Source: https://www.federalregister.gov/articles/2003/09/26/03-24069/medicare-and-medicaid-programs-quarterly-listing-of-program-issuances-april-2003-through-june-2003
Timestamp: 2015-03-02 11:16:24
Document Index: 482830265

Matched Legal Cases: ['art 3', 'art 3', 'arts 409', 'arts 412', 'arts 410', 'art 498', 'art 498', 'art 484', 'art 162', 'arts 160', 'art 422', 'arts 160']

Federal Register | Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-April 2003 Through June 2003
Publication Date: Friday, September 26, 2003
-55634 (17 pages)
Document Number: 03-24069
Shorter URL: https://federalregister.gov/a/03-24069 Action
This notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from April 2003 through June 2003, relating to the Medicare and Medicaid programs. This notice provides information on national coverage determinations affecting specific medical and health care services under Medicare. Additionally, this notice identifies certain devices with investigational device exemption numbers approved by the Food and Drug Administration that potentially may be covered under Medicare. Finally, this notice also includes listings of all approval numbers from the Office of Management and Budget for collections of information in CMS regulations.
D. CMS's Compact Disk—Read Only Memory (CD-ROM)
Addendum VI.—Categorization of Food and Drug Administration-AllowedInvestigational Device Exemptions
Investigational Device Exemption Numbers, 2nd Quarter 2003
Questions concerning items in Addendum III may be addressed to Karen Bowman, Office of Strategic Operations and Regulatory Affairs, Centers for Medicare Medicaid Services, C5-16-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-5252.
Questions concerning national coverage determinations in Addendum V may be addressed to Patricia Brocato-Simons, Office of Clinical Standards and Quality, Centers for Medicare Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.
Questions concerning Investigational Device Exemptions items in Addendum VI may be addressed to Sharon Hippler, Office of Clinical Standards and Quality, Centers for Medicare Medicaid Services, C5-13-27, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-4633.
Questions concerning approval numbers for collections of information in Addendum VII may be addressed to Dawn Willinghan, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare Medicaid Services, C5-09-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6141.
Questions concerning all other information may be addressed to Margie Teeters, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare Medicaid Services, C5-13-18, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-4678.
This notice is organized so that a reader may review the subjects of manual issuances, memoranda, substantive and interpretive regulations, national coverage determinations (NCDs), and Food and Drug Administration (FDA)-approved investigational device exemptions (IDEs) published during the subject quarter to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare Coverage Issues Manual (CIM) may wish to review the August 21, 1989 publication (54 FR 34555). Those interested in the procedures used in making NCDs under the Medicare program may review the April 27, 1999 publication (64 FR 22619).
Addendum V includes completed NCDs, or reconsiderations of completed NCDs, from the quarter covered by this notice. Completed decisions are identified by the section of the CIM in which the decision appears, the title, the date the publication was issued, and the effective date of the decision.
Superintendent of Documents, Government Printing Office, ATTN: New Orders, P.O. Box 371954,Pittsburgh, PA 15250-7954,Telephone (202) 512-1800,Fax number (202) 512-2250 (for credit card orders); or
National Technical Information Service,Department of Commerce,5825 Port Royal Road,Springfield, VA 22161,Telephone (703) 487-4630.
We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the Federal Register. Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is http://cms.hhs.gov/rulings.
The titles of the Compilation of the Social Security Laws are current as of January 1, 1999. (Updated titles of the Social Security Laws are available on the Internet at http://www.ssa.gov/OP_Home/ssact/comp-toc.htm.) The remaining portions of CD-ROM are updated on a monthly basis.
Superintendent of Documents numbers for each CMS publication are shown in Addendum III, along with the CMS publication and transmittal numbers. To help FDLs locate the materials, use the Superintendent of Documents number, plus the transmittal number. For example, to find the Carriers Manual, Part 3—Program Administration (CMS Pub. 14-3) transmittal entitled “Incident to Physician's Professional Services (Subsection A—Commonly Furnished in Physicians' Offices),” use the Superintendent of Documents No. HE 22.8/7 and the transmittal number 1793.
