[Federal Register: August 22, 2003 (Volume 68, Number 163)]
[Rules and Regulations]
[Page 50717-50722]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr22au03-15]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 413
[CMS-1199-F]
RIN 0938-AL51
Medicare Program; Electronic Submission of Cost Reports
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule.
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SUMMARY: This final rule amends regulation by requiring that, for cost
reporting periods ending on or after December 31, 2004, all hospices,
organ procurement organizations, rural health clinics, Federally
qualified health centers, community mental health centers, and end-
stage renal disease facilities must submit cost reports currently
required under the Medicare regulations in a standardized electronic
format. This rule also allows a delay or waiver of this requirement
when implementation would result in financial hardship for a provider.
The provisions of this rule allow for more accurate preparation and
more efficient processing of cost reports.
DATES: Effective Date: The provisions of this final rule are effective
September 22, 2003.
Applicability Date: The provisions of this final rule are effective
for cost reporting periods ending on or after December 31, 2004.
FOR FURTHER INFORMATION CONTACT: Larry Stevenson, (410) 786-5529.
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.
I. Background
Generally, under the Medicare program, hospices, organ procurement
organizations (OPOs), rural health clinics (RHCs), Federally qualified
health centers (FQHCs), community mental health centers (CMHCs), and
end-stage renal disease (ESRD) facilities are paid for the reasonable
costs of the covered items and services they furnish to Medicare
beneficiaries. Sections 1815(a) and 1833(e) of the Social Security Act
(the Act) provided that no payments will be made to a provider unless
it has furnished the information, requested by the Secretary of the
Department of Health and Human Services (the Secretary), needed to
determine the amount of payments due the provider. In general,
providers submit this information through cost reports that cover a 12-
month period. Rules governing the submission of cost reports are set
forth in title 42 of the Code of Federal Regulations (CFR) 413.20 and
413. 24.
Under Sec. 413.20(a), all providers participating in the Medicare
program are required to maintain sufficient financial records and
statistical data for proper determination of costs payable under the
program. In addition, providers must use standardized definitions and
follow accounting, statistical, and reporting practices that are widely
accepted in the health care industry and related fields. Under Sec.
413.20(b) and Sec. 413.24(f), providers are required to submit cost
reports annually, with the reporting period based on the provider's
accounting year. Additionally, under Sec. 412.52, all hospitals
participating in the prospective payment system must meet cost
reporting requirements set forth at Sec. 413.20 and Sec. 413.24.
Section 1886(f)(l)(B)(i) of the Act requires the Secretary to
establish a standardized electronic cost reporting system for all
hospitals participating in the Medicare program. This provision was
effective for hospital cost reporting periods beginning on or after
October 1, 1989. On January 2, 1997, we revised our regulations at
Sec. 413.24(f)(4)(ii) to extend the electronic cost reporting
requirement to skilled nursing facilities (SNFs) and home health
agencies (HHAs) (62 FR 26-31).
The required cost reports must be electronically transmitted to the
intermediary in American Standard Code for Information Interchange
(ASCII) format. In addition to the electronic file, hospitals, SNFs,
and HHAs were initially required to submit a hard copy of the full cost
report. We later revised our regulations in Sec. 413.24(f)(4)(iv) to
state that providers were required to submit, instead, a hard copy of a
one-page settlement summary, a statement of certain worksheet totals
found in the electronic file, and a statement signed by the provider's
administrator or chief financial officer certifying the accuracy of the
electronic file. In order to preserve the integrity of the electronic
file, in the January 1997 final rule we specified procedures regarding
the processing of the electronic cost report once it is submitted to
the intermediary (62 FR 27).
II. Provisions of the Proposed Regulations
With the exception of revising the first cost reporting period
affected from those ending on or after December 31, 2002 to those
ending on or after December 31, 2004, we have adopted the provisions as
set forth in our proposed rule, published in the Federal Register on
July 26, 2002 (67 FR 48840-48844). We revised the cost reporting
periods affected to take into account the publication date for this
final rule. We discuss the finalized provisions in section IV of this
final rule.
