[Federal Register Volume 64, Number 143 (Tuesday, July 27, 1999)]
[Proposed Rules]
[Pages 40534-40539]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-19115]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 414
[HCFA-1010-P]
RIN 0938-AJ00
Medicare Program; Replacement of Reasonable Charge Methodology by
Fee Schedules
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Proposed rule.
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SUMMARY: We are proposing to implement fee schedules to be used for
payment of services, excluding ambulance services, still subject to the
reasonable charge payment methodology. The authority for establishing
these fee schedules is provided by section 4315 of the Balanced Budget
Act of 1997 (Public Law 105-33), which adds to the Social Security Act
a new section 1842(s). A fee schedule for ambulance services is
mandated by a different statutory provision. Section 1842(s) of the
Social Security Act specifies that statewide or other areawide fee
schedules may be implemented for the following services: medical
supplies; home dialysis supplies and equipment; therapeutic shoes;
parenteral and enteral nutrients, equipment, and supplies;
electromyogram devices; salivation devices; blood products; and
transfusion medicine.
DATES: Comments will be considered if we receive them at the
appropriate address, as provided below, no later than 5 p.m. on
September 27, 1999.
ADDRESSES: Mail an original and 3 copies of written comments to the
following address: Health Care Financing Administration, Department of
Health and Human Services, Attention: HCFA-1010-P, P.O. Box 26688,
Baltimore, MD 21207-0488.
[[Page 40535]]
If you prefer, you may deliver an original and 3 copies of your
written comments to one of the following addresses: Room 443-G, Hubert
H. Humphrey Building, 200 Independence Avenue, SW., Washington, D.C.
20201, or Room C5-09-26, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code HCFA-1010-P. 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 443-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).
Copies: To order copies of the Federal Register containing this
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
of the issue requested and enclose a check or money order payable to
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number and expiration date. Credit card orders can also be placed by
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This Federal Register document is also available from the Federal
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guest (no password required). Dial-in users should use communications
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guest (no password required).
FOR FURTHER INFORMATION CONTACT: Joel Kaiser, (410) 786-4499.
SUPPLEMENTARY INFORMATION:
I. Background
A. Payment Under Reasonable Charges
Payment for most services, including supplies and equipment,
furnished under Part B of the Medicare program (Supplementary Medical
Insurance) is made through contractors known as Medicare carriers. At
one point, payment for most of these services was made on a reasonable
charge basis by these carriers. The methodology for determining
reasonable charges is set forth in section 1842(b) of the Social
Security Act (the Act) and 42 CFR part 405, subpart E of our
regulations. Reasonable charge determinations are generally based on
customary and prevailing charges derived from historic charge data. The
reasonable charge for service is generally set at the lowest of the
following factors:
The supplier's actual charge for the service.
The supplier's customary charge for the service.
The prevailing charge in the locality for similar
services. (The prevailing charge may not exceed the 75th percentile of
the customary charges of suppliers in the locality.)
The inflation indexed charge (IIC). The IIC is defined in
Sec. 405.509(a) as the lowest of the fee screens used to determine
reasonable charges for services, including supplies, and equipment paid
on a reasonable charge basis (excluding physicians' services) that is
in effect on December 31 of the previous fee screen year, updated by
the inflation adjustment factor. Fee screens are those factors
identified above, including the IIC and lowest charge level if
applicable, used to determine payment under the reasonable charge
methodology. The inflation adjustment factor is based on the current
change in the consumer price index for all urban consumers (CPI-U) for
the 12-month period ending June 30.
For parenteral and enteral nutrients, equipment, and supplies, an
additional factor, the lowest charge level (LCL), is used to determine
the reasonable charge. In accordance with Sec. 405.511(c), the LCL is
set at the 25th percentile of the charges (incurred or submitted on
claims processed by the carrier) for the above services, in the
locality designated by the carrier for this purpose, during the 3-month
period of July 1 through September 30 preceding the fee screen year
(January 1 through December 31) for which the service was furnished.
Sections 405.502(g) and 405.506 permit exceptions to the general
rules for determining reasonable charges. Section 405.502(g) gives the
carrier the authority to establish special payment limits for a
category of service if it determines that the standard rules for
calculating payments result in grossly deficient or grossly excessive
payments. Section 405.506 provides that a charge which exceeds the
customary charge, the prevailing charge, or the LCL ``may be found to
be reasonable, but only where there are unusual circumstances, or
medical complications requiring additional time, effort or expense
which support an additional charge, and only if it is acceptable
medical or medical service practice in the locality to make an extra
charge in such cases.''