Addendum I Back to Top
Addendum II.—Description of Manuals, Memoranda, and CMS Rulings Back to Top
An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the Medicare Coverage Issues Manual (CIM) was published on August 21, 1989, at 54 FR 34555. A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992, at 57 FR 47468. Addendum III.—Medicare and Medicaid Manual Instructions Back to Top
[April 2003 Through June 2003]
Clinical Diagnostic Laboratory Services Other Than To Inpatients Screening Pap Smears and Pelvic Examinations
Payment Without Common Working File Approval
Filing a Request for Payment
Filing Claims for Payment
Time Limits for Requests and Claims for Payment for Services Reimbursed
Effects on Beneficiary and Provider of Beneficiary's Refusal to File a Request for Payment
Filing Claims Where Usual Time Limit Has Expired
Claims for Payment for Emergency Hospital Services and Services Outside the United States
Time Limits for Filing Part B Reasonable Charge Claims
Time Limitations for Filing Provider Claims
Incomplete or Invalid Claims
Addendum L Paper and Electronic Data Element Requirements
Bill Type Codes and Allowable Provider Numbers
Screening Pap Smears and Screening Pelvic Examinations
Coverage and Billing of Sacral Nerve Stimulation
Clinical Modification Coding for Diagnostic Tests
Incident to Physician's Professional Services (Subsection A—Commonly Furnished in Physicians' Offices)
The “Do Not Forward” Initiative (Subsection C—Internal Revenue Services—1099 Reporting)
Magnetic Resonance Angiography Coverage Summary Coding Requirements
Determining the End of a Skilled Nursing Facility Stay
Types of Facilities Included in and Excluded From Consolidated Billing
Types of Services Included in and Excluded From Consolidated Billing
Risk-Based Health Maintenance Organization Beneficiaries
Clarification of Ambulance Services
Information on a Skilled Nursing Facility Contracting With Outside Entities for Services
Carrier Claims Processing
Special Requirements for Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Revisions to Common Working File Edits To Permit Payment for Certain Diagnostic Services Furnished To Beneficiaries Receiving Treatment for End-Stage Renal Disease at an Independent or Provider-Based Dialysis Facility
Payment Limit for Certain Drugs and Biologicals
Procedures for Determining Payment Limit
Mandatory Assignment for Drugs and Biologicals
Definition of Drug or Biological
Determining Self-Administration of Drugs or Biologicals Incident-To Requirements
Healthcare Common Procedure Coding System Coding
Common Working File Edits for Flu and Pneumonia Claims
Administrative Bulletin Crossover Edit
Health Maintenance Organization Processing
Specialty Code/Place of Service Processing
Foot Care and Supportive Devices for Feet Foot Care
Peripheral Neuropathy With Loss of Protective Sensation in People With Diabetes
Standard System Edits
End-Stage Renal Disease Bill Procedures 1804
Durable Medical Equipment Regional Carriers—Pre-Discharge Delivery of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies for Fitting and Training
Payment Procedures for Intestinal and Multi-Visceral Transplants
International Classification of Diseases 9th Edition Clinical Modification
April 2003 Update of the Hospital Outpatient Prospective Payment System
A-03-021
Announcement of Medicare Rural Health Clinics and Federally Qualified
Health Centers Payment Rate Increases, Clarification on Coverage and Payment of Diabetes Self-Management Training Services and Medical Nutrition Therapy Services
A-03-022
Installation of Version 29.0 of the Provider Statistical and Reimbursement Reporting System—Modification A-03-023
A-03-023
Implementation of the Temporary Equalization of Urban and Rural Standardized Payment Amounts Under the Medicare Inpatient Hospital Prospective Payment System as Required By Section 402(b) of Public Law 108-7
Advance Beneficiary Notices Must Be Given To Beneficiaries and Demands Bills Must Be Submitted By Home Health Agencies
A-03-025
April Outpatient Code Editor Specifications Version (V4.1)
A-03-027
Updated Outpatient Prospective Payment System: Requirements for Provider Education and Training
A-03-028
January Medicare Outpatient Code Editor Specifications Version 18.1R1 for Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System
A-03-029
Corrections to: Changes to the Hospital Inpatient Prospective Payment Systems and Rates and Costs of Graduate Medical Education, etc., as Published in the Federal Register, Fiscal Year 2003 (67 FR 49982, August 1, 2002)
A-03-030
Provider-Based Status On or After October 1, 2002
A-03-031
Medicare Secondary Payer Information Collection Policies Changed for Hospitals
A-03-032
Addition of Patient Status Code 43, Deletion of Patient Status Codes 71 and 72, and Information on New Patient Status Code 65
A-03-033
End-Stage Renal Disease Reimbursement for Automated Multi-Channel Chemistry Tests
A-03-034
Modification to Medicare Timely Filing Edit for Claims Paid Under Certain Prospective Payment Systems
A-03-035
Reporting of Revenue Codes Under the Outpatient Prospective Payment System
A-03-036
Installation of Version 30.0 of the Provider Statistical and Reimbursement Reporting System—Modification
A-03-037
Contractor Reporting of Operational and Workload Data for Electronic Data Interchange and Manual Transactions
A-03-038
Program Integrity Management Reporting System for Part A Phase 2
A-03-039
Clarification to Corrections to Updated Instruction on Receipt and Processing of Non-Covered Changes on Other Than Part A Inpatient Claims (Transmittals A-02-071, A-02-117)—Change In Effective and Implementation Date Only
A-03-040
Clarification of Bill Types 22x and 23x Submitted by Skilled Nursing Facilities
A-03-041
Health Insurance Portability and Accountability Act Version 4010A1
Institutional 837 Health Care Claim Additional Implementation Direction
A-03-042
Updated Revision to Change Request 2508, Suspension, Offset, and Recoupment of Medicare Payment to Providers and Suppliers of Services
A-03-043
Changes to Fiscal Year 2001 Nursing and Allied Health Education Payment Policies
A-03-044
Audit Guidance Pertaining To Write-Offs of Small Debit Balances in Patients' Accounts Receivable
A-03-045
Payment to Hospitals and Units Excluded From the Acute Inpatient Prospective Payment System for Direct Graduate Medical Education and Nursing and Allied Health Education for Medicare+Choice Enrollees
A-03-046
Demonstration—Settlement of Payment for Home Health Services to Beneficiaries Eligible for Both Medicare and Medicaid in Connecticut, and Massachusetts. Regional Home Health Intermediaries Only.