III. Analysis of and Responses to Public Comments
We received approximately 20 comments on the proposed electronic
submission of cost reports requirements. These comments were from
providers, professional organizations, trade associations, vendors and
individuals. Summaries of the public comments
[[Page 50718]]
received and our responses to those comments are set forth below.
Comment: Several commenters requested that we add language to the
regulation that would prohibit fiscal intermediaries (FIs) from
requesting paper copies of the Medicare cost report, in addition to the
electronic cost report.
Response: According to our CMS manual provisions (Provider
Reimbursement Manual 15-2, chapter 1, sections 131 and 132), the
electronic cost report file is considered the official cost report by
the FI and, as a result, must be accepted by the FI. Since March 31,
1993, hospitals have not been required to submit a paper copy of the
cost report to the FI . Similarly, since March 31, 2000, SNFs and HHAs
have not been required to submit a paper copy of the cost report to the
FI. We have, however, provided a two-year phase-in period for the
providers that are subject to this regulation. During this two-year
phase-in period, the paper copy of the cost report will be considered
the official copy. After the expiration of the two-year period, though,
a paper copy of the cost report will not be required to be submitted to
the FI. We believe this phase-in period is necessary, so that providers
are familiar with the requirements of electronic cost reporting.
Comment: We received several comments concerning our proposal to
distribute free electronic cost reporting software to providers who can
demonstrate that it would be a financial hardship to purchase software
from vendors. One comment, from a software vendor, requested that we
add language that would preclude the distribution of free software
because it would be ``unfair'' to small vendors and the software would
be poor quality. Another commenter asked that we specify a date that
the free software would be available to providers. Also, we received a
comment that the CMS-provided software would not allow providers to
determine final settlement and that providers would still have to
complete the cost report manually.
Response: With regard to the comment concerning adding language to
the regulation that would preclude the distribution of free software,
free software is made available to the providers based upon financial
need only. The provider must demonstrate to the FI that the provider is
financially unable to purchase commercial software. It has been our
experience, with the hospitals, SNFs, and HHAs currently required to
file electronically, that relatively few providers request the free
software. If, however, the provider requests the free software and can
demonstrate to the FI that it would be a financial hardship to purchase
the software from a vendor, we will provide the software so that the
provider can comply with the provisions of this rule. The quality of
the software will be sufficient to allow the provider to comply with
all provisions of this rule in a timely and efficient manner.
With regard to the comment concerning the projected date that the
free software will be available, we expect that it should be available
by September 30, 2004.
The comment that the CMS-provided software would not allow
providers to determine final settlement and, as a result, that
providers would still have to complete the cost report manually, is
correct. The software allows the provider to create an electronic cost
report file only for use by the FI and a final settlement amount is not
necessary in this instance. Providers who use free software are always
required to manually complete the cost report and to manually determine
the final settlement.
Comment: We received a comment that the final regulation should
also require that Comprehensive Outpatient Rehabilitation Facilities
(CORFs) and Outpatient Physical Therapy providers (OPTs) file cost
reports electronically.
Response: We are not requiring CORFs and OPTs to file
electronically because CORFs are paid on a fee schedule for services
furnished on or after April 1, 2001 and OPTs will be paid on a fee
schedule for services furnished on or after July 1, 2003. For those
providers with cost reporting periods beginning on or after the
aforementioned dates, cost reports will no longer be required. We
believe that it would be administratively burdensome as well as not
economically feasible to require these providers to meet the electronic
filing requirements for such a short period of time.
Comment: We received a comment that the final rule should include
an exemption from the electronic filing requirement for no or low
utilization providers because it appears that these providers are
exempt from such filing requirements in Sec. 413.24(h).
Response: Section 413.24(h) does not address the electronic filing
requirement but it does provide that an FI may waive the requirement
that a provider submit a full cost report if it qualifies as low
utilization or no cost Medicare provider. Thus, based upon a waiver by
the FI, under Sec. 413.24(h), a low utilization or no Medicare
utilization provider would not be required to file an electronic cost
report. Because our current regulations clearly state that a full cost
report need not be filed by a low utilization or no Medicare
utilization provider, we believe that an exception, such as the one
requested by the commenter, is not necessary for this final rule.
