Federal Register / Vol. 65, No. 127 / Friday, June 30, 2000 / Rules and Regulations 40535

stated previously, EPA has made such a

good cause finding, including the

reasons therefor, and established an

effective date of June 30, 2000. EPA will

submit a report containing this rule and

other required information to the U.S.

Senate, the U.S. House of

Representatives, and the Comptroller

General of the United States prior to

publication of the rule in the Federal

Register. This action is not a ‘‘major

rule’’ as defined by 5 U.S.C. 804(2).

List of Subjects in 40 CFR Part 82

Environmental protection,

Administrative practice and procedure,

Air pollution control, Chemicals,

Chlorofluorocarbons, Exports, Imports,

Ozone layer, Reporting and

recordkeeping requirements.

Dated: June 22, 2000.

Carol M. Browner,

Administrator.

40 CFR Part 82 is to be amended as

follows:

PART 82—PROTECTION OF

STRATOSPHERIC OZONE

1. The authority citation for part 82

continues to read as follows:

Authority: 42 U.S.C. 7414, 7601,7671–

7671q.

Subpart A—Production and

Consumption Controls

2. Section 82.4 is amended by revising

the table in paragraph (t)(2) to read as

follows:

§ 82.4 Prohibitions.

* * * * *

(t) * * *

(2) * * *

TABLE 1—ESSENTIAL USE ALLOCATION FOR CALENDAR YEAR 2000

Company Chemical Quantity

(metric tons)

(i) Metered Dose Inhalers (for oral inhalation) for Treatment of Asthma and Chronic Obstructive Pulmonary Disease (in metric tons)

International Pharmaceutical Aerosol Consortium (IPAC)—Medeva Americas, Inc.,

Boehringer Ingelheim Pharmaceuticals, Glaxo Wellcome, Aventis (formerly RhonePoulene Rorer), 3M.

CFC–11 or ..............................

CFC–12 or ..............................

CFC–114 .................................

2038.0

Medisol Laboratories, Inc. .......................................................................................................... CFC–11 or ..............................

CFC–12 or ..............................

CFC–114 .................................

49.0

Schering Corporation ................................................................................................................. CFC–11 or ..............................

CFC–12 or ..............................

CFC–114 .................................

1048.0

Sciarra Laboratories, Inc. ........................................................................................................... CFC–11 or ..............................

CFC–12 or ..............................

CFC–114 .................................

1.3

(ii) Cleaning, Bonding and Surface Activation Applications for the Space Shuttle Rockets and Titan Rockets

National Aeronautics and Space Administration (NASA)/Thiokol Rocket ................................. Methyl Chloroform .................. 56.7

United States Air Force/Titan Rocket ........................................................................................ Methyl Chloroform .................. 3.4

[FR Doc. 00–16628 Filed 6–29–00; 8:45 am]

BILLING CODE 6560–50–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

Office of Inspector General

42 CFR Parts 409, 410, 411, 412, 413,

419, 424, 489, 498, and 1003

[HCFA–1005-N5]

RIN 0938–AI56

Medicare Program; Prospective

Payment System for Hospital

Outpatient Services; Delay of Effective

Date

AGENCY: Health Care Financing

Administration (HCFA), HHS, and

Office of Inspector General (OIG), HHS.

ACTION: Notice of delay of effective date

for final rule with comment period.

SUMMARY: This document delays the

effective date on a final rule with

comment period published in the

Federal Register on April 7, 2000 (65 FR

18434). That rule implemented a

prospective payment system for hospital

outpatient services furnished to

Medicare beneficiaries, as set forth in

section 1833(t) of the Social Security

Act. It also established requirements for

provider departments and providerbased entities, and it implemented

section 9343(c) of the Omnibus Budget

Reconciliation Act of 1986, which

prohibits Medicare payment for

nonphysician services furnished to a

hospital outpatient by a provider or

supplier other than a hospital, unless

the services are furnished under an

arrangement with the hospital. In

addition, the rule established in

regulations the extension of reductions

in payment for costs of hospital

outpatient services required by section

4522 of the Balanced Budget Act of

1997, as amended by section 201(k) of

the Balanced Budget Refinement Act of

1999. The effective date is delayed from

July 1, 2000 to August 1, 2000.

DATES: Effective date: August 1, 2000,

except that the changes to

§ 412.24(d)(6), new § 413.65, and the

changes to § 489.24(h), § 498.2, and

§ 498.3 are effective October 10, 2000.