A-03-047
Medicare's Coordination of Benefits Contractor Shall Discontinue the Dissemination of the Right of Recovery Letter to Intermediaries
July Outpatient Code Editor Specifications Version (V4.2)
Fiscal Intermediaries Must Install and Use Super Op With the Fiscal Intermediary Standard System
July Medicare Outpatient Code Editor Specifications Version 18.2 for Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System
July 2003 Update of the Hospital Outpatient Prospective System
Revision to Billing for Swing-Bed Services Under the Skilled Nursing Facility Prospective Payment System
Nurse Practitioner Services Under Medicare Hospice
Revision to Change Request 2573, Transmittal A-03-013, dated February 14, 2003: 3-Day Payment Window Refinements Under the Short-Term Hospital Inpatient Prospective Payment System
A-03-055
Disclosure of Information Requirements Related to Hospice Claims
A-03-056
Payment Update for Long-Term Care Hospital Prospective Payment System Rate Year 2004
Program Memorandum Carriers
B-03-023
Correct Payment of January and February 2003 Physician Services
B-03-024
Follow-Up to Implementation of the National Council for Prescription Drug Programs Telecommunications Standard Version 5.1 and the Equivalents
Batch Standard Version 1.1 for Retail Pharmacy Drug Transactions
B-03-025
Durable Medical Equipment Regional Carriers—DeWall Posture Protector Orthotic Body Jacket (L0430)
B-03-026
Standard System Acceptance of Primary Payer Information at the Line Level
B-03-027
Implementation of Carriers Jurisdiction Manual Instructions Based on the Medicare Carriers Manual Part 3, Section 3101 for the Multi-Carrier System
Standard System and Associated Medicare Carriers
B-03-028
Durable Medical Equipment Regional Carriers—Internal Classification of Diseases—9—Classification of Diseases Coding
B-03-029
Manager Care Reasonable Charge Data Disclosure Requirements for Ambulance Services
B-03-030
Types of Services Corrections
B-03-031
Multi-Carriers System Reporting of 2003 Participating Data to the Contractor
Reporting of Operational and Workload Data System
B-03-032
Continuation of April and July 2003 Change Requests (2423 and 2524): Create Import/Export Functionality Between the Unique Provider Identification Number System and the Provider Enrollment Chain Ownership System
B-03-033
Continuation of April and July 2003 Change Requests (2425 and 2525): Create Import/Export Functionality Between the Medicare Claims System and the Provider Enrollment Chain Ownership System
B-03-034
Continuation of April and July 2003 Change Requests (2426 and 2526): Process All Medicare Part B Provider Enrollments in the Provider Enrollment Chain Ownership System. Modify the Medicare Claims System To Incorporate All Claim Payment and Provider Correspondence Functionality That Is Included in the Provider Enrollment System But Will Not Be a Part of Provider Enrollment Chain Ownership System
B-03-035
Continuation of April and July 2003 Change Requests (2427 and 2527): Process All Medicare Part B Provider Enrollments in the Provider Enrollment Chain Ownership System. Create Import/Export Functionality Between the Viable Information Processing Systems Medicare System and Provider Enrollment Chain Ownership System
B-03-036
Expansion of Beneficiary History and Claims In Process Files in the Viable Information Processing System Phase 1—Beneficiary History File Expansion
B-03-037
Excluding From Home Health Consolidated Billing Edits Claims for Therapy Services Rendered by Physicians
B-03-038
B-03-039
Common Working File Skilled Nursing Facility Consolidated Billing Bypass To Allow Separate Payment for Drugs
Update of the Place of Services Code Set
B-03-041
National Council for Prescription Drug Program Batch Transaction Standard 1.1 Billing Request Companion Document
B-03-042
Bi-Annual Updates to the Health Care Provider Taxonomy Code
B-03-043
Diabetes Outpatient Self-Management Training and the “Incident To” Provision
B-03-044
Correction to Business Requirements 2
B-03-045
International Classification of Diseases 9th Edition Clinical Modification Coding
Requirements for Claims Submitted to Medicare Carriers
B-03-046
Provider Education: Establishing New Requirements for ICD-9-CM Coding on Claims Submitted to Medicare Carriers—Increased Role for Physicians/Practitioners
B-03-047
Changes To Correct Coding Edits, Version 9.3, Effective October 1, 2003
B-03-048
Addition of Temporary Codes Q4052 and Q4053
B-03-049
Additional Instructions To Assist in the Implementation of Program Memorandum B-02-075—Carrier Review of Payment Amounts for Portable X-Ray Transportation Services Health Care Procedure Coding System
AB-03-041
Common Working File Reject and Utilization Edits and Carriers Resolution for Consolidated Billing for Skilled Nursing Facility Residents
AB-03-042
Coverage and Billing for Percutaneous Image-Guided Breast Biopsy
AB-03-043
Addition of “K” Codes for Surgical Dressings
AB-03-044
Addition of Temporary “K” Codes
AB-03-045
AB-03-046
Expanding the Number of Source Identifiers for Common Working File Medicare Secondary Payor
