of program issuances and coverage decision updates to
the Coverage Issues Manual. For a complete listing of the quarterly
updates to the Coverage Issues Manual published between March 20, 1990
through November 14, 1994, please refer to the January 3, 1995 update
(60 FR 134).
January 3, 1995 (60 FR 132)
April 6, 1995 (60 FR 17538)
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.
Addendum III.--Medicare and Medicaid Manual Instructions
[January Through March 1995]
------------------------------------------------------------------------
Trans. No. Manual/Subject/Publication Number
------------------------------------------------------------------------
Medicare
Intermediary Manual--Part 2
Audits, Reimbursement
Program Administration (HCFA-Pub. 13-2)
(Superintendent of Documents No. HE 22.8/6-1)
------------------------------------------------------------------------
402 Maximum Payment For Rural Health Clinics
Maximum Payment For Federally Qualified Health
Centers
403 Contractor Performance Evaluation
Fiscal Intermediary Performance Criteria--
General
The RHHI Performance Evaluation
RHHI Performance Criteria--General
404 Beneficiary Services
Provider Services
------------------------------------------------------------------------
Medicare
Intermediary Manual--Part 3
Claims Process (HCFA-Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
------------------------------------------------------------------------
1642 HCPCS for Hospital Outpatient Radiology Services
and Other Diagnostic Procedures
Ambulatory Surgical Center Pricer Program
1643 Billing for Durable Medical Equipment, Orthotic/
Prosthetic Devices and Surgical Dressings
1644 Frequency of Billing
Requirement That Bills Be Submitted In-Sequence
for a Continuous Inpatient Stay
Need to Reprocess Inpatient Claims In-Sequence
1645 PRO Reporting on Medical Review
1646 All-Inclusive Rate Providers
Billing for Parenteral and Enteral Nutrition
Special Billing Instructions for Pneumococcal
Pneumonia
1647 On-Site CMRs
Review Options
------------------------------------------------------------------------
Medicare
Carriers Manual--Part 2
Program Administration (HCFA-Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7-3)
------------------------------------------------------------------------
130 The FY 1995 Contractor Performance Evaluation
131 Beneficiary Services
Provider Services
------------------------------------------------------------------------
Medicare
Carriers Manual--Part 3
Claims Process (HCFA-Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
------------------------------------------------------------------------
1508 Medical Review
Local MR Policy
The Carrier Advisory Committee
[[Page 38347]]
Data Analysis to Identify Aberrancies
Aberrancies
Taking Corrective Actions on Identified
Aberrancies
Conducting Evaluation of Effectiveness of
Correction Action
Standard Postpayment Data Reports
Categories of MR Screens
Provider Audit List
CMR Corrective Actions
Assessing an Overpayment or Potential
Overpayment When the CMR was Based on a Limited
Sample/Subsample
Determination
Consent Settlement Documents
1509 Participating Physician/Supplier Report
Completion of Items on Participating Physician/
Supplier Report
Checking Reports
1510 Recovery From the Physician/Supplier--
Overpayment Demand Letters
Initial Demand Letter to Physicians/Suppliers
Follow-up Demand Letter to Physicians/Suppliers
Overpayment Report
Optional Overpayment Customizing Paragraphs
Sample Letter--Check Included For Correct Amount
Sample Letter--Check Included But Wrong Amount
1511 Personal Computer EMC Software
1512 HCFA Common Procedure Coding System
Use and maintenance of CPT-4 in HCPCS
Local Codes at Regular Carriers
Use and Acceptance of HCPCS Codes and Modifiers
HCPCS Update
Payment Concerns While Updating Codes
Payment, Utilization Review and Coverage
Information on HCFA Tape File
Deleted HCPCS Codes/Modifiers
Claims Review and Adjudication Procedures
HCPCS Release
------------------------------------------------------------------------
Program Memorandum
Intermediaries (HCFA-Pub. 60A)
(Superintendent of Document No. HE 22.8/7)
------------------------------------------------------------------------
A-95-1 Hospital Outpatient Procedures: 1995 Update to
the List of Radiology Procedures and Other
Diagnostic Services Subject to Payment
Limitation and Update to the List of HCPCS
Codes to Be Grossed-Up
A-95-2 Submission of Form HCFA-2552-92 (Hospital and
Hospital Health Care Complex Cost Report)
A-95-3 Ambulatory Surgical Center--PRICER 9.1