Applicability date: For Medicare

services furnished by hospitals that are

subject to the prospective payment

system, including hospitals excluded

from the inpatient prospective payment

system, and by community mental

health centers, the applicability date for

implementation of the hospital

outpatient prospective payment system

is August 1, 2000.

FOR FURTHER INFORMATION CONTACT:

Janet Wellham, (410) 786–4510.

SUPPLEMENTARY INFORMATION:

I. Background

On April 7, 2000, we issued a final

rule with comment period in the

Federal Register (65 FR 18434) that

reflected the provisions of the

September 8, 1998 proposed rule (63 FR

40536 Federal Register / Vol. 65, No. 127 / Friday, June 30, 2000 / Rules and Regulations

47552), except as noted in the preamble

of the April 2000 rule (65 FR 18527).

Based on the following concerns, we

have decided to delay the effective date

of the April 2000 final rule until August

1, 2000.

In order to implement the prospective

payment system (PPS), we have had to

make a major change to the current

claims processing system. This change,

called the claims expansion and line

item processing (CELIP), expands the

electronic version of the claim form

used by hospitals to submit claims to

the automated bill processing systems to

correctly determine the Medicare

payment and beneficiary copayment

amounts for outpatient services under

PPS. Because a beneficiary can receive

many outpatient services during one

hospital visit and the payment system

must properly group all the services

furnished in one visit to accurately

calculate Medicare’s payment and the

beneficiary’s copayment, it was

necessary to expand the electronic claim

form to greatly increase the number of

line items a hospital can bill for any one

visit as well as provide for adjudication

of each individual line item on the

claim. As noted in the final rule with

comment period, the CELIP is a

necessary prerequisite for implementing

outpatient PPS (65 FR 18488).

During most of 1998 and for all of

1999, HCFA, along with other

government agencies and private sector

companies throughout the world,

focused its technology resources on

ensuring the Y2K compliance of its

computer systems. After meeting the

challenges posed by Y2K, HCFA then

resumed other systems work, including

testing implementation of the CELIP. As

we began testing the CELIP, some

unanticipated problems arose, resulting

in a need for reprogramming and testing

the systems changes. Although we

originally believed that the problems

could be corrected in time to implement

the PPS on July 1 as provided in the

April final rule with comment period,

we have concluded based on more

recent testing and adjustment that it is

virtually impossible for the new

payment system to be effectively

implemented on July 1 as we had

planned. We address below some of the

problems HCFA, its contractors, and

hospitals encountered in transitioning

to the new outpatient PPS payment

system that have necessitated a change

in effective date for implementation of

that payment system.

Expanding the number of line items

on the electronic claim form from the

current 56 to the 450 needed to

implement the PPS caused serious

problems for HCFA’s computer systems.

When we attempted to program this

change, we found that our computer

systems could not accommodate the

expanded claim form. As a result, we

had to split the claim form into four

different files, expending time and

programming resources for tasks we had

not anticipated. We encountered similar

problems in installing the outpatient

code editor (OCE). The OCE is also a

critical component of the system we use

to pay outpatient claims. The OCE edits

claim data to identify errors and returns

edit flags when appropriate. It also

assigns the Ambulatory Payment

Classification (APC) number. Each APC

is comprised of services that are similar

clinically and which require similar

hospital resources. The APC is supplied

by the OCE to the pricing program that

calculates a payment rate for each APC.

We found that the OCE did not fit into

the configuration management tool that

governs the size of the software used by

each computer system to make payment

under the PPS. As a result, the tables in

the OCE were reconfigured as with the

claim form, and we had to split the OCE

into segments to allow it to work with

HCFA’s computer systems. Because of

these and similar problems, the testing

of our computer systems with the CELIP

installed had to be repeated a number of

times. (In the testing mode in which we

were operating, this did not cause any

disruptions to payments made under

current payment methodologies.)

As noted above, the CELIP was a

necessary prerequisite for the systems

changes that will actually implement

the new PPS payment methodology. The

OCE and CELIP have now been released

to intermediaries, although we continue

to test and refine CELIP further. Now

that the CELIP has been released, we

must make and fully test the PPS

methodology systems changes before

implementation to ensure that we make

accurate payments. It is not feasible to

complete this work consistent with a

July 1 effective date for the PPS.