AB-03-047
Single Drug Pricer Clarifications
AB-03-048
End-Stage Renal Disease Coordination Period
AB-03-049
Clarification of Payment Responsibilities of Fee-for-Service Contractors as They Relate to Hospice Members Enrolled in Managed Care Organizations and Claims Processing Instructions for Processing Rejected Claims
AB-03-050
Data Center Testing and Production—Electronic Correspondence Referral System User Manual 5.1 and Quick Reference Guide Replacement
AB-03-051
Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-03-052
Managing Medicare Appeals Workloads in Fiscal Year 2003
AB-03-053
Availability of Online Screens for the Laboratory National Coverage Determinations
AB-03-054
Diagnosis Code for Screening Pap Smear and Pelvic Examination Services
AB-03-055
Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act Transaction Release Testing
AB-03-056
New Waived Test—March 21, 2003
AB-03-057
AB-03-058
Collection of Fee-for-Service Payments Made During Periods of Managed Care Enrollment
AB-03-059
Shared Systems Changes for Name Change From Health Care Financing Administration to Centers for Medicare Medicaid Services (Fiscal Intermediary Standard and VIPS Medicare System External Changes Only)
AB-03-060
Flat File Changes in the Health Care Claim Professional (837 Professional) Version 4010A1, Health Care Claim Payment/Advice (835) Version 4010 and 4010A1 and 3051.4A, and Health Care Claim Status Inquiry and Response (276/277) Version 4010A1 Transactions
AB-03-061
Program Memorandum on Written Statements of Intent To Claim Medicare Benefits
AB-03-062
New Common Working File Edits and Standard System Responses on Skilled Nursing Facility Claims
AB-03-063
New Common Working File Medicare Secondary Payer Edit to Reject Medicare Secondary Edit Records for Medicare Beneficiaries Who Are Only Entitled To Medicare Part B, and Are Covered by a Group Health Plan
AB-03-064
System Networking Electronic Correspondence Referral System User Guide
AB-03-065
Schedule Release for July Updates to Software Programs and Pricing/Coding Files
AB-03-066
Issuance of the Eligibility File-Based Standard Trading Partner Agreement for the Purpose of Coordination of Benefits
AB-03-067
Revision to Change Request 2170: Appeals Quality Improvement and Data Analysis Activities
AB-03-068
Common Working File Change for the 270/271 Eligibility Transaction
AB-03-069
Clarification of the Criteria for a Valid Written Statement of Intent To File a Medicare Claim
AB-03-070
Second Update to the 2003 Medicare Physician Fee Schedule Database
AB-03-071
July Quarterly Update for 2003 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-03-072
Mammography Computer-Aided Detection Equipment
AB-03-073
Provider Education Article: Financial Limitation of Claims for Outpatient Rehabilitation Services
AB-03-074
Instructions for Fiscal Intermediary Standard System and Multi-Carrier System Healthcare Integrated General Ledger Accounting System Changes
AB-03-075
Provider Education Article: Quarterly Provider Update
AB-03-076
Remittance Advice Message for Denial of Clinical Diagnostic Laboratory Services Denied Due to Frequency Edits
AB-03-077
Revised Disclosure Desk Reference for Call Centers
AB-03-078
Medicare Fee-for-Service Contractor Guidance of the Health Insurance Portability and Accountability Act Privacy Rule Business Associate Provisions
AB-03-079
Claims Processing Instructions for the Utah Graduate Medical Education Demonstration
AB-03-080
Single Drug Pricer Clarification for Code J7342
AB-03-081
Data Center Testing and Production—Electronic Correspondence Referral System User Manual 6.0
AB-03-082
Medicare Secondary Payer Prepayment and Postpayment Workload Reporting—Activity Code Definitions
AB-03-083
Screening of Complaints Alleging Fraud and Abuse
AB-03-084
Changes to the Laboratory National Coverage Determination Edit Software for July 1, 2003
AB-03-085
Beneficiary Notice of Implementation of Outpatient Therapy Service Limitations
AB-03-086
New Automatic Notice of Change to Medicare Secondary Payer Auxiliary File
AB-03-087
Common Working File Edits With Unsolicited Responses for Skilled Nursing Facility Consolidated Billing
AB-03-088
Prohibition on New Trading Partner Agreements With Certain Entities for the Purpose of Coordination of Benefits
AB-03-089
Coverage and Billing for Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management
AB-03-090
Coverage of Compression Garments in the Treatment of Venous Stasis Ulcers
AB-03-091
Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification
AB-03-092
Expanded Coverage of Positron Emission Tomography Scans and Related Claims Processing Requirements for Thyroid Cancer and Perfusion of the Heart Using Ammonia N-13
AB-03-093
Correction: Coverage and Billing Requirements for Electrical Stimulation for the Treatment of Wounds
Peer Review Organization Monitoring of Hospital Admission Notice to Beneficiaries
Eligibility—has been moved to the Pub. 100-10, Medicare Quality Improvement Organizations Manual, Chapter 2, which can be found at http://www.cms.hhs.gov/manuals.
