[Federal Register: May 27, 2005 (Volume 70, Number 102)]
[Rules and Regulations]
[Page 30640-30643]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27my05-16]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 413
[CMS-1199-IFC]
RIN 0938-AN87
Medicare Program; Electronic Submission of Cost Reports: Revision
to Effective Date of Cost Reporting Period
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Interim final rule with comment period.
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SUMMARY: This interim final rule with comment period revises the
existing effective date by which all organ procurement organizations
(OPOs), rural health clinics (RHCs), Federally qualified health centers
(FQHCs), and community mental health centers (CMHCs) are required to
submit their Medicare cost reports in a standardized electronic format
from cost reporting periods ending on or after December 31, 2004 to
cost reporting periods ending on or after March 31, 2005.
This interim final rule with comment does not affect the current
cost reporting requirement for hospices and end-stage renal disease
(ESRD) facilities. Hospices and ESRD facilities are required to
continue to submit cost reports under the Medicare regulations in a
standardized electronic format for cost reporting periods ending on or
after December 31, 2004.
DATES: Effective date: These regulations are effective on June 27,
2005.
Comment date: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on July 26, 2005.
ADDRESSES: In commenting, please refer to file code CMS-1199-IFC.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of three ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to http://www.cms.hhs.gov/regulations/ecomments.
(Attachments should be in Microsoft Word, WordPerfect, or
Excel; however, we prefer Microsoft Word.)
2. By mail. You may mail written comments (one original and two
copies) to the following address ONLY: Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Attention: CMS-1199-
IFC, P.O. Box 8018, Baltimore, MD 21244-8018.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7197 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and could be considered late. All
comments received before the close of the comment period are available
for viewing by the public, including any
[[Page 30641]]
personally identifiable or confidential business information that is
included in a comment. After the close of the comment period, CMS posts
all electronic comments received before the close of the comment period
on its public Web site.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Darryl E. Simms, (410) 786-4524.
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-1199-IFC and the specific ``issue identifier'' that precedes the
section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all electronic
comments received before the close of the comment period on its public
Web site as soon as possible after they are received. Hard copy
comments received timely will be available for public inspection as
they are received, generally beginning approximately 3 weeks after
publication of a document, at the headquarters of the Centers for
Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore,
Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4
p.m. To schedule an appointment to view public comments, phone 1-800-
743-3951.
I. Background
On August 23, 2003, we published in the Federal Register (68 FR
50717), a final regulation that requires that all 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 submit
Medicare cost reports in a standardized electronic format. This
requirement is effective for cost reporting periods ending on or after
December 31, 2004.
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.
These facilities are generally paid under the Medicare program 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 (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. Regulations governing the submission of
cost reports are set forth in Sec. 413.20 and Sec. 413.24. Section
413.20(a) specifies that 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
Medicare 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. In 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. Section 412.52 specifies that 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)(1)(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 published a final rule in the
Federal Register (62 FR 26) that revised Sec. 413.24(f)(4)(ii) to
extend the electronic cost reporting requirements to skilled nursing
facilities (SNFs) and home health agencies (HHAs).
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. The January 2, 1997 final rule revised 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. To preserve the integrity of the
electronic file, in the January 2, 1997 final rule we specified
procedures regarding the processing of electronic cost reports once
they are submitted to the intermediary.
II. Provisions of the Interim Final Rule
This interim final rule revises the existing effective date for
submission of electronic cost reports for OPOs, RHCs, FQHCs, and CMHCs
from cost reporting periods ending on or after December 31, 2004 to
cost reporting periods ending on or after March 31, 2005. As a result
of the delays in the availability of the CMS free cost reporting
software and commercially available cost reporting software, OPOs,
RHCs, FQHCs, and CMHCs will now be required to file their cost reports
in a standardized electronic format effective for cost reporting
periods ending on or after March 31, 2005. This is a change from the
August 23, 2003 final rule that established the electronic filing
requirement for cost reporting periods ending on or after December 31,
2004.
Hospices and ESRD facilities will continue to be subject to the
electronic filing requirements as referenced in the August 23, 2003
final rule as software for these provider types is available.
Therefore, all hospices and ESRD facilities are still required to
submit standardized electronic cost reports for cost reporting periods
ending on or after December 31, 2004. Standardized electronic cost
reports have been in place since October 1989. Since that time, the
accuracy of cost reporting has increased. Under this interim final
rule, the only change is to the effective date for submission of
electronic cost reporting for OPOs, RHCs, FQHCs, and CMHCs. These
providers will still be given a transition period (described in the
August 23, 2003 final rule (68 FR 50717)) beginning with the new
effective date and are still required to provide a hard copy of the
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 under the new effective date.
III. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not able to acknowledge or
respond to them individually. We will consider all comments we receive
by the date and time specified in the DATES section of
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this preamble, and, when we proceed with a subsequent document, we will
respond to the comments in the preamble to that document.
IV. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment on the proposed rule. The
notice of proposed rulemaking includes a reference to the legal
authority under which the rule is proposed, and the terms and
substances of the proposed rule or a description of the subjects and
issues involved. This procedure can be waived, however, if an agency
finds good cause that a notice-and-comment procedure is impracticable,
unnecessary, or contrary to the public interest and incorporates a
statement of the finding and its reasons in the rule issued.