------------------------------------------------------------------------
Program Memorandum
Carriers (HCFA-Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
------------------------------------------------------------------------
B-95-1 Implementation of 1995 Physician Fee Schedule
Payment Policy Changes
------------------------------------------------------------------------
Program Memorandum
Intemediaries/Carriers (HCFA-Pub. 60AB)
(Superintendent of Documents No. HE 22.8/6-5)
------------------------------------------------------------------------
AB-95-1 Establishment of Standard Rates for Transmitting
Claims Information Between Medicare Contractors
and Complementary Insurers
AB-95-2 New Interest Rate Payable on Clean Claims Note
Paid Timely
AB-95-3 Implementation of ``Physician Ownership and
Referral'' (Section 1877 of the Social Security
Act, as amended by Section 13562 of the Omnibus
Budget Reconciliation Act of 1993 (OBRA 93))
AB-95-4 EDI Enrollment Form
AB-95-5 Temporary HCPCS Codes for Dexamethasone Acetate
------------------------------------------------------------------------
Program Memorandum
Medicaid State Agencies (HCFA-Pub. 17)
(Superintendent of Documents No. HE 22.8/6-5
------------------------------------------------------------------------
95-1 Title XIX, Social Security Act, Transfers of
Assets and Treatment of Trusts
------------------------------------------------------------------------
[[Page 38348]]
Program Memorandum
Insurance Commissioners (HCFA-Pub. 80)
(Superintendent of Documents No. HE 22.8/6-5)
------------------------------------------------------------------------
95-1 Medigap Bulletin Series (Number Four)
------------------------------------------------------------------------
State Operations Manual
Provider Certification (HCFA-Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
------------------------------------------------------------------------
266 Survey Procedures for Swing-Bed Hospitals
Model Letter--Swing Bed Applicants
Nurse Aide Training/Nurse Aide Training and
Competency Evaluation Program
Line-Item Justification for Direct and Indirect
Costs
Preparation of the State Survey Agency
Certification Workload Report--HCFA-434
Distribution of Approved Funds
Disbursement of Approved Funds
General
Goods, Facilities, Services From Other Staff
Agencies or From Local Agencies
Personnel Services
State Agency Accounts
Determination of Necessary Staff
Communications and Supplies
Equipment
Training of State Agency Personnel
Long Term Care Facility Workload (SNF/NF)
Preparation of the State Agency Budget List of
Positions--HCFA-1465A
Preparation of the State Agency Schedule for
Equipment Purchases--HCFA-1466
Preparation of State Survey Agency Budget
Request (Non-LTC)-HCFA-435
Preparation of State Survey Agency Budget
Request--Long-Term Care, HCFA-435
Submittal of Budget Request
Notification of Approval
Need For Additional Title XVIII and Title XIX
Funds
Financial Reporting
Limit on Expenditures
Periodic Analysis of Accounts
Cash Balances and Expenditure Authority
Unliquidated Obligations
State Survey Agency Quarterly Expenditure
Report, HCFA-435 and State Survey Agency
Certification Workload Report HCFA-434--
Submittal and Due Date
Preparation of State Survey Agency Non-TLC
Quarterly Expenditure Report, HCFA-435
Preparation of State Survey Agency Long-Term
Care Quarterly Expenditure Report, HCFA-435
State Survey Agency/Certification Workload
Report
267 Community Mental Health Centers--Citations and
Description
Certification Process
Model Letter to CMHCs
CMHC Crucial Data Extract
Public Health Service Act Requirements
Health Insurance Benefit Agreement
Conditions to Be Assessed Prior to Scheduling An
RHC Survey
268 Assignment of Provider and Supplier
Identification Numbers
Essential Access Community Hospital//Rural
Primary Care Hospital (EACH/RPCH) Program--
Citations and Description
Procedures for EACH Approval by the Regional
Office (RO)
Procedures for RPCH Approval by the RO
Procedures for Processing RPCH Swing-Bed
Applications
Processing Complaints Against EACHs and RPCHs
Processing Denials and Terminations for EACHs
and RPCHs
EACH Approval Letter
RPCH Approval Letter
EACH Denial Letter
RPCH Denial Letter
------------------------------------------------------------------------
Medicare
Hospital Manual (HCFA-Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
------------------------------------------------------------------------
675 HCPCS for Hospital Outpatient Radiology Services
and Other Diagnostic Procedures
676 Billing for Durable Medical Equipment, Orthotic/