Data Management—has been moved to the Pub. 100-10, Medicare Quality Improvement Organizations Manual, Chapter 8, which can be found at http://www.cms.hhs.gov/manuals.
Management—has been moved to the Pub. 100-10, Medicare Quality Improvement Organizations Manual, Chapter 13, which can be found at http://www.cms.hhs.gov/manuals.
Performance Evaluation—has been moved to the Pub. 100-10, Medicare Quality Improvement Organizations Manual, Chapter 15, which can be found at http://www.cms.hhs.gov/manuals.
(Superintendent of Documents No. HE 22. 8/18)
Rural Health Clinic Manual Federally Qualified Health Centers Manual
(Superintendent of Documents No. He 22. 8/19:985)
Rural Dialysis Facility Manual (Non-Hospital Operated)
(CMS Pub. 29)
Hospital Healthcare Complex Cost Report
Local Provider Education and Training Program
Benefit Integrity/Payment Safeguard Contractor vs. Provider Enrollment Contractors
Ambulance Services Suppliers
Independent Diagnostic Testing Facilities—Attachment 1
Capitalization Requirements for Home Health Agencies
Special Processing Situation
Community Mental Health Centers Enrollment and Change of Ownership
Deactivation of Billing Numbers for Inactive Community Mental Health Centers
State Survey Regional Office Process
Changes of Information—New Form CMS-855 Data
Procedures for Request for Additional Information, Approval, Denial or Transmission of Recommendations
Failure to Sign and/or Date the Application
Provider-Based Processing and Changes in Status
File Maintenance and Review
Effectuating Favorable Final Appellate Decisions That a Beneficiary Is Confined To Home
Medical Records Information Reported Electronically
Electronic Media Claim Flat File Record for End-Stage Renal Disease
Argus Filed Descriptions and Formats
(Pub. 100-16)
Services of Noncontracting Providers and Suppliers
Terms of Medicare+Choice Plans
Multiple Plans in One Service Area
Centers for Medicare Medicaid Services Review and Approval of Medicare+Choice Benefits
Requirements Relating To Medicare Conditions of Participation
Requirements Relating To Benefits
Supplemental Benefits—Mandatory Supplemental and Optional Supplemental
Medicare+Choice Medical Savings Account Plan Benefits
Countable Expenses
Services After the Deductible
Special Rules on Supplemental Benefits for Medicare+Choice Medical Savings Account Plans
Point of Services Related Data
Factors That Influence Service Area Approvals
Coordination of Benefits With Employer Group Health Plans and Medicaid
Requirements, Rights, and Beneficiary Protection
Medicare Secondary Payer Procedures
Responsibilities of the Medicare+Choice Organization
Collecting From Other Entities
Collecting From Other Insurers or the Enrollee
Collecting From Group Health Plans and Large Group Health Plans
A Medicare+Choice Organization's Responsibility
Information Pertaining to a Medicare+Choice Organization Changing Its Rules or Provider Network
Other Information That Is Disclosable
Access to (and Availability of ) Service
Access and Availability Rule for Coordinated Care Plans
Ambulance, Emergency, and Urgently Needed, and Post-Stabilization Care Services Ambulance
Definition Basic Rule
State Law Primary
Content of Enrollee Information and Other Medicare+Choice Obligations
Incapacitated Enrollees
Community Education Requirements
Medicare+Choice Organization Rights
Appeal and Anti-Discrimination Rights
Introduction Provider Involvement in Policy-Making
Physician Consultation in Medical Policies
Consultation in Development of Credentialing Policies
Written Information on Physician Participation
Interference With Health Care Professionals' Advice to Enrollees Prohibited
Provider Anti-Discrimination
Notice of Reason for Not Granting Participation
Confirmation of Eligibility for Participation in Medicare Excluded and Outpatient Physical Therapy and Opt-Out Provider Checks
Credentialing, Monitoring, and Recredentialing
Suspension, Termination, or Nonrenewal of Physician Contract
Institutional Provider and Supplier Certification
Disclosure of Physician Incentive Plans
Provider Indemnification of Medicare+Choice Organization Prohibited
Special Rules for Services Furnished by Non-Contract Provider
Rules Governing Premiums and Cost Sharing
Uniformity of Premiums
Segmented Services Area Option
Timing of Payments Monetary Inducements Prohibited
Submission of Proposed Premiums and Related Information
Information Required for Coordinated Care Plans and Private Fee-For-Service Plans
Centers for Medicare Medicaid Services Review
Limits on Premiums and Cost-Sharing Amounts
Rules for Coordinated Care Plans
Rules for Medicare+Choice Private Fee-for-Service Plans
Special Rules for Mid-Year (Benefit) Enhancement
Incorrect Collections of Premiums and Cost Sharing Definitions
Reduction by Centers for Medicare Medicaid Services
Adjusted Community Rate Process
Initial Rate Calculation
Initial Rate Adjustment by Medicare+Choice Organization