Comment: We received a comment that we should clarify the minimum
requirements of what constitutes a financial hardship for the purposes
of qualifying for the waiver and/or free software.
Response: Given the wide spectrum of the providers affected, we
believe it is best to determine financial hardship on a case-by-case
basis. Some examples of financial hardship include cash flow problems,
previous year's net operating loss, and a required repayment of the
past year's overpayment. These are some examples of financial hardship
but should not be seen as all-encompassing. The flexibility to make
these determinations is necessary as the providers differ greatly in
terms of size, location, expenses, and services provided. The FI will
need to have this flexibility in order to make a fair and reasonable
determination for each provider.
Comment: We received several comments concerning the one-time pass
through of costs (direct reimbursement on a dollar-for-dollar basis)
for RHCs and FQHCs rather than reimbursing those providers based on the
determination of the total allowable costs of the RHCs and FQHCs.
Response: We are unable to reimburse RHCs and FQHCs in a way other
than direct reimbursement because to do so would require a statutory
change in the method of reimbursement for the RHCs and FQHCs.
Comment: We received a comment reflecting concern that the cost of
dial up Internet service required to file electronically would be a
burden for rural providers.
Response: There is no requirement to use the Internet to
electronically file a cost report. The medium for transfer of cost
reports submitted electronically to FIs is a 3\1/2\'' diskette.
Comment: We received two comments expressing concern about the
phase-in period. One concern was that the two-year phase-in period was
too long. Another concern was that the two-year period should be
extended to three years.
Response: We believe that the two-year phase-in period is necessary
to allow providers to become familiar with the requirements of
electronic filing and that a shorter phase-in period would be
insufficient to accomplish this.
Similarly, prior experience with the hospital cost report, the SNF
cost report,
[[Page 50719]]
and the HHA cost report indicate that the two-year phase-in period
provides ample time for the providers to adjust to the electronic
methods for filing the cost report, and a longer period is not
necessary.
Comment: We received a comment that we should delay the
implementation of the electronic filing requirement for FQHCs from
December 31, 2002 until June 30, 2003 to allow those providers more
time for implementation.
Response: We are revising the implementation date to December 31,
2004 to allow all providers more time to implement the rule.
Comment: We received a comment that recommended that we have a
pilot testing period before implementing the electronic filing
requirement.
Response: Electronic filing of cost reports has been required since
March 31, 1993 for hospitals and for SNFs and HHAs since March 31, 2000
and, based on our experiences with hospitals, SNFs, and HHAs, we
believe that the electronic filing requirements will be implemented by
hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD facilities, as efficiently
as has been the case with the other providers mentioned. Moreover, the
two-year phase-in period, which will end May 31, 2007, will allow
sufficient time for the providers subject to this regulation to adapt
to the electronic filing requirement. The hard copy of the cost report
is the official copy during the two-year transition period. For this
two-year phase-in period, no cost report will be rejected but the FIs
will make the provider aware of the edits that the provider did not
pass. This flexibility will allow the provider to correct any problems
that the provider has encountered with electronic filing before the
phase-in period ends.
Comment: We received a comment that a correction period of 60 days
be allowed for providers to resubmit electronic cost reports that are
rejected by the FI.
Response: While it is the responsibility of the provider to submit
an acceptable cost report to the FI by the required due date of the
cost report, we have established a two-year phase-in period where the
hardcopy of the cost report will be the official cost report and will
not be rejected by the FI--a concern of the commenter. The two-year
phase-in period has been established to allow the provider sufficient
time to familiarize itself with the electronic filing requirements.
Also, during this two-year phase-in period, the FI will inform the
provider concerning any problems that the provider may encounter with
the electronic filing requirement that would cause rejection in the
future. It should be noted, as well, that there already exists a 30-day
period during which providers can correct errors and resubmit
electronic cost reports to the FI (See Provider Reimbursement Manual
15-II, Chapter 1, section 140).