Because of the delay in the availability of the requisite cost
reporting software (CMS-provided and commercially available) needed to
comply with the effective date provisions of the August 23, 2003 final
rule, OPOs, RHCs, FQHCs, and CMHCs are not able to submit cost reports
in a standardized electronic format for cost reporting periods ending
December 31, 2004. These cost reports are due to their respective
fiscal intermediaries (FIs) 150 days or 5 months following the close of
the cost reporting period which is May 31, 2005. Revising the reporting
requirement to be effective for cost reporting periods ending on or
after March 31, 2005, provides the time for the contractors to develop
the requisite cost reporting software. The new electronic filing
requirement for cost reporting periods ending on or after March 31,
2005 requires OPOs, RHCs, FQHCs, and CMHCs, with a March 31, 2005 cost
reporting ending date to submit cost reporting data to FIs by August
31, 2005. We find the notice-and-comment procedure impracticable since
it is not feasible for these providers to meet the current effective
date as the technology to meet the reporting requirement is not
available. Also, this interim final rule with comment does not impose
any additional requirements, but merely extends the effective date of
the existing reporting requirement until the software is available.
Therefore, we find good cause to waive notice-and-comment procedures
and to issue this final rule on an interim basis. However, we are
providing a 60-day public comment period.
V. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, we are required to
provide 60-day 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, to submit cost reports
in a standardized electronic format for cost reporting periods
beginning on or after October 1, 1989. SNFs, and HHAs must submit cost
reports in a standardized electronic format for cost reporting periods
ending on or after December 31, 1996. Hospices, ESRD facilities, OPOS,
RHCs, FQHCs and CMHCs must submit cost reports in a standardized
electronic format for cost reporting periods ending on or after
December 31, 2004. These reporting requirements are currently approved
as described below.
This interim final rule revises the dates by which OPOs, RHCs,
FQHCs, and CMHCs must submit cost reports in a standardized electronic
format. Under the revised requirements OPOs, RHCs, FQHCs, and CMHCs
must now submit cost reports in a standardized electronic format for
cost reporting periods ending on or after March 31, 2005, rather than
December 31, 2004. This change does not impose any new burden.
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 April
30, 2007; 0938-0022, ``Home Health Agency Cost Report,'' with a current
expiration date of April 30, 2007; 0938-0758, ``Hospice Cost Report,''
with a current expiration date of January 31, 2008; 0938-0102, ``Organ
Procurement Agency/Laboratory Statement of Reimbursable Costs,'' with a
current expiration date of August 31, 2006; 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 June 30, 2007; and 0938-0657, ``End
Stage Renal Disease Network Cost Report,'' with a current expiration
date of September 30, 2006.
If you comment on these information collection and recordkeeping
requirements, please mail copies directly to the following:
Centers for Medicare & Medicaid Services, Office of Strategic
Operations and Regulatory Affairs, Regulations Development Group, Attn:
Jim Wickliffe, CMS-1199-IFC, Room C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and
Budget, Room 10235, New Executive Office Building, Washington, DC
20503, Attn: Christopher Martin, CMS Desk Officer, CMS-1199-IFC,
Christopher_Martin@omb.eop.gov, Fax (202) 395-6974.
VI. Regulatory Impact Statement
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act (the Act), the Unfunded
Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if 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 in any 1 year). This rule
does not reach the economic threshold and thus is not considered a
major rule.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and government agencies.
Most hospitals and most other providers and suppliers are small
entities, either by nonprofit status or by having revenues of $6
million to $29 million in any 1 year. Individuals and States are not
included in the definition of a small entity. We are not preparing an
analysis for the RFA because we have determined that this rule will not
have a significant economic impact on a substantial number 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
[[Page 30643]]
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 an analysis for section 1102(b) of the Act because we have
determined that this rule will not have a significant impact on the
operations of a substantial number of small rural hospitals.
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 expenditure in any 1 year by State,
local, or tribal governments, in the aggregate, or by the private
sector, of $110 million. This rule will have no consequential effect on
the governments mentioned or on the private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it publishes a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on State
and local governments, preempts State law, or otherwise has Federalism
implications. Since this regulation does not impose any costs on State
or local governments, the requirements of E.O. 13132 are not
applicable.
In accordance with the provisions of Executive Order 12866, this
regulation 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 Services amends 42 CFR chapter IV, as set forth below:
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), 1871, 1881, 1883 and 1886 of the Social Security Act (42 U.S.C.
1302, 1395dd(d), 1395f(b), 1395g, 1395l(a), (i) and (n), 1395hh,
1395rr, 1395tt, and 1395ww).
Subpart B--Accounting Records and Reports
0
2. Section 413.24 is amended by--
0
A. Revising paragraph (f)(4)(ii).
0
B. Revising paragraph (f)(4)(iv).
The revisions read as follows:
Sec. 413.24 Adequate cost data and cost finding.
* * * * *
(f) * * *
(4) * * *
(i) * * *
(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, cost reporting periods ending on or after December 31, 2004
for hospices, and end-stage renal disease facilities, and cost
reporting periods ending on or after March 31, 2005 for organ
procurement organizations, rural health clinics, Federally qualified
health centers, and community mental health centers, 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.
* * * * *
(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, cost reporting periods ending on or after December 31, 2004
for hospices and end-stage renal disease facilities, and cost reporting
periods ending on or after March 31, 2005 for organ procurement
organizations, rural health clinics, Federally qualified health
centers, and community mental health centers, 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 for hospices and end-stage renal disease facilities,
and the first two cost-reporting periods on or after March 31, 2005 for
organ procurement organizations, rural health clinics, Federally
qualified health centers, community mental health centers) providers
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.
* * * * *
(Catalog of Federal Domestic Assistance; Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: April 14, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
Approved: May 3, 2005.
Michael O. Leavitt,
Secretary.
[FR Doc. 05-10570 Filed 5-26-05; 8:45 am]
BILLING CODE 4120-01-P