Initial Rate Adjustment by Centers for Medicare Medicaid Services
Other Methods for Computing Adjusted Community Rate
Special Rule for Centers for Medicare Medicaid Services Average Payment
Rate or Adjusted Community Rate Calculation
Sufficiency of Documentation and Periodic Audits
Requirement for Additional Benefits—42 Code of Federal Regulations 422.312
Limit Per Contract Period
Exception to the Limit Per Contract Period
Interest on and Accounting of Reserved Funds
Withdrawal From a Stabilization Fund
Criteria for Centers for Medicare Medicaid Services Approval
Part B Premium Reduction As an Additional Benefit
Reduction of Charges to Enrollees for Basic Benefits
Additional Supplemental Health Care Benefits and Related Premiums
Enrollees Who Elect Hospice While Remaining Enrolled in a Medicare+Choice Plan
Medicare+Choice Non-Medicare-Covered Benefits
Medicare+Choice Medicare-Covered Benefits (Except Hospice)
Enrollees with End-Stage Renal Stage Disease User Fees
End-Stage Renal Disease Network Fee
Information Campaign User Fee
Waivers for Medicare+Choice Organization Contracts With Employer or Union Groups
Section 617 Waiver Categories Approved
Adjusted Community Rate Filings
Effect on Medicare+Choice Plan Cash Flow
Effect on Adjusted Community Rate Calculations
Medicaid Program; Provider Qualifications for Audiologists.
Medicare Program; Improvements to the Medicare+Choice Appeal and Grievance Procedures.
Medicare Program; Notice of Ambulance Fee Schedule in Accordance With Federal District Court Order.
Civil Money Penalties: Procedures for Investigations, Imposition of Penalties, and Hearings.
Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2003 Rates; Correction.
Medicare Program; Requirements for Establishing and Maintaining Medicare Billing Privileges.
Medicare Program; Meeting of the Practicing Physicians Advisory Council—May 19, 2003.
Medicare Program: Meeting of the Advisory Panel on Medicare Education—May 21, 2003.
Medicare and Medicaid Programs; Application by the Community Health Accreditation Program (CHAP) for Continued Approval of Deeming Authority for Hospices.
Medicare Program; Improvements to the Medicare+Choice Appeal and Grievance Procedures; Correction.
Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships: Extension of Partial Delay of Effective Date.
CMS-0010-IFC (OFR) Correction)
Civil Money Penalties: Procedures for Investigations, Imposition of Penalties, and Hearings; Correction.
Grants to States for Operation of Qualified High Risk Pools.
CMS-1474-P
Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2004.
42 CFR Parts 409, 413, 440, and 483
Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update.
Medicare Program; Town Hall Meeting on the Refinement of the Minimum Data Set (MDS), Version 3.0.
42 CFR Parts 412 and 413
Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2004 Rates.
CMS-2185-N
Fiscal Year 2003 Program Announcement; Availability of Funds and Notice Regarding Applications.
Medicare and Medicaid Programs; Approval of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for Deeming Authority for Hospices.
Medicare Program; Request for Nominations for Members for the Medicare Coverage Advisory Committee.
Medicare Program; Update of Ambulatory Surgical Center List of Covered Procedures Effective July 1, 2003.
42 CFR Parts 410, 414, and 485
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2003 and Inclusion of Registered Nurses in the Personnel Provision of the Critical Access Hospital Emergency Services Requirement for Frontier Areas and Remote Locations.
CMS-1470-P (OFR Correction)
Medicare Program; Demonstration: End-Stage Renal Disease—Disease Management.
Medicare Program; Prospective Payment System for Long-Term Care Hospitals: Annual Payment Rate Updates and Policy Changes.
Medicare Program; Change in Methodology for Determining Payment for Extraordinarily High-Cost Cases (Cost Outliers) Under the Acute Care Hospital Inpatient and Long-Term Care Hospital Prospective Payment Systems.
Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2004 Rates; Correction.
Medicare Program; Public Meeting in Calendar Year 2003 for New Clinical Laboratory Tests Payment Determinations.
Medicare Program; Extension of Date of Submissions and Informational Meeting on the Application Process for the End-Stage Renal Disease—Disease Management Demonstration.
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—January 2003 Through March 2003.
Medicare and Medicaid Programs; Solicitation for Information on the Hospital CAHPS.
Medicare Program: Notice of the Practicing Physicians Advisory Council Rechartering.
Medicare Program; Negotiated Rulemaking Committee on Special Payment Provisions and Requirements for Prosthetics and Certain Custom-Fabricated Orthotics; Meeting Announcement.
Amendment to the Interim Final Regulation for Mental Health Parity.
