Medicare program; prospective payment system for hospital outpatient services: revisions to criteria to define new or innovative medical devices, drugs, and biologicals eligible for pass-through payments and corrections to the criteria for the grandfather provision for certain Federally Qualified Health Centers.  Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period.
This interim final rule with comment period changes one criterion and postpones the effective date for two other criteria that a new device, drug, or biological must meet in order for its cost to be considered "not significant" for purposes of determining its eligibility for transitional pass-through payments.  It also changes the transitional pass-through payment policy to include new single use medical devices that come in contact with human tissue and that are surgically implanted or inserted in a patient whether or not the devices remain with the patient after the patient is released from the hospital outpatient department.  These policies represent a departure from those presented in the April 7, 2000 Federal Register final rule with comment period entitled, "Prospective Payment System for Hospital Outpatient Services."  This interim final rule with comment period also corrects a trigger date for grandfathering of provider-based Federally Qualified Health Centers (FQHCs) to conform with the intent not to disrupt existing FQHCs with longstanding provider-based treatment that we discussed in the April 2000 final rule.  Under the criteria in the April 2000 final rule with comment period, FQHCs are treated as departments of a provider without regard to the criteria for provider-based status in that document if they meet other criteria and were designated as FQHCs before 1995.  Under this correction, facilities that meet those other criteria and were designated as FQHCs or "look-alikes" on or before April 7, 2000 would continue to be treated as provider-based.  In addition, we are clarifying how the requirement for prior notice to beneficiaries is to be applied in emergency situations.  Also, we are clarifying the protocols for off-campus departments in emergency situations.
D000553:Ambulatory Care / Q000191:economics / Q000331:legislation & jurisprudence; D004865:Equipment and Supplies, Hospital / Q000191:economics; D006801:Humans; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence*; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000331:legislation & jurisprudence*; D011445:Prospective Payment System / Q000191:economics / Q000331:legislation & jurisprudence*; D014481:United States