Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices 54131

Friday, November 7, 1997

8:30 A.M.—8:35 A.M.: Opening

Remarks by the ACRS Chairman

(Open)—The ACRS Chairman will make

opening remarks regarding conduct of

the meeting.

8:35 A.M.—9:35 A.M.: Severe

Accident Management (Open)—The

Committee will hear presentations by

and hold discussions with

representatives of the NRC staff

regarding the staff evaluation of the

BWR Owners Group emergency

procedure and severe accident

guidelines and the Westinghouse severe

accident guidelines.

9:35 A.M.—10:30 A.M.: Staff Actions

Related to the Development of a Revised

Fire Protection Rule (Open)—The

Committee will hear presentations by

and hold discussions with

representatives of the NRC staff

regarding staff actions related to the

development of a revised Fire Protection

Rule.

10:45 A.M.—11:15 A.M.: Future ACRS

Activities (Open)—The Committee will

discuss the recommendations of the

Planning and Procedures Subcommittee regarding items proposed for

consideration by the full Committee

during future meetings.

11:15 A.M.—11:30 A.M.:

Reconciliation of ACRS Comments and

Recommendations (Open)—The

Committee will discuss responses from

the NRC Executive Director for

Operations to comments and

recommendations included in recent

ACRS reports. The EDO responses are

expected to be provided to the ACRS

prior to the meeting.

11:30 A.M.—12:00 Noon: Report of

the Planning and Procedures

Subcommittee (Open/Closed)—The

Committee will hear a report of the

Planning and Procedures Subcommittee

on matters related to the conduct of

ACRS business, qualifications of

candidates nominated for appointment

to the ACRS, and organizational and

personnel matters relating to the ACRS.

[Note: A portion of this session may be

closed to discuss organizational and

personnel matters that relate solely to the

internal personnel rules and practices of this

Advisory Committee, and information the

release of which would constitute a clearly

unwarranted invasion of personal privacy.]

1:00 P.M.—1:30 P.M.: Miscellaneous

(Open)—The Committee will discuss

matters related to the conduct of

Committee activities and matters and

specific issues that were not completed

during previous meetings, as time and

availability of information permit.

1:30 P.M.—7:00 P.M.: Preparation of

ACRS Reports (Open)—The Committee

will continue its discussion regarding

proposed ACRS reports on matters

considered during this meeting.

Procedures for the conduct of and

participation in ACRS meetings were

published in the Federal Register on

September 4, 1997 (62 FR 46782). In

accordance with these procedures, oral

or written statements may be presented

by members of the public and

representatives of the nuclear industry,

electronic recordings will be permitted

only during the open portions of the

meeting, and questions may be asked

only by members of the Committee, its

consultants, and staff. Persons desiring

to make oral statements should notify

Mr. Sam Duraiswamy, Chief, Nuclear

Reactors Branch, at least five days

before the meeting, if possible, so that

appropriate arrangements can be made

to allow the necessary time during the

meeting for such statements. Use of still,

motion picture, and television cameras

during this meeting may be limited to

selected portions of the meeting as

determined by the Chairman.

Information regarding the time to be set

aside for this purpose may be obtained

by contacting the Chief of the Nuclear

Reactors Branch prior to the meeting. In

view of the possibility that the schedule

for ACRS meetings may be adjusted by

the Chairman as necessary to facilitate

the conduct of the meeting, persons

planning to attend should check with

the Chief of the Nuclear Reactors Branch

if such rescheduling would result in

major inconvenience.

In accordance with Subsection 10(d)

P.L. 92–463, I have determined that it is

necessary to close portions of this

meeting noted above to discuss matters

that relate solely to the internal

personnel rules and practices of this

Advisory Committee per 5 U.S.C.

552b(c)(2), and to discuss information

the release of which would constitute a

clearly unwarranted invasion of

personal privacy per 5 U.S.C. 552b(c)(6).

Further information regarding topics

to be discussed, whether the meeting

has been cancelled or rescheduled, the

Chairman’s ruling on requests for the

opportunity to present oral statements

and the time allotted therefor, can be

obtained by contacting Mr. Sam

Duraiswamy, Chief, Nuclear Reactors

Branch (telephone 301/415–7364),

between 7:30 A.M. and 4:15 P.M. EDT.

ACRS meeting notices, meeting

transcripts, and letter reports are now

available on FedWorld from the ‘‘NRC

MAIN MENU.’’ The Direct Dial Access

number to FedWorld is (800) 303–9672

or ftp.fedworld. These documents and

the meeting agenda are also available for

downloading or reviewing on the

internet at http://www.nrc.gov/

ACRSACNW.

Dated: October 10, 1997.

Andrew L. Bates,

Advisory Committee Management Officer.