B. Payment Under Fee Schedules
The law gradually replaced the reasonable charge payment
methodology with fee schedule payment methodologies for most services
furnished under Part B of the Medicare program. Fee schedules have been
established for physicians' services, laboratory services, durable
medical equipment (DME), prosthetics and orthotics, surgical dressings,
and, beginning in the year 2000, ambulance services. Subject to
coinsurance and deductible rules, Medicare payment for these services
is equal to the lower of the actual charge for the service or the
amount determined under the fee schedule methodology.
Section 4315 of the Balanced Budget Act of 1997 (BBA) amends the
Act at section 1842 by adding a new subsection(s). Section 1842(s) of
the Act provides authority for implementing statewide or other areawide
fee schedules to be used for payment of the following services that are
currently paid on a reasonable charge basis:
Medical supplies.
Home dialysis supplies and equipment (as defined in
section 1881(b)(8) of the Act).
Therapeutic shoes.
Parenteral and enteral nutrients, equipment, and supplies
(PEN).
Electromyogram devices.
Salivation devices.
Blood products.
Transfusion medicine.
Section 1842(s)(1) of the Act provides that the fee schedules for
the services listed above are to be updated on an annual basis by the
percentage increase in the CPI-U (United States city average) for the
12-month period ending with June of the preceding year. The fee
schedules for PEN, however, may not be updated before the year 2003.
Finally, total payments for the initial year of the fee schedules must
be approximately equal to the estimated total payments that would have
been made under the
[[Page 40536]]
reasonable charge payment methodology.
II. Provisions of the Proposed Regulations
A. General
We propose, under section 1842(s) of the Act, to implement fee
schedules for those services listed above. Subject to coinsurance and
deductible rules, Medicare payment for these services is to be equal to
the lower of the actual charge for the service or the amount determined
under the applicable fee schedule payment methodology presented below.
The fee schedules we propose would apply to services furnished on or
after January 1, 1999, and would be calculated using base reasonable
charges updated by an inflation update factor.
Section 4315(d) of the BBA requires that the total payments for the
initial year of the fee schedules be approximately equal to the
estimated total payments that would have been made under the reasonable
charge payment methodology. For this reason, for services other than
PEN, we are proposing that the fee schedule amounts be based on average
reasonable charges from the period July 1, 1996 through June 30, 1997,
the same data period used in calculating the 1998 reasonable charges.
Furthermore, for the purposes of calculating the 1999 fee schedule
amounts, we are proposing that the base fee schedule amounts be
increased by the change in the CPI-U for the 12-month period ending
with June of 1998, the inflation adjustment factor that would have
otherwise been used in calculating the 1999 IICs. This would update the
reasonable charge data to the 1999 level, the initial year of the fee
schedules. For PEN, which accounts for approximately 90 percent of the
Medicare expenditures for services addressed in this rule, we are
proposing that the fee schedule amounts be based on the reasonable
charges that would have been used in determining payment for PEN in
1999.
The proposed fee schedules would have a minimal, if any, impact on
the efforts of HCFA and its contractors to revise their current systems
to be millennium or Y2K compliant, as Y2K compliant fee schedule
systems are already in place for other services. The proposed fee
schedules would be incorporated into these current systems.
B. National Limits
For medical supplies, electromyogram devices, salivation devices,
blood products, and transfusion medicine furnished within the
continental United States, we propose national limits on the statewide
fee schedule amounts similar to those that were mandated by the
Congress for DME and surgical dressings in section 1834 of the Act. The
Congress mandated ceilings and floors, equal to 100 percent and 85
percent, respectively, of the median of all statewide fee schedule
amounts, to limit unreasonably high and low fees resulting from the
local fee calculations for DME and surgical dressings. The Congress
recognized the unique costs of doing business in areas outside the
continental United States and therefore did not apply the national
limits for DME and surgical dressings to these areas.
The national limits for DME and surgical dressings have been
effective at eliminating outlying fees that cannot be explained by the
differences in the costs of doing business in one part of the country
versus another. We are therefore proposing that this methodology be
applied to the services identified above. Accordingly, the statewide
fee schedule amounts for these services may not exceed 100 percent of
the median of all statewide fee schedule amounts for areas within the
continental United States and may not be less than 85 percent of the
median of all statewide fee schedule amounts for areas within the
continental United States. The statewide fee schedule amounts for areas
outside the continental United States will not be subject to the
national limits. National limits are not proposed for home dialysis
supplies and equipment, therapeutic shoes, or PEN because the payment
amounts for these services are already subject to national limits or
are determined on a national basis in the case of PEN.