Prosthetic Devices and Surgical Dressings
677 Oral Cancer Drugs
Requirement That Bills Be Submitted In-Sequence
for a Continuous Inpatient Stay
678 Pneumococcal Pneumonia, Influenza Virus and
Hepatitis B Vaccines
------------------------------------------------------------------------
Medicare
Home Health Agency Manual (HCFA-Pub. 11)
(Superintendent of Documents No. HE 22.8/5)
------------------------------------------------------------------------
274 Pneumococcal Pneumonia, Influenza Virus and
Hepatitis B Vaccines
------------------------------------------------------------------------
Medicare
Skilled Nursing Facility Manual (HCFA-Pub. 12)
(Superintendent of Documents No. HE 22.8/3)
------------------------------------------------------------------------
334 Billing for Durable Medical Equipment, Orthotic/
Prosthetic Devices and Surgical Dressings
335 Requirement That Bills Be Submitted In-Sequence
For a Continuous Inpatient Stay
336 Special Billing Instructions for Pneumococcal
Pneumonia, Influenza Virus and Hepatitis B
Vaccines
------------------------------------------------------------------------
Medicare
Rural Health Clinic and Federally
Qualified Health Centers Manual (HCFA-Pub. 27)
(Superintendent of Documents No. HE 22.8/19:985)
------------------------------------------------------------------------
18 Rural Health Clinics
Federally Qualified Health Centers
19 Billing of Pneumococcal Pneumonia, Influenza
Virus and Hepatitis B Vaccines by Rural Health
Clinics and Federally Qualified Health Centers
------------------------------------------------------------------------
Medicare
Hospice Manual (HCFA-Pub. 21)
(Superintendent of Documents No. HE 22.8/18)
------------------------------------------------------------------------
45 Special Billing Instructions for Pneumococcal
Pneumonia, Influenza Virus and Hepatitis B
Vaccines
------------------------------------------------------------------------
Medicare
Provider Reimbursement Manual Part 1 (HCFA-Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
------------------------------------------------------------------------
380 Board Action on Request for Hearing
381 Ancillary Services in SNFs
382 Principles
Land (Non-Depreciable)
Historical Cost
Purchase of Facility as Ongoing Operation
Fair Market Value
Donated Assets
Net Book Value
Acquisitions
Sale and Leaseback Agreements--Rental Charges
[[Page 38350]]
Lease Purchase Agreements--Rental Charges
Assets Partially or Fully Depreciated on
Provider's Books When Provider Enters Program
Transfer of Governmental Facilities
Assets Donated to Provider
Useful Life of Depreciable Assets
------------------------------------------------------------------------
Medicare
Provider Reimbursement Manual
Part II--Provider Cost Reporting Forms and Instructions (HCFA-Pub. 15-
11AF)
(Superintendent of Documents No. HE 22.8/4)
------------------------------------------------------------------------
1 Home Health Agency Cost Report, Form HCFA-1728-
94
2 Rounding Standards for Fractional Computations
Method of Payment
Worksheet S--Independent Renal Dialysis Facility
Cost Report Certification
Worksheet A--Reclassification and Adjustments of
Trial Balance of Expenses
Worksheet A-2--Adjustments to Expenses
Worksheet B, Cost Allocation--General Service
Costs and Worksheet B-1--Cost Allocation--
Statistical Basis
------------------------------------------------------------------------
Medicare
Provider Reimbursement Manual
Part II--Provider Cost Reporting Forms
and Instructions (General) (HCFA-Pub. 15-11A)
(Superintendent of Documents No. HE 22.8/4)
------------------------------------------------------------------------
17 Submission of Cost Reports
------------------------------------------------------------------------
Medicare
Outpatient Physical Therapy and
Comprehensive Outpatient Rehabilitation Facility
Manual (HCFA-Pub. 9)
(Superintendent of Documents No. HE 22.8/9)
------------------------------------------------------------------------
120 Billing for Durable Medical Equipment, Orthotic/
Prosthetic Devices and Surgical Dressing
121 Pneumococcal Pneumonia, Influenza Virus and
Hepatitis B Vaccines
122 Pneumococcal Pneumonia, Influenza Virus and
Hepatitis B Vaccines
------------------------------------------------------------------------
Peer Review Organization Manual
(HFCA-Pub. 19)
(Superintendent of Documents No. HE 22.8/15)
------------------------------------------------------------------------
44 Introduction
HCFA-Provided Data
PRO-Selected Data
Confidentiality of PRO Data
45 Training