[FR Doc. 97–27598 Filed 10–16–97; 8:45 am]

BILLING CODE 7590–01–P

OFFICE OF MANAGEMENT AND

BUDGET

Cost of Hospital and Medical Care

Treatment Furnished by the United

States; Certain Rates Regarding

Recovery From Tortiously Liable Third

Persons

By virtue of the authority vested in

the President by section 2(a) of Pub. L.

87–693 (76 Stat. 593; 42 U.S.C. 2652),

and delegated to the Director of the

Office of Management and Budget by

Executive Order No. 11541 of July 1,

1970 (35 FR 10737), the three sets of

rates outlined below are hereby

established. These rates are for use in

connection with the recovery, from

tortiously liable third persons, of the

cost of hospital and medical care and

treatment furnished by the United States

(Part 43, Chapter I, Title 28, Code of

Federal Regulations) through three

separate Federal agencies. The rates

have been established in accordance

with the requirements of OMB Circular

A–25, requiring reimbursement of the

full cost of all services provided. The

rates are established as follows:

1. Department of Defense

The Fiscal Year 1998 (FY98)

Department of Defense (DoD)

reimbursement rates for inpatient,

outpatient, and other services are

provided in accordance with Section

1095 of title 10, United States Code. Due

to size, the sections containing the Drug

Reimbursement Rates (Section III.D) and

the rates for Ancillary Services

Requested by Outside Providers

(Section III.E) are not included in this

package. The Office of the Assistant

Secretary of Defense (Health Affairs)

will provide these rates upon request.

The medical and dental service rates in

this package (including the rates for

ancillary services, prescription drugs or

other procedures requested by outside

providers) are effective October 1, 1997.

2. Health and Human Services

The sum of obligations for each cost

center providing medical service is

broken down into amounts attributable

to inpatient care on the basis of the

proportion of staff devoted to each cost

center. Total inpatient costs and

outpatient costs thus determined are
54132 Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices

divided by the relevant workload

statistic (inpatient day, outpatient visit)

to produce the inpatient and outpatient

rates. In calculation of the rates, the

Department’s unfunded retirement

liability cost and capital and equipment

depreciation cost were incorporated to

conform to requirements set forth in

OMB Circular A–25. In addition, each

cost center’s obligations include costs

for certain other accounts, such as

Medicare and Medicaid collections and

Contract Health funds used to support

direct program operation. Certain cost

centers that primarily support workload

outside of the directly operated

hospitals or clinics (public health

nursing, public health nutrition, health

education) were excluded this year as

not being a part of the traditional cost

of hospital operations and not

contributing directly to the inpatient

and outpatient visit workload. Overall,

these rates reflect a more accurate

indication of the cost of care in HHS

facilities.

In addition, separate rates per

inpatient day and outpatient visit were

computed for Alaska and the rest of the

United States. This gives proper weight

to the higher cost of operating medical

facilities in Alaska.

3. Department of Veterans Affairs

Actual direct and indirect costs are

compiled by type of care for the

previous year, and facility overhead

costs are added. Adjustments are made

using the budgeted percentage changes

for the current year and the budget year

to compute the base rate for the budget

year. The budget year base rate is then

adjusted by estimated costs for

depreciation of buildings and

equipment, central office overhead,

Government employee retirement

benefits, and return on fixed assets

(interest on capital for land, buildings,

and equipment (net book value)), to

compute the budget year tortiously

liable reimbursement rates. Also shown

for the tortiously liable inpatient per

diem rates are breakdowns into three

cost components: Physician; Ancillary;

and Nursing, Room, and Board. As with

the total per diem rates, these

breakdowns are calculated from actual

data by type of care.

The interagency rates shown are to be

used when VA medical care or service

is furnished to a beneficiary of another

Federal agency, and that care or service

is not covered by an applicable local

sharing agreement. Government

employee retirement benefits and return

on fixed assets are not included in the

interagency rates, but in all other

respects the interagency rates are the

same as the tortiously liable rates.

Inpatient charges will be at the per

diem rates shown for the type of bed

section or discrete treatment unit

providing the care. Prescription Filled

charge in lieu of the Outpatient Visit

rate will be charged when the patient

receives no service other than the

Pharmacy outpatient service. This

charge applies whether the patient

receives the prescription in person or by

mail.

When medical care or service is

obtained at the expense of the

Department of Veterans Affairs from a

non-VA source, the charge for such care

or service will be the actual amount

paid by the VA for that care or service.