C. Medical Supplies
Medical supplies are miscellaneous supplies or devices including,
but not limited to, casts, splints, and paraffin that are not already
included under an existing fee schedule. In addition, intraocular
lenses (IOLs) inserted during or subsequent to cataract surgery in a
physician's office are considered medical supplies for payment purposes
under this rule. For calendar year 1999, we propose statewide fee
schedule amounts equal to the weighted average of allowed charges for
the services. For these calculations, we will use reasonable charge
data with dates of service from July 1, 1996 through June 30, 1997,
increased by the change in the CPI-U for the 12-month period ending
with June of 1998. The fee schedule amounts are to be updated on an
annual basis in accordance with section 1842(s)(1) of the Act.
Beginning with the second year of the fee schedule, the statewide fee
schedule amounts for IOLs inserted in a physician's office are not to
exceed the Medicare allowed payment amount for IOLs furnished by
ambulatory surgical centers (ASCs).
D. Home Dialysis Supplies And Equipment
These are services as defined in Sec. 410.52. For calendar year
1999, we propose statewide fee schedule amounts equal to the weighted
average of allowed charges for the services. For these calculations, we
will use reasonable charge data with dates of service from July 1, 1996
through June 30, 1997, increased by the change in the CPI-U for the 12-
month period ending with June of 1998. However, amount of payment under
this methodology may not exceed the limit specified for equipment and
supplies in Sec. 414.330(c)(2). The fee schedule amounts are to be
updated on an annual basis in accordance with section 1842(s)(1) of the
Act.
E. Therapeutic Shoes
These services are defined in section 1861(s)(12) of the Act as
``extra-depth shoes with inserts or custom molded shoes with inserts
for an individual with diabetes.'' In addition, section 1833(o)(2)(D)
of the Act provides that an individual ``may substitute modification of
such shoes instead of obtaining one (or more, as specified by the
Secretary) pairs of inserts (other than the original pair of inserts
with respect to such shoes).'' Section 1833(o)(2)(A) of the Act
establishes national payment limits for these services. These are upper
payment limits, or ceilings, applied to the reasonable charges
calculated for these services. The initial year, 1988 limits were $300
for one pair of custom molded shoes (including any inserts that are
provided initially with the shoes), $100 for one pair of extra-depth
shoes (not including inserts provided with such shoes), and $50 for any
pairs of inserts. In accordance with section 1833(o)(2)(C) of the Act,
these national payment limits are increased on an annual basis by the
same annual percentage increase provided for DME, rounded to the
nearest multiple of $1. We may establish limits lower than these limits
if shoes and inserts of appropriate quality are readily available at or
below the limits. We have determined that, to the extent that
reasonable charges for shoes and inserts are lower than the limitations
contained in section 1834(o)(2)(A) of the Act, shoes and inserts are
readily available at that level. Therefore, we find it appropriate and
consistent with the
[[Page 40537]]
direction of the BBA to apply fee schedule amounts lower than the
limits.
For calendar year 1999, we propose statewide fee schedule amounts
equal to the weighted average of allowed charges for the services. For
these calculations, we will use reasonable charge data with dates of
service from July 1, 1996 through June 30, 1997, increased by the
change in the CPI-U for the 12-month period ending with June of 1998.
In addition, the statewide fee schedule amounts may not exceed the
national payment limits established under section 1833(o)(2) of the
Act. The fee schedule amounts are to be updated on an annual basis in
accordance with section 1842(s)(1) of the Act.
F. Parenteral and Enteral Nutrients (PEN)
These services are covered by Medicare as prosthetic devices, which
are defined in section 1861(s)(8) of the Act. However, PEN is excluded
from the prosthetic and orthotic fee schedule payment methodology by
section 1834(h)(4)(B) of the Act. In accordance with section 4551(b) of
the BBA, the reasonable charges for PEN for the years 1998 through 2002
may not exceed the reasonable charges determined for 1995. The
prevailing charges for PEN are currently determined on a nationwide
basis (that is, the 75th percentile of the customary charges of
suppliers in the entire nation).