46 Objectives of the Internal Quality Control
Program
IQC Program Requirements
IQC Control Process
Analysis and Reporting Requirements
47 Introduction
Uses for PDC
Conducting PDC
Concerns Identified During PDC
Confidentiality
Reports to HCFA
Required HCFA Notification/Approval
Office of Management and Budget Clearance
Related Activities Through PRO/Carrier
Intermediary/ESRD Network Cooperation
Timeline for PDC Process
48 Statutory Basis
Grounds for Termination
Recommendation to Initiate Termination
Notice of Intent to Terminate Contract
Termination Panel
Termination Decision
------------------------------------------------------------------------
[[Page 38351]]
Medicare
Coverage Issues Manual (HCFA-Pub. 6)
(Superintendent of Documents No. 22. 8/14)
------------------------------------------------------------------------
74 Bladder Stimulators (Pacemakers)
------------------------------------------------------------------------
State Medicaid Manual
Part 3--Eligibility (HCFA-Pub. 45-6)
(Superintendent of Documents No. HE 22.8/10)
------------------------------------------------------------------------
65 Persons with Drug Addition or Alcoholism
------------------------------------------------------------------------
State Medicaid Manual
Part 6--Payment for Services (HCFA-Pub. 45-6)
(Superintendent of Documents No. HE 22.8/10)
------------------------------------------------------------------------
27 Physician Services to Children Under 21
Physican Services to Pregnant Women
------------------------------------------------------------------------
End Stage Renal Disease
Network Organizations Manual (HCFA-Pub. 81)
(Superintendent of Documents No. HE 22.9/4)
------------------------------------------------------------------------
2 Introduction
Board of Directors
Network Staff
Network Council
Patient Involvement
Medical Review Board
Other Committees
Meetings
Goals
Internal Quality Control System
Continuous Quality Improvement
Medicare Benefits for ESRD Patients
Hospital Insurance for Persons Needing Kidney
Transplant or Dialysis
When ESRD Coverage Begins
When ESRD Coverage Ends
Supplemental Medical Insurance
Organizational Conflicts of Interest Among
Governing Body of ESRD Network Organizations,
Facilities, and Patients
Conflict of Interest--Private Arrangements
Prohibited
Organizational Conflicts of Interest
Permitted Activities
------------------------------------------------------------------------
Medicare
Renal Dialysis Facility Manual (HCFA-Pub. 29)
(Superintendent of Document No. HE 22.8/13)
------------------------------------------------------------------------
71 Pneumococcal Pneumonia, Influenza Virus and
Hepatitis B Vaccines
------------------------------------------------------------------------
Medicare/Medicaid
Sanction/Reinstatement Report
------------------------------------------------------------------------
95-1 Report of Physicians/Practitioners, Providers
and/or Other Health Care Suppliers Excluded/
Reinstated
95-2 Report of Physicians/Practitioners, Providers
and/or Other Health Care Suppliers Excluded/
Reinstated
95-3 Report of Physicians/Practitioners, Providers
and/or Other Health Care Suppliers Excluded/
Reinstated
------------------------------------------------------------------------
Addendum IV--Medicare Coverage Issues Manual
(For the reader's convenience, new material and changes to
previously published material are in italics. If any part of a sentence
in the manual instruction has changed, the entire line is shown in
italics. The transmittal includes material unrelated to revised
sections. We are not reprinting the unrelated material.)
Transmittal No. 74; sections 65-10.1-65-11 Bladder Stimulators
(Pacemakers) CHANGED IMPLEMENTING INSTRUCTIONS--EFFECTIVE DATE: For
services performed on or after 03-01-95.
Section 65-10.1, Bladder Stimulators (Pacemakers).--This section is
revised to reflect that pelvic floor stimulators, whether inserted into
the vaginal canal or rectum or implanted in the pelvic area, used as a
treatment for urinary incontinence either as a bladder pacer or a
retraining mechanism are not covered for the reason that the safety
[[Page 38352]]
and effectiveness of these devices are unproven.
65-11 BLADDER STIMULATORS (PACEMAKERS)--NOT COVERED Pelvic floor
stimulators, whether inserted into the vaginal canal or rectum or
implanted in the pelvic area, used as a treatment for urinary
incontinence either as a bladder pacer or a retraining mechanism are
not covered for the reason that the safety and effectiveness of these
devices are unproven.