Comment: We received a comment that all current cost reports should
be settled by the FIs before the implementation of the electronic
filing requirement.
Response: The settlement of cost reports is not governed by this
final rule and any changes regarding the settlement of cost reports are
beyond the scope of this rule which is concerned solely with electronic
filing requirements.
Comment: We received a comment that we should provide electronic
Provider Statistical Reimbursement & Report data (PS&R)--reimbursement
and statistical data that we prepare--to providers.
Response: Although this comment does not fall within the scope of
this rule, we believe that it may be helpful to address this process
issue. We note, therefore, that this information is used by the FI for
the settlement of cost reports. The detailed PS&R, however, is
available from the FI upon written request from the provider if there
are any discrepancies between the provider's data and the PS&R summary
report. The FI is required to send the summary PS&R report to the
provider 30 days before the due date of the cost report.
Comment: A commenter requested that we not extend the ``complex''
and ``punitive'' criteria for acceptable cost reports currently imposed
on hospitals, SNFS, and HHAs to the other providers affected by this
final rule.
Response: We do not believe that acceptability criteria for
electronic cost report filings are complex and they certainly are not
intended to be punitive. We developed these criteria both to help the
provider and to ensure that the provider is aware of what is required
to file an acceptable cost report. We believe these criteria, which we
attempt to keep at a minimum, will help ensure accuracy and save time
to both the provider and the FI. Generally included in the criteria,
for example, are the level one electronic edits that all cost reports
must pass in order for the cost report to be acceptable. By clearly
enumerating these level one edits in our criteria--the criteria most
critical in the filing of an acceptable electronic cost report--we
believe providers will have every opportunity to meet the requirements
in a timely and accurate manner.
IV. Provisions of the Final Rule
In this final rule, we are applying the current hospital, SNF, and
HHA electronic cost reporting requirements to hospices, OPOs, RHCs,
FQHCs, CMHCs, and ESRD facilities with the exception that, for the
first 2 years, the hard copy of the cost report must be submitted with
the electronic cost report. Over that 2-year period (until May 31,
2007) the hard copy will continue to be the official copy. We believe
that the use of electronically prepared cost reports will be beneficial
for hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD facilities because the
cost reporting software for these reports will virtually eliminate
computational errors and substantially reduce preparation time.
Moreover, the use of cost reporting software will save time whenever
the provider needs to change individual entries in a cost report.
This rule provides that a hospice, organ procurement organization,
RHC, FQHC, CMHC, or ESRD facilities may submit a written request for a
waiver or a delay of these requirements if it believes that
implementation of the electronic submission requirement would cause a
financial hardship. Consistent with the existing regulations (see Sec.
413.24(h)), we are continuing to allow providers with low or no
Medicare utilization to request a waiver of full or simplified cost
reporting.
V. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995 (PRA 1995), we are
required to provide 30 days notice in the Federal Register and solicit
public comment before a collection of information requirement is
submitted to the Office of Management and Budget (OMB) for review and
approval. However, the requirements referenced and discussed below are
currently approved by OMB.
Section 413.24 Adequate Cost Data and Cost Finding
Currently, Sec. 413.24 requires hospitals, SNFs, and HHAs to
submit electronic cost reports. However, as proposed in the regulation,
hospices, OPOs, RHCs, FQHCs, CMHCs, or ESRD facilities will no longer
have the option of submitting either a hard copy or electronic cost
report. In addition to the electronic cost report, these providers will
also continue to be required to submit to the appropriate FI, hard
copies of a settlement summary, statement of certain worksheet totals,
and the Federally prescribed statement signed
[[Page 50720]]
by its administrator or chief financial officer certifying the accuracy
of the electronic file or the manually prepared cost report. We believe
that these electronic filing requirements will initially increase the
burden by approximately 40 hours and cost approximately $5000 for each
cost reporting period. We expect that this burden will decrease as the
providers become familiar and proficient in electronic filing.