As explained above, section 4551(b) of the BBA limits the
reasonable charges calculated for 1998 through 2002 for PEN to the
reasonable charges calculated in 1995. Therefore, payment under the
reasonable charge methodology would be based on the lesser of the
charges calculated for the given fee screen year (for example, 1999) or
the charges calculated for 1995. For calendar year 1999, we propose
nationwide fee schedule amounts equal to the lesser of the charges
determined to be reasonable for the services during 1995 or the charges
determined to be reasonable for the services during 1998 (using charge
data with dates of service from July 1, 1996 through June 30, 1997),
increased by the inflation adjustment factor that would have otherwise
been used in calculating the 1999 IICs, in effect, the 1999 reasonable
charges. Beginning the fee screen year 2003, the fee schedule amounts
are to be updated on an annual basis in accordance with section
1842(s)(1) of the Act.
G. Electromyogram Devices And Salivation Devices
The decision regarding Medicare coverage of these services is made
at the carrier's discretion. In any carrier area in which these
services are covered, for calendar year 1999, we propose statewide fee
schedule amounts equal to the weighted average of allowed charges for
the services. For these calculations, we will use reasonable charge
data with dates of service from July 1, 1996 through June 30, 1997,
increased by the change in the CPI-U for the 12-month period ending
with June of 1998. The fee schedule amounts are to be updated on an
annual basis in accordance with section 1842(s)(1) of the Act.
H. Blood Products
For calendar year 1999, we propose statewide fee schedule amounts
equal to the weighted average of allowed charges for the blood products
services. These services are not included under the definition of drugs
and biologicals in section 1861(t)(1) of the Act. For these
calculations, we will use reasonable charge data with dates of service
from July 1, 1996 through June 30, 1997, increased by the change in the
CPI-U for the 12-month period ending with June of 1998. The fee
schedule amounts are to be updated on an annual basis in accordance
with section 1842(s)(1) of the Act.
I. Transfusion Medicine
For calendar year 1999, we propose statewide fee schedule amounts
equal to the weighted average allowed charges for transfusion medicine
services. For these calculations, we will use reasonable charge data
with dates of service from July 1, 1996 through June 30, 1997,
increased by the change in the CPI-U for the 12-month period ending
with June of 1998. The fee schedule amounts are to be updated on an
annual basis in accordance with section 1842(s)(1) of the Act.
III. Response to Comments
Because of the large 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
all comments we receive by the date and time specified in the DATES
section of this preamble, and, if we proceed with a subsequent
document, we will respond to the comments in the preamble to that
document.
IV. Regulatory Impact Statement
We have examined the impacts of this proposed rule as required by
Executive Order 12866 and the Regulatory Flexibility Act (RFA) (Public
Law 96-354). Executive Order 12866 directs agencies to assess all costs
and benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). The RFA requires agencies
to analyze options for regulatory relief of small businesses. For
purposes of the RFA, small entities include small businesses, non-
profit organizations and government agencies. Most hospitals and most
other providers and suppliers are small entities, either by non-profit
status or by having revenues of $5 million or less annually. For
purposes of the RFA, all suppliers of Medicare Part B services are
considered to be small entities. Individuals and States are not
included in the definition of a small entity.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
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 is located outside of a Metropolitan
Statistical Area and has fewer than 50 beds.
We expect suppliers of the Part B services listed in this preamble
to be affected by this proposed rule. For 1999, the initial year of the
fee schedules, we estimate that there will be a decrease of less than 1
percent in total expenditures for the services addressed in this
proposed rule. Therefore, we expect that the overall impact of this
proposed rule will be negligible.
With regard to IOLs, beginning with the second year of the fee
schedules, we are proposing that the fee schedule amounts not exceed
the Medicare allowed payment amount for IOLs furnished by ASCs.
Therefore, it is likely that the IOL fee schedule amounts will decrease
after the first year of the fee schedules. We do not believe, however,
that limiting payment for IOLs furnished in a physician's office to the
amount paid for IOLs furnished in an ASC will result in a lack of
availability of IOLs to Medicare beneficiaries. The IOLs furnished by
ASCs are the same devices that are furnished in a physician's office.
The Medicare payment amount for IOLs furnished by ASCs is established
through separate regulations and is based on the average price paid by
ASCs for these devices. This amount should represent adequate payment
to physicians for the cost of the IOL device that they insert in their
office.