A one-month delay in the effective

date of the PPS will also allow hospitals

to have sufficient time to adjust to the

programming changes necessary to

implement the new payment system.

Hospitals need sufficient time after

HCFA completes its programming

changes to complete modifications of

their own systems, test those systems in

interaction with HCFA’s new systems,

and train their personnel on use of the

new systems. As previously discussed,

these activities have been delayed due

to problems with various required

systems changes and modifications to

the OCE, the magnitude of which was

not known when we published the

April 2000 final rule with comment

period.

We acknowledge that unavoidable

delays in software development by

HCFA have impeded the ability of the

hospital industry to fully prepare for

implementation of outpatient PPS. We

have been informed by hospitals and

major hospital associations that, given

these programming delays that HCFA

has encountered, maintaining the

current effective date for the PPS would

virtually ensure that hospitals would

not be able to implement the PPS

accurately. A brief delay in the effective

date would allow the industry more

time for training and preparation for

what we hope will be a fully operational

PPS, which would in turn help reduce

the number of errors or other problems

that might occur as hospitals transition

to the new PPS.

We are intensifying our efforts to

provide clear and accurate training to

fiscal intermediaries, hospitals, and

community mental health centers. On

June 15, 2000, we held a national

satellite broadcast to assist hospitals in

preparing for implementation. We are

also compiling a booklet of ‘‘Frequently

Asked Questions and Answers’’ that

will be available both on the internet

and in printed form. Other efforts

include reconfiguring the PPS materials

on the HCFA web site to facilitate access

to relevant program instructions,

training documents, and other materials.

In July 2000, we plan to host a face-toface town hall meeting at the HCFA

headquarters in Baltimore, Maryland.

The purpose of this meeting will be to

respond to any remaining concerns

about the implementation of the new

system. To assure that our fiscal

intermediaries remain up-to-date, and

that we can respond to any contractor

concerns, we are continuing our weekly

conference calls with them and will also

provide them with a video to update

their training. We also plan to continue

our weekly teleconferences with

hospital and beneficiary associations to

keep them abreast of our

implementation schedule, and to

answer any questions.

We considered, but rejected as

unworkable, contingency plans that we

hoped might have allowed us to meet

the July 1 effective date. Under these

plans, we might have been able to meet

the effective date even though we would

not have been able to implement the

PPS on that date. Under this scenario,

we would have had to either request

hospitals to hold claims until our

systems were ready or hold the claims

ourselves. We concluded that we could

not request hospitals to hold their

claims, thus interrupting their stream of

Federal Register / Vol. 65, No. 127 / Friday, June 30, 2000 / Rules and Regulations 40537

payment for outpatient services for a

potentially significant period of time. In

addition, many of our intermediaries do

not have sufficient electronic storage

space to hold claims for nearly as long

as it will take for our systems to be fully

tested.

Even if sufficient storage capacity

were available, holding claims until

HCFA was fully able to implement the

PPS would lead to problems. These

would have included extensive

operational delays at the intermediaries

to process and pay the claims once the

software became available. Considerable

risk of improper or inaccurate payment

exists in later working off what would

be a crippling backlog of held claims in

an expedited manner. Therefore, given

our need to accurately program and test

the PPS, it would not be feasible, given

our operational limitations, to maintain

the previous July 1 effective date.

Because of the uncertainty for providers,

beneficiaries, and HCFA contractors that

would be caused by holding claims for

any significant period of time, we do not

believe that such a course of action

provides a viable alternative to a brief

delay in the effective date of the PPS.

We had hoped and planned to be able

to implement the PPS on July 1, 2000

as stated in the April final rule with

comment period. We regret that we

must postpone the benefits of the new

payment system for beneficiaries, even

for only one month. Nevertheless,

because of the significance of the

considerations discussed above and the

unacceptable risk to the successful

implementation of the PPS that would

be incurred if we chose to move forward

as originally planned and implement

the PPS on July 1, we have recognized

the need to postpone the effective date

announced in the April rule.

As stated earlier, the changes to

§ 412.24(d)(6), new § 413.65, and the

changes to § 489.24(h), § 489.2 and

§ 489.3 will still be effective on October

10, 2000.