However, as currently approved, these providers may request a delay
or waiver of the electronic submission requirement in paragraph
(f)(4)(ii) of this section if this requirement would cause a financial
hardship.
As noted above, while all the above reporting requirements are
subject to the PRA, they are currently approved under OMB approval
numbers 0938-0050, ``Hospital/Healthcare Complex Cost Report,'' with a
current expiration date of November 30, 2005, 0938-0463; ``Skilled
Nursing Facility Cost Report,'' with a current expiration date of May
31, 2004; 0938-0022, ``Home Health Agency Cost Report,'' with a current
expiration date of May 31, 2004; 0938-0758, ``Hospice Cost Report,''
with a current expiration date of March 31, 2005; 0938-0102, ``Organ
Procurement Agency/Laboratory Statement of Reimbursable Costs,'' with a
current expiration date of October 31, 2003, which is currently at OMB
awaiting re-approval; 0938-0107, ``Independent Rural Health Clinic/
Freestanding Federally Qualified Health Center Cost Report,'' with a
current expiration date of October 31, 2005; 0938-0236, ``Medicare
Independent Renal Dialysis Facility Cost Report,'' with a current
expiration date of August 31, 2004; and 0938-0657, ``End Stage Renal
Disease Network Cost Report,'' with a current expiration date of
December 31, 2003, which is currently in the re-approval process.
VI. Regulatory Impact Statement
We have examined the impacts of this final rule as required by
Executive Order 12866 (September 1993, Regulatory Planning and Review),
the Regulatory Flexibility Act (RFA) (September 16, 1980 Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1955 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, which
merely reassigns responsibility of duties) directs agencies to assess
all costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). A
regulatory impact analysis (RIA) must be prepared for major rules with
economically significant effects ($100 million or more annually). This
rule will not have a significant economic impact on hospices, OPOs,
RHCs, FQHCs, CMHCs, and ESRD facilities, and, therefore, is not a major
rule. There are no requirements for hospices, OPOs, RHCs, FQHCs, CMHCs,
and ESRD facilities to initiate new processes of care, and reporting;
to increase the amount of time spent on providing or documenting
patient care services; or to purchase computer software.
The RFA requires agencies to analyze options for regulatory relief
of small entities. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and small governmental
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having annual
receipts of $6 million to $29 million or less annually (see 65 FR
69432). For purposes of the RFA, all providers and small businesses
that distribute cost-report software to providers are considered small
entities. We do not believe that this rule will have a significant
impact on these providers as no or low utilization providers already
have the ability to file for a waiver of the electronic filing
requirement. In demonstrated cases of financial hardship, however, we
will provide free software. With computers so common in the work place
today it is hard to imagine that a provider does not already access to
a computer and, in the rare instance when a provider would have to
purchase a computer, we believe the cost would be neglible. In
addition, the providers have a period of almost two years to
familiarize themselves with the electronic filing requirements, since
the first cost reports will not be due until May 31, 2005. Our
intermediaries are not considered small entities for the purposes of
the RFA. Individuals and States are not included in the definition of
small entities.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds.
We are not preparing analyses for either the RFA or section 1102(b)
of the Act because we have determined, and we certify, that this rule
will not have a significant economic impact on a substantial number of
small entities or a significant impact on the operations of a
substantial number of small rural hospitals.
As stated above, under Sec. 413.20(b) and Sec. 413.24(f),
providers are required to submit cost reports annually, with reporting
periods based on the provider's accounting year. This final rule
requires hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD facilities, like
hospitals, SNFs and HHAs, to submit their Medicare cost reports in a
standardized electronic format. This requirement will take effect for
cost reporting periods ending on or after December 31, 2004, meaning
that the first electronic cost reports will be due May 31, 2005.
