[Code of Federal Regulations] [Title 42, Volume 4] [Revised as of October 1, 2006] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR493.643] [Page 1006-1008] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 493_LABORATORY REQUIREMENTS--Table of Contents Subpart F_General Administration Sec. 493.643 Fee for determination of program compliance. (a) Fee requirement. In addition to the fee required under Sec. 493.638, a laboratory subject to routine inspections must pay a fee to cover the cost of determining program compliance. Laboratories issued a certificate for PPM procedures, certificate of waiver, or a certificate of accreditation are not subject to this fee for routine inspections. (b) Costs included in the fee. Included in the fee for determining program compliance is the cost of evaluating qualifications of personnel; monitoring proficiency testing; conducting onsite inspections; documenting deficiencies; evaluating laboratories' plans to correct deficiencies; and necessary administrative costs. HHS sets the fee amounts annually on a calendar year basis. Laboratories are inspected biennially; therefore, fees are assessed and [[Page 1007]] payable biennially. If additional expenses are incurred to conduct follow up visits to verify correction of deficiencies, to impose sanctions, and/or for surveyor preparation for and attendance at ALJ hearings, HHS assesses an additional fee to include these costs. The additional fee is based on the actual resources and time necessary to perform the activities. (c) Classification of laboratories that require inspection for purpose of determining amount of fee. (1) There are ten classifications (schedules) of laboratories for the purpose of determining the fee amount a laboratory is assessed. Each laboratory is placed into one of the ten following schedules based on the laboratory's scope and volume of testing (excluding tests performed for quality control, quality assurance, and proficiency testing purposes). (i) (A) Schedule A Low Volume. The laboratory performs not more than 2,000 laboratory tests annually. (B) Schedule A. The laboratory performs tests in no more than 3 specialties of service with a total annual volume of more than 2,000 but not more than 10,000 laboratory tests. (ii) Schedule B. The laboratory performs tests in at least 4 specialties of service with a total annual volume of not more than 10,000 laboratory tests. (iii) Schedule C. The laboratory performs tests in no more 3 specialties of service with a total annual volume of more than 10,000 but not more than 25,000 laboratory tests. (iv) Schedule D. The laboratory performs tests in at least 4 specialties with a total annual volume of more than 10,000 but not more than 25,000 laboratory tests. (v) Schedule E. The laboratory performs more than 25,000 but not more than 50,000 laboratory tests annually. (vi) Schedule F. The laboratory performs more than 50,000 but not more than 75,000 laboratory tests annually. (vii) Schedule G. The laboratory performs more than 75,000 but not more than 100,000 laboratory tests annually. (viii) Schedule H. The laboratory performs more than 100,000 but not more than 500,000 laboratory tests annually. (ix) Schedule I. The laboratory performs more than 500,000 but not more than 1,000,000 laboratory tests annually. (x) Schedule J. The laboratory performs more than 1,000,000 laboratory tests annually. (2) For purposes of determining a laboratory's classification under this section, a test is a procedure or examination for a single analyte. (Tests performed for quality control, quality assurance, and proficiency testing are excluded from the laboratory's total annual volume). Each profile (that is, group of tests) is counted as the number of separate procedures or examinations; for example, a chemistry profile consisting of 18 tests is counted as 18 separate procedures or tests. (3) For purposes of determining a laboratory's classification under this section, the specialties and subspecialties of service for inclusion are: (i) The specialty of Microbiology, which includes one or more of the following subspecialties: (A) Bacteriology. (B) Mycobacteriology. (C) Mycology. (D) Parasitology. (E) Virology. (ii) The specialty of Serology, which includes one or more of the following subspecialties: (A) Syphilis Serology. (B) General immunology (iii) The specialty of Chemistry, which includes one or more of the following subspecialties: (A) Routine chemistry. (B) Endocrinology. (C) Toxicology. (D) Urinalysis. (iv) The specialty of Hematology. (v) The specialty of Immunohematology, which includes one or more of the following subspecialties: (A) ABO grouping and Rh typing. (B) Unexpected antibody detection. (C) Compatibility testing. (D) Unexpected antibody identification. (vi) The specialty of Pathology, which includes the following subspecialties: (A) Cytology. (B) Histopathology. (C) Oral pathology. (vii) The specialty of Radiobioassay. [[Page 1008]] (viii) The specialty of Histocompatibility. (ix) The specialty of Clinical Cytogenetics. (d) Additional fees. (1) If after a certificate of compliance is issued, a laboratory adds services and requests that its certificate be upgraded, the laboratory must pay an additional fee if, in order to determine compliance with additional requirements, it is necessary to conduct an inspection, evaluate personnel, or monitor proficiency testing performance. The additional fee is based on the actual resources and time necessary to perform the activities. HHS revokes the laboratory's certificate for failure to pay the compliance determination fee. (2) If it is necessary to conduct a complaint investigation, impose sanctions, or conduct a hearing, HHS assesses the laboratory holding a certificate of compliance a fee to cover the cost of these activities. If a complaint investigation results in a complaint being unsubstantiated, or if an HHS adverse action is overturned at the conclusion of the administrative appeals process, the government's costs of these activities are not imposed upon the laboratory. Costs for these activities are based on the actual resources and time necessary to perform the activities and are not assessed until after the laboratory concedes the existence of deficiencies or an ALJ rules in favor of HHS. HHS revokes the laboratory's certificate of compliance for failure to pay the assessed costs. [57 FR 7138 and 7213, Feb. 28, 1992, as amended at 60 FR 20047, Apr. 24, 1995; 68 FR 3702, Jan. 24, 2003]