[[Page 40538]]
We expect that total expenditures in the outlying fee schedule
years of 2000 and beyond will continue to approximate total
expenditures that would have otherwise been made under the reasonable
charge methodology in part because the fee schedules are updated using
the same factor used in updating the IICs under the reasonable charge
methodology.
For these reasons, we are not preparing an analysis for either the
RFA or section 1102(b) of the Act because we have determined, and we
certify, that this proposed rule would not have a significant economic
impact on a substantial number of small entities or a significant
impact on the operations of a substantial number of small rural
hospitals.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
42 CFR part 414 would be amended as set forth below:
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
1. The authority citation for part 414 continues to read as
follows:
Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).
Subpart A--General Provisions
2. A new Sec. 414.70 is added to read as follows:
Sec. 414.70 Fee schedules for certain items and services previously
paid on a reasonable charge basis.
(a) General rule. For services defined in Sec. 400.202 of this
chapter furnished on or after January 1, 1999, Medicare pays for the
services as described in paragraph (b) of this section on the basis of
80 percent of the lesser of--
(1) The actual charge for the service; or
(2) The fee schedule amount for the service, as determined in
accordance with paragraphs (e) through (k) of this section.
(b) Payment classification. (1) HCFA or the carrier determines fee
schedules for the following categories of services:
(i) Medical supplies, as specified in paragraph (e) of this
section.
(ii) Home dialysis supplies and equipment, as specified in
paragraph (f) of this section.
(iii) Therapeutic shoes, as specified in paragraph (g) of this
section.
(iv) Parenteral and enteral nutrients, equipment, and supplies
(PEN), as specified in paragraph (h) of this section.
(v) Electromyogram devices and salivation devices, as specified in
paragraph (i) of this section.
(vi) Blood products, as specified in paragraph (j) of this section.
(vii) Transfusion medicine, as specified in paragraph (k) of this
section.
(2) HCFA designates the specific services in each category through
program instructions.
(c) Definition. Local payment amount means the weighted average
reasonable charge for the service furnished in a State, the District of
Columbia, or a United States territory during the period July 1, 1996
through June 30, 1997, as determined by the carrier, increased by the
change in the consumer price index for all urban consumers (CPI-U) for
the 12-month period ending with June 1998.
(d) Updating the fee schedule amounts. Except for the fee schedule
amounts for services described in paragraph (h) of this section, for
each year subsequent to 1999, the fee schedule amounts of the preceding
year are updated by the percentage increase in the CPI-U for the 12-
month period ending with June of the preceding year. For services
described in paragraph (h) of this section, for each year subsequent to
2002, the fee schedule amounts of the preceding year are updated by the
percentage increase in the CPI-U for the 12-month period ending with
June of the preceding year.
(e) Medical supplies. (1) This category includes, but is not
limited to, cast supplies, splints, paraffin, and intraocular lenses
(IOLs) inserted during or subsequent to cataract surgery in a
physician's office.
(2) Payment for medical supplies is made in a lump sum amount for
purchase of the item based on the applicable fee schedule amount.
(3) The fee schedule amount for an item furnished in 1999 is one of
the following:
(i) Within the continental United States, 100 percent of the local
payment amount if the local payment amount is neither greater than the
median nor less than 85 percent of the median of all local payment
amounts for areas within the continental United States.
(ii) Within the continental United States, 100 percent of the
median of all local payment amounts for areas within the continental
United States if the local payment amount exceeds the median of all
local payment amounts for areas within the continental United States.
(iii) Within the continental United States, 85 percent of the
median of all local payment amounts for areas within the continental
United States if the local payment amount is less than 85 percent of
the median of all local payment amounts for areas within the
continental United States.
(iv) 100 percent of the local payment amount for areas outside the
continental United States.
(4) For each year subsequent to 1999, the fee schedule payment
amounts for IOLs inserted in a physician's office may not exceed the
Medicare allowed payment amount for IOLs furnished by ambulatory
surgical centers.
(f) Home dialysis supplies and equipment. (1) This category
includes items and services as defined in Sec. 410.52 of this chapter.
(2) Payment for home dialysis supplies and equipment is made in a
lump sum based on the applicable fee schedule amount, but may not
exceed the limit for equipment and supplies in Sec. 414.330(c)(2).
(3) The fee schedule amount for a service furnished in 1999 is
equal to the local payment amount.
(g) Therapeutic shoes. (1) This category includes extra-depth shoes
with inserts or custom molded shoes with inserts for an individual with
diabetes, modifications of the shoes, and replacement inserts for the
shoes.
