Final Rule with Comment Period on Medicare OPPS - Ropes & Gray

jlentini on DSK4TPTVN1PROD <strong>with</strong> RULES274582 Federal Register / Vol. 76, No. 230 / Wednesday, November 30, 2011 / <strong>Rule</strong>s and Regulationslicensed as of the date that the hospitalsubmits a request for an exception; andthe additional number of operatingrooms, procedure rooms, and beds bywhich the hospital requests to expand.(iii) A request must include thefollowing certification signed by anauthorized representative of thehospital: ‘‘With knowledge of thepenalties for false statements providedby 18 U.S.C. 1001, I certify that all of theinformation provided in the request andall of the documentation provided <strong>with</strong>the request is true and correct to the bestof my knowledge and belief.’’ Anauthorized representative is the chiefexecutive officer, chief financial officer,or other comparable officer of thehospital.(5) Community input and timing ofcomplete request. Upon submitting arequest for an exception and until thehospital receives a CMS decision, thehospital must disclose on any publicWeb site for the hospital that it isrequesting an exception. Individualsand entities in the hospital’s communitymay provide input <strong>with</strong> respect to thehospital’s request no later than 30 daysafter CMS publishes notice of thehospital’s request in the FederalRegister. Such input must take the formof written comments. The writtencomments must be either mailed orsubmitted electronically to CMS.(i) If CMS does not receive writtencomments from the community, arequest will be deemed complete at theend of the 30-day period.(ii) If CMS receives written commentsfrom the community, the hospital has 30days after CMS notifies the hospital ofthe written comments to submit arebuttal statement. A request will bedeemed complete at the end of this 30-day period regardless of whether thehospital submits a rebuttal statement.(6) A permitted increase under thissection—(i) May not result in the number ofoperating rooms, procedure rooms, andbeds for which the hospital is licensedexceeding 200 percent of the hospital’sbaseline number of operating rooms,procedure rooms, and beds; and(ii) May occur only in facilities on thehospital’s main campus.(7) Publication of final decisions. Notlater than 60 days after receiving acomplete request, CMS will publish thefinal decision in the Federal Register.(8) Limitation on review. There shallbe no administrative or judicial reviewunder section 1869, section 1878, orotherwise of the process under thissection (including the establishment ofsuch process).PART 416—AMBULATORY SURGICALSERVICES■ 5. The authority citation for Part 416continues to read as follows:Authority: Secs. 1102 and 1871 of theSocial Security Act (42 U.S.C. 1302and1395hh).■ 6. Section 416.166 is amended byrevising paragraph (b) to read as follows:§ 416.166 Covered surgical procedures.* * * * *(b) General standards. Subject to theexclusions in paragraph (c) of thissection, covered surgical procedures aresurgical procedures specified by theSecretary and published in the FederalRegister and/or via the Internet on theCMS Web site that are separately paidunder the OPPS, that would not beexpected to pose a significant safety riskto a Medicare beneficiary whenperformed in an ASC, and for whichstandard medical practice dictates thatthe beneficiary would not typically beexpected to require active medicalmonitoring and care at midnightfollowing the procedure.* * * * *■ 7. Section 416.171 is amended by—■ a. Revising paragraph (b).■ b. Revising paragraph (d).The revisions read as follows:§ 416.171 Determination of payment ratesfor ASC services.* * * * *(b) Exception. The national ASCpayment rates for the following itemsand services are not determined inaccordance <strong>with</strong> paragraph (a) of thissection but are paid an amount derivedfrom the payment rate for the equivalentitem or service set under the paymentsystem established in part 419 of thissubchapter as updated annually in theFederal Register and/or via the Interneton the CMS Web site. If a payment rateis not available, the following items andservices are designated as contractorpriced:* * * * *(d) Limitation on payment rates foroffice-based surgical procedures andcovered ancillary radiology services.Not<strong>with</strong>standing the provisions ofparagraph (a) of this section, for anycovered surgical procedure under§ 416.166 that CMS determines iscommonly performed in physicians’offices or for any covered ancillaryradiology service, excluding those listedin paragraphs (d)(1) and (d)(2) of thissection, the national unadjusted ASCpayment rates for these procedures andservices will be the lesser of the amountdetermined under paragraph (a) of thisVerDate Mar2010 17:08 Nov 29, 2011 Jkt 226001 PO 00000 Frm 00462 Fmt 4701 Sfmt 4700 E:\FR\FM\30NOR2.SGM 30NOR2section or the amount calculated at thenonfacility practice expense relativevalue units under § 414.22(b)(5)(i)(B) ofthis subchapter multiplied by theconversion factor described in§ 414.20(a)(3) of this subchapter.(1) The national unadjusted ASCpayment rate for covered ancillaryradiology services that involve certainnuclear medicine procedures will be theamount determined under paragraph (a)of this section.(2) The national unadjusted ASCpayment rate for covered ancillaryradiology services that use contrastagents will be the amount determinedunder paragraph (a) of this section.* * * * *■ 8. Section 416.173 is revised to readas follows:§ 416.173 Publication of revised paymentmethodologies and payment rates.CMS publishes annually, throughnotice and comment rulemaking in theFederal Register and/or via the Interneton the CMS Web site, the paymentmethodologies and payment rates forASC services and designates the coveredsurgical procedures and coveredancillary services for which CMS willmake an ASC payment and otherrevisions as appropriate.PART 419—PROSPECTIVE PAYMENTSYSTEM FOR HOSPITAL OUTPATIENTDEPARTMENT SERVICES■ 9. The authority citation for Part 419continues to read as follows:Authority: Secs. 1102, 1833(t), and 1871of the Social Security Act (42 U.S.C. 1302,1395(t), and 1395hh).■ 10. Section 419.32 is amended by:■ a. Revising paragraph (b)(1)(iv)(A).■ b. Removing the word ‘‘and’’ thatappears at the end of paragraph(b)(1)(iv)(B)(1).■ c. Removing the period and adding ‘‘;and’’ in its place at the end of paragraph(b)(1)(iv)(B)(2).■ d. Adding a new paragraph(b)(1)(iv)(B)(3).The revision and addition read asfollows:§ 419.32 Calculation of prospectivepayment rates for hospital outpatientservices.* * * * *(b) * * *(1) * * *(iv)(A) For calendar year 2003 andsubsequent years, by the hospitalinpatient market basket percentageincrease applicable under section1886(b)(3)(B)(iii) of the Act, reduced bythe factor(s) specified in paragraph(b)(1)(iv)(B) of this section.