Addendum V.—National Coverage Determinations, April 2003 Through June 2003 Back to Top
A national coverage determination (NCD) is a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under Title XVIII of the Social Security Act, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title, or determination with respect to the amount of payment made for a particular item or service so covered. We include below all of the NCDs that became effective during the quarter covered by this notice. The entries below include information concerning completed decisions as well as sections on program and decision memoranda, which also announce impending decisions or, in some cases, explain why it was not appropriate to issue an NCD. We identify completed decisions by section of the Coverage Issues Manual (CIM) in which the decision appears, the title, the date the publication was issued, and the effective date of the decision. Information on completed decisions as well as pending decisions has also been posted on the CMS Web site at http://cms.hhs.gov/coverage.
National Coverage Decisions Back to Top
Magnetic Resonance Angiography of the Abdomen and Pelvis
PET for Thyroid Cancer
PET for Soft Tissue Sarcoma
PET for Alzheimer's Disease/Dementia
PET for Myocardial Perfusion of the Heart Using Ammonia N-13
Changes to the Laboratory NCD Edit Software For 07/03 (Blood Counts, Blood Glucose Testing, HIV Testing)
Addendum VI.—Categorization of Food and Drug Administration-AllowedInvestigational Device Exemptions Back to Top
The following information presents the device number and category (A or B) for the second quarter, April through June 2003.
Investigational Device Exemption Numbers, 2nd Quarter 2003 Back to Top
G010175
G010354
G020083
G020230
G020244
G020273
G020307
G020319
G020323
G030034
G030044
G030045
G030051
G030054
G030055
G030056
G030058
G030061
G030062
G030063
G030064
G030065
G030073
G030074
G030075
G030078
G030082
G030088
G030089
G030090
G030091
G030095
G030096
G030097
G030103
G030104
G030105
G030108
G030109
G030110
G030113
G030114
G030115
G030117
G030118
G030120
G030122
G030124
G030126
G030128
Addendum VII.—Approval Numbers for Collections of Information Back to Top
0938-0008
414.40, 424.32, 424.44.
0938-0022
413.20, 413.24, 413.106.
0938-0023
0938-0025
406.28, 407.27.
0938-0027
486.100-486.110.
0938-0034
405.821.
0938-0035
0938-0037
413.20, 413.24.
0938-0041
0938-0042
410.40, 424.124.
0938-0045
405.711.
0938-0046
405.2133.
0938-0050
0938-0062
431.151, 435.1009, 440.250, 440.220, 442.1, 442.10-442.16, 442.30, 442.40, 442.42, 442.100-442.119, 483.400-483.480, 488.332, 488.400, 498.3-498.5.
0938-0065
485.701-485.729.
0938-0074
491.1-491.11.
0938-0080
406.7, 406.13.
0938-0086
420.200-420.206 and 455.100-455.106.
0938-0101
0938-0102
0938-0107
0938-0146
431.800-431.865.
0938-0147
0938-0151
493.1405, 493.1411, 493.1417, 493.1423, 493.1443, 493.1449, 493.1455, 493.1461, 493.1469, 493.1483, 493.1489.
0938-0155
405.247.
0938-0170
493.1269-493.1285.
0938-0193
430.10-430.20 and 440.167.
0938-0202
413.17, 413.20.
0938-0214
411.25, 489.2, 489.20.
0938-0236
0938-0242
416.44, 418.100, 482.41, 483.270, 483.470.
0938-0245
407.10, 407.11.
0938-0251
0938-0266
416.41, 416.83, 416.47, 416.48.
0938-0267
485.56, 485.58, 485.60, 485.64, 485.66, 410.65.
0938-0269
412.116, 412.632, 413.64, 413.350, 484.245.
0938-0270
405.376.
0938-0272
440.180, 441.300-441.305.
0938-0273
0938-0279
0938-0287
447.31.
0938-0296
413.17.
0938-0300
0938-0301
0938-0313
418.1-418.405.
482.12, 482.22, 482.27, 482.30, 482.41,482.43,482.53,482.56, 482.57, 482.60, 482.61, 482.62, 482.66.
0938-0334
491.9 Subpart A.
0938-0338
486.104, 486.106, 486.110.
0938-0354
0938-0355
484.10-484.52.
0938-0357
409.40-409.50, 410.36, 410.170, 411.4-411.15, 421.100, 424.22, 484.18 and 489.21.
0938-0358
412.20-412.30.
0938-0359
412.40-412.52.
0938-0360
405.2100-405.2184.
0938-0365
484.10, .11, .12, .14, .16, .18, .20, .36, .48, .52.
0938-0372
414.33.
482.60-482.62.
0938-0379
0938-0380
482.1-482.66.
0938-0386
405.2100-405.2171.
488.18, 488.26, 488.28.
476.104, 476.105, 476.116, 476.134.
0938-0429
447.53.
0938-0443
473.18, 473.34, 473.36, 473.42.
0938-0444
1004.40, 1004.50, 1004.60, 1004.70.
0938-0445
412.44, 412.46, 431.630, 456.654, 466.71, 466.73, 466.74, 466.78.
0938-0447
0938-0449
440.180, 441.300-441.310.