Currently, approximately 55 percent of all hospices, OPOs, RHCs,
FQHCs, CMHCs, and ESRD facilities submit a hard copy of an
electronically prepared cost report to the intermediary. We believe
that the provisions of this final rule will have little or no effect on
these providers, except to reduce the time involved in copying and
collating a hard copy of the report for intermediaries. Under this
rule, instead of submitting a complete hard copy of the report,
providers will be required to submit only hard copies of a settlement
summary, statement of certain worksheet totals, and a statement signed
by the administrator or chief financial officer certifying the accuracy
of the electronic file or the manually prepared cost report. In
addition to the 55 percent of providers that currently use electronic
cost reporting, this rule will not affect those providers that do not
file a full cost report and, as stated above, would not be required to
submit cost reports electronically.
This rule may have an impact on those providers who do not prepare
electronic cost reports, some of whom may have to purchase computer
equipment, obtain the necessary software, and train staff to use the
software. However, as discussed below, we believe that the potential
impact of this final rule on those providers who do not prepare
electronic cost reports will be insignificant.
First, a small number of the 45 percent of providers that do not
submit electronic cost reports may have to purchase computer equipment
to comply with the provisions of this rule. These providers are
generally owned
[[Page 50721]]
and operated by one or two individuals and are often located in rural
areas. They include approximately 1,500 RHCs and 1,500 FQHCs. We
estimate that 1,350 of the 3000 RHCs and FQHCs may not have the
necessary computer equipment. We believe, however, that most providers
already have access to computer equipment, which they are now using for
internal record keeping purposes, as well as for submitting
electronically generated bills to their fiscal intermediaries, for
example. Thus, we do not believe that obtaining computer equipment will
be a major obstacle to electronic cost reporting for most providers.
For those providers that may have to purchase computer equipment, we
note that, in accordance with current regulations governing payment of
provider costs, we will pay for the cost of the equipment as an
overhead cost. Rural health clinics and FQHCs will be reimbursed
subject to a payment limit; OPOs reimbursed based on costs; hospices
reimbursed according to fee schedule; ESRDs paid a composite rate, and
CMHCs will be reimbursed through a blend of prospective payment (PPS)
and cost.
We recognize that a potential cost for providers that do not submit
electronic cost reports will be that of training staff to use the
software. Since most hospices, OPOs, RHCs, FQHCs, CMHCs, and ESRD
facilities currently use computers, we do not believe that training
staff to use the new software will impose a large burden on providers.
An additional cost would be the cost of the software offered by
commercial vendors. However, providers could eliminate this cost by
obtaining the necessary software from us, free of charge. In those
instances when these requirements may cause hardship, a waiver can be
granted.
The requirement that hospitals submit cost reports in a
standardized electronic format has been in place since October 1989.
Since that time, the accuracy of cost reports has increased and we have
received very few requests for waivers. Additionally, we have not
received any comments from the hospital industry indicating that the
use of electronic cost reporting is overly burdensome. We believe that
electronic cost reporting will be equally effective for hospices, OPOs,
RHCs, FQHCs, CMHCs, and ESRD facilities, with the benefits (such as
increased accuracy and decreased preparation time) outweighing the
costs of implementation for most providers.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in an expenditure in any one year by
State, local, or tribal governments, in the aggregate, or by the
private sector, that exceeds the inflation-adjusted threshold of $110
million. This rule does not impose any costs that would exceed the $110
million threshold on the governments mentioned, or the private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct compliance costs on State
and local governments, preempts State law, or otherwise has Federalism
implications. We have examined this final rule and have determined that
this rule will not have an impact on the rights, roles, and
responsibilities of State, local, or tribal governments.
In accordance with the provisions of Executive Order 12866, this
final rule was reviewed by the Office of Management and Budget.
List of Subjects in 42 CFR Part 413
Health facilities, Kidney diseases, Medicare, Reporting and
recordkeeping requirements.
0
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid amends 42 CFR chapter IV part 413 as follows:
PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT
RATES FOR SKILLED NURSING FACILITIES
0
1. The authority citation for part 413 continues to read as follows:
Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i) and
(n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act
(42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n),
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww).
0
2. Section 413.24 is amended by revising existing paragraphs (f)(4)(i)
through (f)(4)(v) to read as follows:
Sec. 413.24 Adequate cost data and cost finding.