1. Department of Defense

For the Department of Defense, effective October 1, 1997 and thereafter:

Inpatient, Outpatient and Other Rates and Charges

I. Inpatient Rates 1 2

Per inpatient day

International

Military Education & Training (IMET)

Interagency

and other Federal agency

sponsored patients

Other (Full/

Third party)

A. Burn Center ............................................................................................................................. $2,618.00 $4,754.00 $5,079.00

B. Surgical Care Services (Cosmetic Surgery) ............................................................................ 955.00 1,733.00 1852.00

C. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG) 3)

1. FY98 Direct Care Inpatient Reimbursement Rates

Adjusted standard amount IMET Other interagency

(Full/Third

party)

Large Urban ................................................................................................................................. $2,199.00 $4,131.00 $4,372.00

Other Urban/Rural ........................................................................................................................ 2,194.00 4,215.00 4,499.00

Overseas ...................................................................................................................................... 2,450.00 5,614.00 5,960.00

2. Overview

The FY98 inpatient rates are based on the cost per DRG, which is the inpatient full reimbursement rate per hospital

discharge weighted to reflect the intensity of the principal diagnosis, secondary diagnoses, procedures, patient age,

etc. involved. The average cost per Relative Weighted Product (RWP) for large urban, other urban/rural, and overseas

facilities will be published annually as an inpatient adjusted standardized amount (ASA) (see paragraph I.C.1., above).

The ASA will be applied to the RWP for each inpatient case, determined from the DRG weights, outlier thresholds,

and payment rules published annually for hospital reimbursement rates under the Civilian Health and Medical Program

of the Uniformed Services (CHAMPUS) pursuant to 32 CFR 199.14(a)(1), including adjustments for length of stay (LOS)

outliers. The published ASAs will be adjusted for area wage differences and indirect medical education (IME) for

the discharging hospital. An example of how to apply DoD costs to a DRG standardized weight to arrive at DoD

costs is contained in paragraph I.C.3., below.

3. Example of Adjusted Standardized Amounts for Inpatient Stays

Figure 1 shows examples for a nonteaching hospital in a Large Urban Area.
Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices 54133

a. The cost to be recovered is DoD’s cost for medical services provided in the nonteaching hospital located in a large urban area. Billings will be at the third party rate. b. DRG 020: Nervous System Infection Except Viral Meningitis. The RWP for an inlier case is the CHAMPUS weight of 2.9769. (DRG statistics shown are from FY 1996). c. The DoD adjusted standardized amount to be charged is $4,372 (i.e., the third party rate as shown in the table).

d. DoD cost to be recovered at a nonteaching hospital with area wage index of 1.0 is the RWP factor (2.9769) in 3.b., above, multiplied by the amount ($4,372) in 3.c., above. e. Cost to be recovered is $13,015.

FIGURE 1.—THIRD PARTY BILLING EXAMPLES

DRG

No. DRG description DRG weight Arithmeticmean LOS

Geometric

mean LOS

Short stay

threshold

Long stay

threshold

020 ... Nervous System Infection Except Viral Meningitis .................... 2.9769 11.2 7.8 1 30

Hospital Location Area wage

rate index

IME adjustment Group ASA Applied

ASA

Nonteaching Hospital ....................................................... Large Urban ....................... 1.0 1.0 $4,372.00 $4,372.00

Patient Length of stay Days above

threshold

Relative weighted product TPC

Inlier* Outlier** Total Amount***

#1 ............. 7 days ................................................................................. 0 2.9769 0.0000 2.9769 $13,015

#2 ............. 21 days ............................................................................... 0 2.9769 0.0000 2.9769 13,015

#3 ............. 35 days ............................................................................... 5 2.9769 0.6297 3.6066 15,768

*DRG Weight

**Outlier calculation = 33 percent of per diem weight′ number of outlier days = .33 (DRG Weight/Geometric Mean LOS)′ (Patient LOS—Long

Stay Threshold)

=.33 (2.9769/7.8) ′ (35–30)

=.33 (.38165)′ 5 (take out to five decimal places)

=.12594′ 5 (take out to five decimal places)

=.6297 (take out to four decimal places)

*** Applied ASA′ Total RWP

II. Outpatient Rates 1 2 Per Visit

MEPRS

Code 4 Clinical service

International

Military Education & Training (IMET)

Interagency

and other Federal agency

sponsored patients

Other

(Full/Third

party)

A. Medical Care

BAA .......... Internal Medicine .................................................................................................... $105.00 $195.00 $208.00

BAB .......... Allergy .................................................................................................................... 39.00 73.00 78.00

BAC ......... Cardiology .............................................................................................................. 81.00 150.00 160.00

BAE .......... Diabetic .................................................................................................................. 44.00 82.00 87.00

BAF .......... Endocrinology (Metabolism) ................................................................................... 85.00 158.00 168.00

BAG ......... Gastroenterology .................................................................................................... 110.00 203.00 216.00