Addendum V.--Regulation Documents Published in the Federal Register
--------------------------------------------------------------------------------------------------------------------------------------------------------
End of
Publication date FR vol. 60 page CFR part File code Regulation title comment Effective
period date
--------------------------------------------------------------------------------------------------------------------------------------------------------
01/03/95........ 46-54........... 410,414......... BPD-789-CN Medicare Program; Refinements to Geographic Adjustment ........... 01/01/95
Factor Values, Revisions to Payment Policies,
Adjustments to the Relative Value Units (RVUs) Under
the Physician Fee Schedule for Calendar Year 1995,
and the 5-Year Refinement of RVUs.
01/03/95........ 130-132......... ................ HSQ-224-N CLIA Program: Approval of the Joint Commission on ........... 01/03/95
Accreditation of Healthcare Organizations As An
Accrediting Organization.
01/03/95........ 132-141......... ................ BPO-129-N Medicare and Medicaid Programs; Quarterly Listing of ........... 01/03/95
Program Issuances and Coverage Decisions--Third
Quarter 1994.
1/09/95......... 2325-2330....... 400, 405, 410, BPD-798-FC Medicare Program; Providers and Suppliers of 03/10/95 02/08/95
484, 485, 486, Specialized Services: Technical Amendments.
498,.
01/13/95........ 3250-3253....... ................ MB-089-N Medicaid Program; Limitations on Aggregate Payments to ........... 01/13/95
Disproportionate Share Hospitals: Federal Fiscal Year
1995.
01/17/95........ 3405-3410....... ................ BPD-778-FN Medicare Program; Special Payment Limits for Home ........... 02/16/95
Blood Glucose Monitors.
01/23/95........ 4418-4423....... ................ ORD-070-N New and Pending Demonstration Project Proposals ........... 01/23/95
Submitted Pursuant to Section 1115(a) of the Social
Security Act: November and December 1994.
01/26/95........ 5185-5204....... ................ BPD-776-FNC Medicare Program; Additions To and Deletions From the 03/27/95 02/27/95
Current List of Covered Surgical Procedures for
Ambulatory Surgical Centers.
02/02/95........ 6537-6547....... ................ BPD-812-NC Medicare Program; Criteria for Medicare Coverage of 04/03/95 02/02/95
Lung Transplants.
02/08/95........ 7514............ 482............. BPD-826-N Medicare Program; Hospice Wage Index.................. ........... 02/08/95
02/09/95........ 7774-7780....... ................ HSQ-223-N CLIA Program: Approval of the College of American ........... 02/09/95
Pathologists.
02/14/95........ 8389-8406....... ................ BPD-793-NC Medicare Program; Schedule of Limits on Home Health 04/17/95 07/01/94
Agency Costs Per Visit.
02/16/95........ 8951-8955....... 410............. BPD-424-F Medicare Program; Medicare Coverage of Prescription ........... 01/01/95
Drugs Used in Immunosuppressive Therapy.
02/24/95........ 10395-10396..... ................ OPL-004-N Medicare Program; Meeting of the Practicing Physicians ........... 02/24/95
Advisory Council.
03/02/95........ 11632-11633..... 485, 486........ BPD-798-CN Medicare Program; Providers and Suppliers of ........... 02/08/95
Specialized Services-Technical Amendments;
Corrections.
03/13/95........ 13441........... ................ BPD-833-N Medicare Program; Hospice Wage Index.................. ........... 03/13/95
03/16/95........ 14223-14224..... 410............. BPD-724-F Medicare Program; Medicare Coverage of Screening ........... 10/01/94
Mammography; Correction.
03/30/95........ 16481-16486..... ................ ORD-073-N New and Pending Demonstration Project Proposals ........... ...........
Submitted Pursuant to Section 1115(a) of the Social
Security Act: January 1995.
--------------------------------------------------------------------------------------------------------------------------------------------------------
*GN--General Notice; PN--Proposed Notice; FN--Final Notice; P--Notice of Proposed Rulemaking (NPRM); F--Final Rule: FC--Final Rule with Comment Period;
CN--Correction Notice; SN--Suspension Notice; WN--Withdrawal Notice; NR--Notice of HCFA Ruling
[FR Doc. 95-18333 Filed 7-25-95; 8:45 am]
BILLING CODE 4120-01-P