(2) Payment for therapeutic shoes is made in a lump sum based on
the applicable fee schedule amount.
(3) The fee schedule amount for payment for a service furnished in
1999 is the lesser of--
(i) The local payment amount; or
(ii) The national payment limit specified in section 1833(o)(2) of
the Act.
(h) Parenteral and enteral nutrients, equipment, and supplies
(PEN). (1) Payment for PEN is made in a lump sum based on the
applicable fee schedule amount.
(2) The fee schedule amount for payment for a service furnished in
1999 is the lesser of--
(i) The charge determined to be reasonable for the service during
1995; or
(ii) The charge determined to be reasonable for the service during
1998, increased by the inflation adjustment factor used in calculating
the 1999 IIC.
(i) Electromyogram and salivation devices.
(1) Payment for an electromyogram device or a salivation device is
made in a lump sum for purchase of the device or on a monthly rental
basis based on the applicable fee schedule amount.
(2) The fee schedule amount for payment for an electromyogram
device or a salivation device furnished in 1999 is one of the
following:
(i) Within the continental United States, 100 percent of the local
payment
[[Page 40539]]
amount if the local payment amount is neither greater than the median
nor less than 85 percent of the median of all local payment amounts for
areas within the continental United States.
(ii) 100 percent of the median of all local payment amounts for
areas within the continental United States if the local payment amount
within the continental United States exceeds the median of all local
payment amounts for areas within the continental United States.
(iii) 85 percent of the median of all local payment amounts for
areas within the continental United States if the local payment amount
within the continental United States is less than 85 percent of the
median of all local payment amounts for areas within the continental
United States.
(iv) 100 percent of the local payment amount for areas outside the
continental United States.
(j) Blood products. (1) Payment for blood products is made in a
lump sum based on the applicable fee schedule amount.
(2) The fee schedule amount for payment for a blood product
furnished in 1999 is one of the following:
(i) Within the continental United States, 100 percent of the local
payment amount if the local payment amount is neither greater than the
median nor less than 85 percent of the median of all local payment
amounts for areas within the continental United States.
(ii) 100 percent of the median of all local payment amounts for
areas within the continental United States if the local payment amount
within the continental United States exceeds the median of all local
payment amounts for areas within the continental United States.
(iii) 85 percent of the median of all local payment amounts for
areas within the continental United States if the local payment amount
within the continental United States is less than 85 percent of the
median of all local payment amounts for areas within the continental
United States.
(iv) 100 percent of the local payment amount for areas outside the
continental United States.
(k) Transfusion medicine. (1) Payment for transfusion medicine is
made in a lump sum based on the applicable fee schedule amount.
(2) The fee schedule amount for payment for transfusion medicine
furnished in 1999 is one of the following:
(i) Within the continental United States, 100 percent of the local
payment amount if the local payment amount is neither greater than the
median nor less than 85 percent of the median of all local payment
amounts for areas within the continental United States.
(ii) 100 percent of the median of all local payment amounts for
areas within the continental United States if the local payment amount
within the continental United States exceeds the median of all local
payment amounts for areas within the continental United States.
(iii) 85 percent of the median of all local payment amounts for
areas within the continental United States if the local payment amount
within the continental United States is less than 85 percent of the
median of all local payment amounts for areas within the continental
United States.
(iv) 100 percent of the local payment amount for areas outside the
continental United States.
Subpart E--Determination of Reasonable Charges Under the ESRD
Program
3. In Sec. 414.330 the introductory text of paragraph (a)(2) is
revised to read as follows:
Sec. 414.330 Payment for home dialysis equipment, supplies, and
support services.
(a) * * *
(2) Exception. If the conditions in paragraphs (a)(2)(i) through
(a)(2)(iv) of this section are met, Medicare pays for home dialysis
equipment and supplies on a fee schedule basis in accordance with
Sec. 414.70, but the amount of payment may not exceed the limit for
equipment and supplies in paragraph (c)(2) of this section.
* * * * *
(Catalog of Federal Domestic Assistance Programs No. 93.774,
Medicare-Supplementary Medical Insurance Program)
Dated: January 3, 1999.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Dated: February 25, 1999.
Donna E. Shalala,
Secretary.
[FR Doc. 99-19115 Filed 7-26-99; 8:45 am]
BILLING CODE 4120-01-P