II. Impact Statement

In the April 7, 2000 final rule, we

discussed the changes the BBA and

BBRA will have on payments to

hospitals and beneficiaries. Because we

are delaying the implementation of the

final rule, the current payment rates

required under pre-BBA rules will

remain in effect for an additional 32

days which may have a significant

impact on a substantial number of small

entities.

(Catalog of Federal Domestic Assistance

93.774, Medicare—Supplementary Medical

Insurance Program)

Dated: June 22, 2000.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing

Administration.

Dated: June 23, 2000.

Michael F. Mangano,

Principal Deputy Inspector General,

Department of Health and Human Services.

Approved: June 23, 2000.

Donna E. Shalala,

Secretary.

[FR Doc. 00–16586 Filed 6–29–00; 8:45 am]

BILLING CODE 4120–01–P

DEPARTMENT OF COMMERCE

National Oceanic and Atmospheric

Administration

50 CFR Parts 600 and 660

[Docket No. 991223347–9347–01; I.D.

120299C]

Fisheries off West Coast States and in

the Western Pacific; Pacific Coast

Groundfish Fishery; Extension of

Emergency Rule

AGENCY: National Marine Fisheries

Service (NMFS), National Oceanic and

Atmospheric Administration (NOAA),

Commerce.

ACTION: Extension of emergency rule

effectiveness period.

SUMMARY: This action extends an

existing emergency rule that was

published in conjunction with the

annual specifications and management

measures for the Pacific coast

groundfish fishery off Washington,

Oregon, and California in 2000. The

emergency authority was used to

implement and designate as routine a

number of management measures that

are intended to achieve rebuilding plans

for overfished stocks, reduce bycatch,

prevent overfishing, maximize the

harvest of healthy stocks while

protecting and rebuilding overfished

and depleted stocks, and equitably

distribute the burdens among the

different fishing sectors. The emergency

rule is authorized by the MagnusonStevens Fishery Conservation and

Management Act (Magnuson-Stevens

Act).

DATES: The emergency rule published

January 4, 2000, beginning at 65 FR 221,

is extended until the effective date of

the annual specifications and

management measures for the 2001

groundfish fishery, but no later than

January 3, 2001. The 2001 annual

specifications and management

measures will be published in the

Federal Register.

ADDRESSES: Copies of the environmental

assessment/regulatory impact review are

available from William Stelle, Jr.,

Administrator, Northwest Region

(Regional Administrator), NMFS, 7600

Sand Point Way NE., BIN C15700, Bldg.

1, Seattle, WA 98115–0070; or Rodney

McInnis, Acting Administrator,

Southwest Region, NMFS, 501 West

Ocean Blvd., Suite 4200, Long Beach,

CA 90802–4213.

FOR FURTHER INFORMATION CONTACT:

Katherine King at 206–526–6140.

SUPPLEMENTARY INFORMATION: NMFS is

extending an emergency rule (65 FR

221, January 4, 2000) which otherwise

would expire on July 3, 2000. The

emergency authority was used to

implement and designate as routine a

number of management measures that

were designed to achieve rebuilding

plans for overfished stocks, reduce

bycatch, prevent overfishing, maximize

the harvest of healthy stocks while

protecting and rebuilding overfished

and depleted stocks, and equitably

distribute the burdens among the

different fishing sectors. NMFS is

extending the rule pursuant to the

emergency rulemaking authority of the

Secretary of Commerce (Secretary)

under the Magnuson-Stevens Act, 16

U.S.C. 1855(c)(3)(B). Amendment 13 to

the FMP, currently under development,

includes provisions that would

authorize, on a permanent basis, future

use of the provisions implemented

under the emergency rule. This action is

necessary to maintain the management

regime approved by the Secretary,

implemented on January 1, 2000,

pending Secretarial review and approval

of Amendment 13. No changes to the

emergency rule are made by this

extension.

Background

In the past, annual management

measures have been primarily set

through ‘‘routine’’ management

procedures that consisted of adjusting

commercial trip limits and recreational

bag limits. For most species, the limited

entry commercial trip limit did not vary

with the type of gear used. However,

because of the drastic reductions in

harvest limits for many species which

were necessary in 2000, and the

multispecies characteristic of the

fishery, the existing routine

management measures did not produce

sufficient and appropriately targeted

harvest reductions. Therefore, at its

November 1999 meeting, the Pacific

Fishery Management Council (Council)

recommended that NMFS implement an

emergency rule for 2000 that would

address these concerns. At the time,