BAH ......... Hematology ............................................................................................................ 145.00 269.00 287.00

BAI ........... Hypertension .......................................................................................................... 81.00 149.00 159.00

BAJ .......... Nephrology ............................................................................................................. 171.00 317.00 338.00

BAK .......... Neurology ............................................................................................................... 109.00 202.00 215.00

BAL .......... Outpatient Nutrition ................................................................................................ 34.00 63.00 67.00

BAM ......... Oncology ................................................................................................................ 114.00 211.00 225.00

BAN ......... Pulmonary Disease ................................................................................................ 141.00 260.00 278.00

BAO ......... Rheumatology ........................................................................................................ 84.00 156.00 166.00

BAP .......... Dermatology ........................................................................................................... 63.00 117.00 124.00

BAQ ......... Infectious Disease .................................................................................................. 141.00 260.00 278.00

BAR ......... Physical Medicine .................................................................................................. 78.00 145.00 155.00

BAS .......... Radiation Therapy .................................................................................................. 72.00 132.00 141.00

BAZ .......... Medical Care Not Elsewhere Classified (NEC) ..................................................... 84.00 156.00 166.00

B. Surgical Care

BBA .......... General Surgery ..................................................................................................... 119.00 220.00 235.00

BBB .......... Cardiovascular and Thoracic Surgery ................................................................... 110.00 203.00 216.00

BBC ......... Neurosurgery .......................................................................................................... 137.00 253.00 270.00

BBD ......... Ophthalmology ....................................................................................................... 84.00 155.00 166.00

BBE .......... Organ Transplant ................................................................................................... 191.00 353.00 376.00

BBF .......... Otolaryngology ....................................................................................................... 88.00 162.00 173.00

BBG ......... Plastic Surgery ....................................................................................................... 100.00 184.00 196.00

BBH ......... Proctology .............................................................................................................. 67.00 124.00 132.00
54134 Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices

MEPRS

Code 4 Clinical service

International

Military Education & Training (IMET)

Interagency

and other Federal agency

sponsored patients

Other

(Full/Third

party)

BBI ........... Urology ................................................................................................................... 101.00 187.00 199.00

BBJ .......... Pediatric Surgery .................................................................................................... 89.00 164.00 175.00

BBZ .......... Surgical Care NEC ................................................................................................. 65.00 120.00 127.00

C. Obstetrical and Gynecological (OB–GYN) Care

BCA ......... Family Planning ...................................................................................................... 45.00 83.00 89.00

BCB ......... Gynecology ............................................................................................................ 74.00 136.00 146.00

BCC ......... Obstetrics ............................................................................................................... 68.00 126.00 135.00

BCZ .......... OB-GYN Care NEC ............................................................................................... 112.00 207.00 221.00D

D. Pediatric Care

BDA ......... Pediatric ................................................................................................................. 54.00 100.00 106.00

BDB ......... Adolescent .............................................................................................................. 55.00 101.00 108.00

BDC ......... Well Baby ............................................................................................................... 36.00 66.00 70.00

BDZ .......... Pediatric Care NEC ................................................................................................ 64.00 119.00 126.00

E. Orthopaedic Care

BEA .......... Orthopaedic ............................................................................................................ 83.00 153.00 164.00

BEB .......... Cast ........................................................................................................................ 45.00 82.00 88.00

BEC ......... Hand Surgery ......................................................................................................... 38.00 70.00 75.00

BEE .......... Orthotic Laboratory ................................................................................................ 59.00 110.00 117.00

BEF .......... Podiatry .................................................................................................................. 49.00 91.00 97.00

BEZ .......... Chiropractic ............................................................................................................ 21.00 38.00 40.00

F. Psychiatric and/or Mental Health Care

BFA .......... Psychiatry ............................................................................................................... 97.00 179.00 191.00

BFB .......... Psychology ............................................................................................................. 71.00 132.00 141.00

BFC .......... Child Guidance ....................................................................................................... 59.00 109.00 117.00

BFD .......... Mental Health ......................................................................................................... 80.00 147.00 157.00

BFE .......... Social Work ............................................................................................................ 80.00 149.00 159.00

BFF .......... Substance Abuse ................................................................................................... 62.00 115.00 123.00

G. Family Practice/Primary Medical Care

BGA ......... Family Practice ....................................................................................................... 67.00 124.00 132.00

BHA ......... Primary Care .......................................................................................................... 64.00 118.00 126.00

BHB ......... Medical Examination .............................................................................................. 59.00 109.00 117.00

BHC ......... Optometry ............................................................................................................... 42.00 77.00 82.00

BHD ......... Audiology ................................................................................................................ 30.00 55.00 58.00

BHE ......... Speech Pathology .................................................................................................. 81.00 149.00 159.00