0938-0454
0938-0456
412.105.
0938-0463
0938-0465
411.404, 411.406, 411.408.
0938-0467
431.17, 431.306, 435.910, 435.920, 435.940-435.960.
0938-0469
417.107, 417.478.
0938-0470
417.143 and 417.408.
0938-0477
412.92.
0938-0484
424.123.
0938-0486
498.40-498.95.
0938-0501
406.15.
0938-0502
433.138.
0938-0512
486.301-486.325.
0938-0526
475.100 Subpart C, 475.106 and 475.107, 462.102, 462.103.
0938-0534
410.38, 424.5.
0938-0544
493.1-493.2001.
0938-0565
411.20-411.206.
0938-0566
411.404(b)(c), 411.406(d), 411.408(d)(2) and (f).
0938-0567
Part 498 Subpart H, Part 498 Subparts D and E, and 20 CFR 404.933.
0938-0573
412.256 and 412.230.
0938-0581
0938-0599
0938-0600
405.371, 405.378 and 413.20.
0938-0610
417.436, 417.801, 417.436(d), 422.128, 430.12(c)(1)(ii), 431.20, 31.107, 434.28, 483.10, 484.10(c)(ii), 489.102.
0938-0612
0938-0618
433.68, 433.74, 447.272.
0938-0653
0938-0655
493.184.
0938-0657
405.2110, 405.2112.
0938-0658
0938-0667
482.12, 488.18, 489.20 and 489.24.
0938-0673
0938-0679
410.38.
0938-0685
410.32, 410.71, 413.17, 424.57, 424.73, 424.80, 440.30, 484.12.
0938-0686
493.551-493.557.
0938-0688
0938-0690
488.4-488.9, 488.201.
0938-0691
412.106.
0938-0692
466.78, 489.20, and 489.27.
0938-0700
417.479, 417.500; 422.208, 422.210; 434.44, 434.67, 434.70; 1003.100, 1003.101, 1003.103 1003.106.
0938-0701
422.152.
45 CFR 146.111, 146.115, 146.117, 146.150, 146.152, 146.160, 146.180.
0938-0703
45 CFR 148.120, 148.124, 148.126, and 148.128.
0938-0714
411.370-411.389.
0938-0717
424.57.
0938-0721
410.33.
0938-0722
422.370-422.378.
0938-0723
421.300-421.318.
0938-0730
405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61, 415.110, 424.24.
0938-0732
417.126, 417.470.
0938-0734
45 CFR 5b.
0938-0739
413.337, 413.343, 424.32, 483.20.
0938-0742
422.300-422.312.
0938-0749
0938-0753
422.000-422.700.
0938-0754
441.152.
0938-0758
0938-0760
Part 484 Subpart E, 484.55.
0938-0761
484.11, 484.20.
0938-0763
422.1-422.10, 422.50-422.80, 422.100-422.132, 422.300-422.312, 422.400-422.404, and 422.560-422.622.
0938-0768
417.800-417.840.
0938-0770
0938-0778
422.64, 422.111, 422.560-422.622.
0938-0779
417.470, 417.126(a), 422.210(h), 422.64(10).
0938-0781
411.404-411.406, 484.10.
0938-0786
438.352, 438.360, 438.362, 438.364.
0938-0787
0938-0790
460.12, 460.22, 460.26, 460.30, 460.32, 460.52, 460.60, 460.70, 460.71, 460.72, 460.74, 460.80, 460.82, 460.98, 460.100, 460.102, 460.104, 460.106, 460.110, 460.112, 460.116, 460.118, 460.120, 460.122, 460.124, 460.132, 460.152, 460.154, 460.156, 460.160, 460.164, 460.168, 460.172, 460.190, 460.196, 460.200, 460.202, 460.204, 460.208, 460.210.
0938-0792
491.3, 491.8, 491.11.
0938-0798
413.65, 419.42.
0938-0802
419.43.
0938-0810
482.45.
0938-0819
45 CFR 146.121.
0938-0823
420.41.
0938-0824
482.13(f)(7), 440.10(1)(3)(iii).
0938-0827
45 CFR 146.141.
0938-0829
422.568.
0938-0832
0938-0833
483.350-483.376.
0938-0840
422.152(b)(2).
0938-0841
431.636, 457.50, 457.60, 457.70,457.340, 457.350, 457.431, 457.440, 457.525, 457.560, 457.570, 457.740, 457.750, 457.810, 457.940, 457.945, 457.965, 457.985, 457.1005, 457.1015, and 457.1180.
0938-0842
412 and 413.
0938-0846
411.1, 411.350-411.357 and 424.22.
0938-0857
0938-0860
0938-0866
45 CFR Part 162.
0938-0872
483.20, 413.337.
0938-0873
0938-0874
45 CFR Parts 160 and 162.
0938-0878
Part 422 Subparts F and G.
0938-0883
45 CFR Parts 160 and 164.
0938-0887
45 CFR 148.316, 148.318, 148.320.
0938-0897
412.22, 412.533.
[FR Doc. 03-24069 Filed 9-25-03; 8:45 am]