* * * * *
(f) Cost reports. * * *
(4) Electronic submission of cost reports.
(i) As used in this paragraph, ``provider'' means a hospital,
skilled nursing facility, home health agency, hospice, organ
procurement organization, rural health clinic, Federally qualified
health clinic, community mental health center, or end-stage renal
disease facility.
(ii) Effective for cost reporting periods beginning on or after
October 1, 1989 for hospitals, cost reporting periods ending on or
after December 31, 1996 for skilled nursing facilities and home health
agencies, and cost reporting periods ending on or after December 31,
2004 for hospices, organ procurement organizations, rural health
clinics, Federally qualified health centers, community mental health
centers, and end-stage renal disease facilities, a provider is required
to submit cost reports in a standardized electronic format. The
provider's electronic program must be capable of producing the CMS
standardized output file in a form that can be read by the fiscal
intermediary's automated system. This electronic file, which must
contain the input data required to complete the cost report and to pass
specified edits, must be forwarded to the fiscal intermediary for
processing through its system.
(iii) The fiscal intermediary stores the provider's as-filed
electronic cost report and may not alter that file for any reason. The
fiscal intermediary makes a ``working copy'' of the as-filed electronic
cost report to be used, as necessary, throughout the settlement process
(that is, desk review, processing audit adjustments, and final
settlement). The provider's electronic program must be able to disclose
if any changes have been made to the as-filed electronic cost report
after acceptance by the intermediary. If the as-filed electronic cost
report does not pass all specified edits, the fiscal intermediary must
return it to the provider for correction. For purposes of the
requirements in paragraph (f)(2) of this section concerning due dates,
an electronic cost report is not considered to be filed until it is
accepted by the intermediary.
(iv) Effective for cost reporting periods ending on or after
September 30, 1994 for hospitals, cost reporting periods ending on or
after December 31, 1996 for skilled nursing facilities and home health
agencies, and cost reporting periods ending on or after December 31,
2004 for hospices, organ procurement organizations, rural health
clinics, Federally qualified health centers, community mental health
centers, and end-stage renal disease facilities, a provider must submit
a hard copy of a settlement summary, a statement of certain worksheet
totals found within the electronic file, and a statement signed by its
administrator or chief financial officer certifying the accuracy of the
electronic file or the manually prepared cost report. During a
transition period (first two cost-reporting periods on or after
December 31, 2004), hospices, organ procurement
[[Page 50722]]
organizations, rural health clinics, Federally qualified health
centers, community mental health centers, and end-stage renal disease
facilities must submit a hard copy of the completed cost report forms
in addition to the electronic file. The following statement must
immediately precede the dated signature of the provider's administrator
or chief financial officer:
I hereby certify that I have read the above certification statement
and that I have examined the accompanying electronically filed or
manually submitted cost report and the Balance Sheet Statement of
Revenue and Expenses prepared by--------(Provider Name(s) and
Number(s)) for the cost reporting period beginning ------ and ending
------ and that to the best of my knowledge and belief, this report
and statement are true, correct, complete and prepared from the
books and records of the provider in accordance with applicable
instructions, except as noted. I further certify that I am familiar
with the laws and regulations regarding the provision of health care
services, and that the services identified in this cost report were
provided in compliance with such laws and regulations.
(v) A provider may request a delay or waiver of the electronic
submission requirement in paragraph (f)(4)(ii) of this section if this
requirement would cause a financial hardship or if the provider
qualifies as a low or no Medicare utilization provider. The provider
must submit a written request for delay or waiver with necessary
supporting documentation to its intermediary no later than 30 days
after the end of its cost reporting period. The intermediary reviews
the request and forwards it, with a recommendation for approval or
denial, to CMS central office within 30 days of receipt of the request.
CMS central office either approves or denies the request and notifies
the intermediary within 60 days of receipt of the request.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: February 21, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Approved: April 24, 2003.
Tommy G. Thompson,
Secretary.
[FR Doc. 03-21441 Filed 8-21-03; 8:45 am]
BILLING CODE 4120-01-P