BHF .......... Community Health .................................................................................................. 41.00 75.00 80.00

BHG ......... Occupational Health ............................................................................................... 59.00 108.00 115.00

BHH ......... TRICARE Outpatient .............................................................................................. 42.00 78.00 83.00

BHI ........... Immediate Care ...................................................................................................... 82.00 152.00 162.00

BHZ .......... Primary Care NEC ................................................................................................. 43.00 79.00 84.00

H. Emergency Medical Care

BIA ........... Emergency Medical ................................................................................................ 107.00 198.00 211.00

I. Flight Medical Care

BJA .......... Flight Medicine ....................................................................................................... 85.00 157.00 167.00

J. Underseas Medical Care

BKA .......... Underseas Medicine .............................................................................................. 32.00 58.00 62.00

K. Rehabilitative Services

BLA .......... Physical Therapy .................................................................................................... 29.00 54.00 57.00

BLB .......... Occupational Therapy ............................................................................................ 53.00 98.00 104.00
Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices 54135

III. Other Rates and Charges 1 2 Per Visit

MEPRS

code 4 Clinical service

International

Military Education & Training (IMET)

Interagency

and other Federal agency

sponsored patients

Other

(Full/Third

party)

FBI ........... A. Immunization ..................................................................................................... $10.00 $19.00 $20.00

DGC ......... B. Hyperbaric Chamber 5 ....................................................................................... 180.00 333.00 355.00

C. Ambulatory Procedure Visit (APV) 6 ................................................................. 376.00 691.00 737.00

D. Family Member Rate (formerly Military Dependents Rate) .............................. 10.20 ........................ ........................

E. Reimbursement Rates For Drugs Requested By Outside Providers 7

The FY98 drug reimbursement rates for drugs are for prescriptions requested by outside providers and obtained

at a Military Treatment Facility. The rates are established based on the cost of the particular drugs provided. Final

rule of 32 CFR part 220, estimated to be published October 1, 1997, will eliminate the high cost ancillary services’

dollar threshold and the associated term ‘‘high cost ancillary service.’’ In anticipation of that change, the phrase ‘‘high

cost ancillary service’’ has been replaced with the phrase ‘‘ancillary services requested by an outside provider.’’ The

list of drug reimbursement rates is too large to include here. These rates are available on request from OASD (Health

Affairs)—see Tab N for the point of contact.

F. Reimbursement Rates for Ancillary Services Requested By Outside Providers 8

Final rule of 32 CFR part 220, estimated to be published October 1, 1997, will eliminate the high cost ancillary

services’ dollar threshold and the associated term ‘‘high cost ancillary service.’’ In anticipation of that change, the

phrase ‘‘high cost ancillary service’’ has been replaced with the phrase ‘‘ancillary services requested by an outside

provider.’’ The list of FY98 rates for ancillary services requested by outside providers and obtained at a Military Treatment

Facility is too large to include here. These rates are available on request from OASD(Health Affairs)—see Tab N for

the point of contact.

G. Elective Cosmetic Surgery Procedures and Rates

Cosmetic surgery procedureInternational Classification Diseases (ICD–9)Current Procedural Terminology (CPT) 9 FY98 charge 10 Amount of

charge

Mammaplasty ................. 85.50, 85.32, 85.31 ....... 19325, 19324, 19318 .... Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Mastopexy ...................... 85.60 ............................. 19316 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Facial Rhytidectomy ....... 86.82, 86.22 .................. 15824 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Blepharoplasty ................ 08.70, 08.44 .................. 15820, 15821, 15822,

15823.

Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Mentoplasty (Augmentation Reduction).76.68, 76.67 .................. 21208, 21209 ................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Abdominoplasty .............. 86.83 ............................. 15831 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Lipectomy suction per region 11.86.83 ............................. 15876, 15877, 15878,

15879.

Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Rhinoplasty ..................... 21.87, 21.86 .................. 30400, 30410 ................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Scar Revisions beyond

CHAMPUS.

86.84 ............................. 1578l ........................... Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Mandibular or Maxillary

Repositioning.

76.41 ............................. 21194 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Minor Skin Lesions 12 ..... 86.30 ............................. 1578l ........................... Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Dermabrasion ................. 86.25 ............................. 15780 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Hair Restoration .............. 86.64 ............................. 15775 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Removing Tattoos .......... 86.25 ............................. 15780 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Chemical Peel ................ 86.24 ............................. 15790 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Arm/Thigh

Dermolipectomy.

86.83 ............................. 1583l ........................... Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)

Brow Lift .......................... 86.3 ............................... 15839 ............................ Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate.(a b c)
54136 Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices

H. Dental Rate 13 Per Procedure

MEPRS

code 4 Clinical service

International

military education and

training (IMET)

Interagency

and other federal agency

sponsored patients

Other

(Full/third

party)

oDental Services .................................................................................................... $35.00 $101.00 $106.00

ADA code and DoD established weight.

I. Ambulance Rate 14 Per Visit

MEPRS

code 4 Clinical service

International

military education and

training (IMET)

nteragency

and other federal agency

sponsored patients

Other

(Full/Third

party)

FEA .......... Ambulance ............................................................................................................. $32.00 $60.00 $64.00

J. Laboratory and Radiology Services Requested by an Outside Provider 8 Per Procedure

MEPRS

code 4 Clinical service

International

military education & training (IMET)

nteragency &

other federal

agency sponsored patients

Other (full/third

party)

Laboratory procedures requested by an outside provider CPT–4 Weight Multiplier.$9.00 $13.00 $14.00

Radiology procedures requested by an outside provider CPT–4 Weight Multiplier.23.00 35.00 37.00

K. AirEvac Rate 15 Per Visit

MEPRS

code 4 Clinical service

International

military education and

training (IMET)

Interagency

and other federal agency

sponsored patients

Other

(Full/third

party)

AirEvac Services—Ambulatory .............................................................................. $113.00 $209.00 $223.00

AirEvac Services—Litter ........................................................................................ 323.00 598.00 638.00

Notes on Cosmetic Surgery Charges

aPer diem charges for inpatient surgical care services are listed in section I.B. (See notes 9 through 11, below, for further details

on reimbursable rates.) bCharges for ambulatory procedure visits (formerly same day surgery) are listed in section III.C. (See notes 9 through 11, below,

for further details on reimbursable rates.) The APV rate is used if the elective cosmetic surgery is performed in an ambulatory procedure

unit (APU). cCharges for outpatient clinic visits are listed in section II.A–K. The outpatient clinic rate is not used for services provided

in an APU. The APV rate should be used in these cases.

Notes on Reimbursable Rates

1Percentages can be applied when preparing bills for both inpatient and outpatient services. Pursuant to the provisions of 10

U.S.C. 1095, the inpatient Diagnosis Related Groups and inpatient per diem percentages are 96 percent hospital and 4 percent professional

charges. The outpatient per visit percentages are 88 percent outpatient services and 12 percent professional charges. 2 DoD civilian employees located in overseas areas shall be rendered a bill when services are performed. Payment is due 60

days from the date of the bill. 3The cost per DRG (Diagnosis Related Group) is based on the inpatient full reimbursement rate per hospital discharge, weighted

to reflect the intensity of the principal and secondary diagnoses, surgical procedures, and patient demographics involved. The adjusted

standardized amounts (ASA) per Relative Weighted Product (RWP) for use in the direct care system is comparable to procedures

used by the Health Care Financing Administration (HCFA) and the Civilian Health and Medical Program for the Uniformed Services

(CHAMPUS). These expenses include all direct care expenses associated with direct patient care. The average cost per RWP for large

urban, other urban/rural, and overseas will be published annually as an adjusted standardized amount (ASA) and will include the

cost of inpatient professional services. The DRG rates will apply to reimbursement from all sources, not just third party payers. 4The Medical Expense and Performance Reporting System (MEPRS) code is a three digit code which defines the summary account

and the subaccount within a functional category in the DoD medical system. MEPRS codes are used to ensure that consistent expense

and operating performance data is reported in the DoD military medical system. An example of the MEPRS hierarchical arrangement

follows: Outpatient Care (Functional Category), B (MEPRS Code), Medical Care (Summary Account), BA (MEPRS Code), Internal Medicine

(Subaccount), BAA (MEPRS Code). 5Hyperbaric services charges shall be based on hours of service in 15 minute increments. The rates listed in section III.B. are

for 60 minutes or 1 hour of service. Providers shall calculate the charges based on the number of hours (and/or fractions of an

hour) of service. Fractions of an hour shall be rounded to the next 15 minute increment (e.g., 31 minutes shall be charged as 45

minutes). 6Ambulatory Procedure Visit (APV) is defined in DOD Instruction 6025.8, September 23, 1996, as immediate (day of procedure)

pre-procedure and immediate post-procedure care requiring an unusual degree of intensity and provided in an ambulatory procedure
Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices 54137

unit (APU). Care is required in the facility for less than 24 hours. This rate is also used for elective cosmetic surgery performed

in an APU. 7Prescription services requested by outside providers (physicians, dentists, etc.) are relevant to the Third Party Collection Program.

Third party payers (such as insurance companies) shall be billed for prescription services when beneficiaries who have medical insurance

obtain medications from a Military Treatment Facility (MTF) that are prescribed by providers external to the MTF. Eligible beneficiaries

(family members or retirees with medical insurance) are not personally liable for this cost and shall not be billed by the MTF.

Medical Services Account (MSA) patients, who are not beneficiaries as defined in 10 U.S.C. 1074 and 1076, are charged at the

‘‘Other’’ rate if they are seen by an outside provider and come to the MTF for prescription services. The standard cost of medications

ordered by an outside provider includes the cost of the drugs plus a dispensing fee per prescription. The prescription cost is calculated

by multiplying the number of units (tablets, capsules, etc.) by the unit cost and adding a $5.00 dispensing fee per prescription.

Final rule of 32 CFR part 220, estimated to be published October 1, 1997, will eliminate the high cost ancillary services’ dollar

threshold (by changing it from $25 to $0) and the associated term ‘‘high cost ancillary service.’’ In anticipation of that change, the

phrase ‘‘high cost ancillary service’’ has been replaced with the phrase ‘‘ancillary services requested by an outside provider.’’ The

elimination of the threshold ipso facto eliminates the bundling of costs whereby a patient was billed if the total ancillary services

costs in a day (defined as 0001 hours to 2400 hours) exceeded $25.00. 8Charges for ancillary services requested by an outside provider (physicians, dentists, etc.) are relevant to the Third Party Collection

Program. Third party payers (such as insurance companies) shall be billed for ancillary services when beneficiaries who have medical

insurance obtain services from the MTF that are prescribed by providers external to the MTF. Laboratory and Radiology procedure

costs are calculated using the Physicians’ Current Procedural Terminology (CPT)–4 Report weight multiplied by either the laboratory

or radiology multiplier (section III.J). Eligible beneficiaries (family members or retirees with medical insurance) are not personally

liable for this cost and shall not be billed by the MTF. MSA patients, who are not beneficiaries as defined by 10 U.S.C. 1074

and 1076, are charged at the ‘‘Other’’ rate if they are seen by an outside provider and come to the MTF for services. Final rule

of 32 CFR Part 220, estimated to be published October 1, 1997, will eliminate the high cost ancillary services’ dollar threshold

(by changing it from $25 to $0) and the associated term ‘‘high cost ancillary service.’’ In anticipation of that change, the phrase

‘‘high cost ancillary service’’ has been replaced with the phrase ‘‘ancillary services requested by an outside provider.’’ The elimination

of the threshold ipso facto eliminates the bundling of costs whereby a patient was billed if the total ancillary services costs in

a day (defined as 0001 hours to 2400 hours) exceeded $25.00. 9The attending physician is to complete the CPT–4 code to indicate the appropriate procedure followed during cosmetic surgery.

The appropriate rate will be applied depending on the treatment modality of the patient: Ambulatory procedure visit, outpatient

clinic visit or inpatient surgical care services. 10Family members of active duty personnel, retirees and their family members, and survivors shall be charged elective cosmetic

surgery rates. Elective cosmetic surgery procedure information is contained in Section III G. The patient shall be charged the rate

as specified in the FY98 reimbursable rates for an episode of care. The charges for elective cosmetic surgery are at the full reimbursement

rate (designated as the ‘‘Other’’ rate) for inpatient per diem surgical care services in section I.B., ambulatory procedure visits as

contained in section III.C, or the appropriate outpatient clinic rate in section II A–K. The patient is responsible for the cost of

the implant(s) and the prescribed cosmetic surgery rate. NOTE: The implants and procedures used for the augmentation mammaplasty

are in compliance with Federal Drug Administration guidelines. 11Each regional lipectomy shall carry a separate charge. Regions include head and neck, abdomen, flanks, and hips. 12These procedures are inclusive in the minor skin lesions. However, CHAMPUS separates them as noted here. All charges shall

be for the entire treatment, regardless of the number of visits required. 13 Dental service rates are based on a dental rate multiplier times the American Dental Association (ADA) code and the DoD

established weight for that code. 14Ambulance charges shall be based on hours of service in 15 minute increments. The rates listed in section III.I are for 60

minutes or 1 hour of service. Providers shall calculate the charges based on the number of hours (and/or fractions of an hour)

that the ambulance is logged out on a patient run. Fractions of an hour shall be rounded to the next 15 minute increment (e.g.,

31 minutes shall be charged as 45 minutes). 15Air in-flight medical care reimbursement charges are determined by the status of the patient (ambulatory or litter) and are

per patient. The charges are billed only by the Air Force Global Patient Movement Requirement Center (GFMRC).

2. Department of Health and Human Services

For the Department of Health and Human Services, Indian Health Service, effective October 1, 1997 and thereafter:

Hospital Care Inpatient Day

General Medical Care ....................................................................... Alaska .............................................................................................. $1,702

Rest of the United States ................................................................ 1,049

Outpatient Medical Treatment

Outpatient Visit ................................................................................ Alaska .............................................................................................. 340

Rest of the United States ................................................................ 209

3. Department of Veterans Affairs

For the Department of Veterans Affairs, effective October 1, 1997 and thereafter:

Tortiously

liable rates

Interagency

rates

Hospital Care, Rates Per Inpatient Day

General Medicine:

Total .................................................................................................................................................................. $1208 $1098

Physician .................................................................................................................................................... 145 ........................

Ancillary ..................................................................................................................................................... 315 ........................

Nursing, Room, and Board ........................................................................................................................ 748 ........................

Neurology:

Total .................................................................................................................................................................. 1154 1042

Physician .................................................................................................................................................... 169 ........................

Ancillary ..................................................................................................................................................... 305 ........................
54138 Federal Register / Vol. 62, No. 200 / Friday, October 17, 1997 / Notices

Tortiously

liable rates

Interagency

rates

Nursing, Room, and Board ........................................................................................................................ 680 ........................

Rehabilitation Medicine:

Total ...................................................................................................................................................................... 808 729

Physician .................................................................................................................................................... 92 ........................

Ancillary ..................................................................................................................................................... 247 ........................

Nursing, Room, and Board ........................................................................................................................ 469 ........................

Blind Rehabilitation:

Total ...................................................................................................................................................................... 957 873

Physician .................................................................................................................................................... 77 ........................

Ancillary ..................................................................................................................................................... 475 ........................

Nursing, Room, and Board ........................................................................................................................ 405 ........................

Spinal Cord Injury:

Total ...................................................................................................................................................................... 886 801

Physician .................................................................................................................................................... 110 ........................

Ancillary ..................................................................................................................................................... 223 ........................

Nursing, Room, and Board ........................................................................................................................ 553 ........................

Surgery:

Total .................................................................................................................................................................. 2079 1904

Physician .................................................................................................................................................... 229 ........................

Ancillary ..................................................................................................................................................... 631 ........................

Nursing, Room, and Board ........................................................................................................................ 1219 ........................

General Psychiatry:

Total .................................................................................................................................................................. 557 518

Physician .................................................................................................................................................... 54 ........................

Ancillary ..................................................................................................................................................... 91 ........................

Nursing, Room, and Board ........................................................................................................................ 432 ........................

Substance Abuse (Alcohol and Drug Treatment):

Total .................................................................................................................................................................. 333 300

Physician .................................................................................................................................................... 32 ........................

Ancillary ..................................................................................................................................................... 77 ........................

Nursing, Room, and Board ........................................................................................................................ 224 ........................

Intermediate Medicine:

Total .................................................................................................................................................................. 396 356

Physician .................................................................................................................................................... 19 ........................

Ancillary ..................................................................................................................................................... 58 ........................

Nursing, Room, and Board ........................................................................................................................ 319 ........................

Nursing Home Care, Rates Per Day

Nursing Home Care:

Total .................................................................................................................................................................. 299 270

Physician .................................................................................................................................................... 9 ........................

Ancillary ..................................................................................................................................................... 40 ........................

Nursing Room, and Board ......................................................................................................................... 250 ........................

Outpatient Medical and Dental Treatment

Outpatient Visit:

Total .................................................................................................................................................................. 229 211

Emergency Dental .................................................................................................................................................... 143 127

Outpatient Visit Prescription Filled ........................................................................................................................... 25 25

For the period beginning October 1, 1997, the rates prescribed herein superseded those established by the Director

of the Office of Management and Budget, October 31, 1996 (61 FR 56360).

Franklin D. Raines,

Director, Office of Management and Budget.

[FR Doc. 97–27629 Filed 10–16–97; 8:45 am]

BILLING CODE 3110–01–P

PENSION BENEFIT GUARANTY

CORPORATION

Submission of Information Collection

for OMB Review; Comment Request;

Payment of Premiums

AGENCY: Pension Benefit Guaranty

Corporation.

ACTION: Notice of request for extension

of OMB approval.

SUMMARY: The Pension Benefit Guaranty

Corporation (‘‘PBGC’’) is requesting that

the Office of Management and Budget

(‘‘OMB’’) extend approval, under the

Paperwork Reduction Act, of the

collection of information under its

regulation on Payment of Premiums (29

CFR Part 4007), including Form 1–ES,

Form 1, and Schedule A to Form 1, and

related instructions (OMB control

number 1212–0009; expires February

28, 1998). The collection of information

also includes a certification (on

Schedule A) of compliance with

requirements to provide certain notices

to participants under the PBGC’s

regulation on Disclosure to Participants

(29 CFR Part 4011), and surveys of plan