Medicare Program; Rechartering of the Advisory Panel on Ambulatory Payment Classification Groups, 72489-72490 [E8-28179]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 73, Number 230 (Friday, November 28, 2008)]
[Notices]
[Pages 72489-72490]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-28179]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1397-N]


Medicare Program; Rechartering of the Advisory Panel on 
Ambulatory Payment Classification Groups

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (DHHS).

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the Rechartering of the Advisory Panel 
on Ambulatory Payment Classification (APC) Groups (the Panel) by the 
Secretary, DHHS (the Secretary) for a 2-year period with the new 
charter effective through November 21, 2010.

FOR FURTHER INFORMATION CONTACT: Shirl Ackerman-Ross, Designated 
Federal Official (DFO), Advisory Panel on APC Groups; Center for 
Medicare Management, Hospital & Ambulatory Policy Group, Division of 
Outpatient Care; 7500 Security Boulevard, Mail Stop C4-05-17; 
Baltimore, MD 21244-1850. You may also contact the DFO by phone at 410-
786-4474 or by e-mail at CMS_APCPanel@cms.hhs.gov.
    For additional information on the APC Panel and updates to the 
Panel's activities, please search our Web site at: https://
www.cms.hhs.gov/FACA/05_
AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp#TopOfPage. You 
may also refer to the CMS Federal Advisory Committee Hotline at 1-877-
449-5659 (toll-free) or call 410-786-9379 (local) for additional 
information. News media representatives should contact the CMS Press 
Office at 202-690-6145.

SUPPLEMENTARY INFORMATION:

I. Background

Purpose

    The Secretary of the Department of Health and Human Services (DHHS) 
(the Secretary) is required by section 1833(t)(9)(A) of the Social 
Security Act (the Act), as amended by section 201(h) of the Medicare, 
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) 
(Public Law [Pub. L.] 106-113), and re-designated by section 202(a)(2) 
of the BBRA to establish and consult with an expert, outside advisory 
panel on the ambulatory payment classification (APC) groups established 
under the Medicare hospital Outpatient Prospective Payment System 
(OPPS).

Authority

    Section 1833(t)(9)(A) of the Act (42 U.S.C. 1395l(t)), as amended 
by section 201(h) of the BBRA of 1999 (Pub. L. 106-113). The Advisory 
Panel on APC Groups (the Panel) is governed by the provisions of Pub. 
L. 92-463, the Federal Advisory Committee Act (FACA), as amended (5 
U.S.C. Appendix 2), which sets forth standards for the formation and 
use of advisory panels.
    The Panel was established by statute and has functions that are of 
a continuing nature. Therefore, its duration is not governed by section 
14(a) of FACA, but rather it is otherwise provided by law. The Panel is 
rechartered in accordance with section 14(b)(2) of FACA.

Function

    The Panel shall advise the Secretary and the Administrator, Centers 
for Medicare & Medicaid Services (CMS), about the clinical integrity of 
the APC groups and their associated weights, which are major elements 
of the Medicare hospital OPPS. The Panel is technical in nature, and it 
shall deal with the following issues:
     Addressing whether procedures within an APC group are 
similar both clinically and in terms of resource use.
     Evaluating APC group weights.
     Reviewing the packaging of OPPS services and costs, 
including the methodology and the impact on APC groups and payment.
     Removing procedures from the inpatient list for payment 
under the OPPS.
     Using single and multiple procedure claims data for 
determination of APC group payments.
     Addressing other technical issues concerning APC group 
structure.
    The subject matter before the Panel shall be limited to these and 
related topics. Unrelated topics are not subjects for discussion. 
Unrelated topics include, but are not limited to, the conversion 
factor, charge compression, pass-through payments for medical devices 
and drugs, correct code usage, and wage adjustments.
    The Panel may use data collected or developed by entities and 
organizations other than the DHHS and CMS in conducting its review. The 
Secretary and the Administrator shall be advised of all matters 
pertaining to the Panel (i.e., membership, recommendations, 
subcommittees, meetings, etc.).

Structure

    The Panel must be fairly balanced in its membership in terms of the 
points of

[[Page 72490]]

view represented and the functions to be performed. The Panel shall 
consist of up to 15 members who are representatives of providers.
    Each Panel member must be employed full-time by a hospital, 
hospital system, or other Medicare provider subject to payment under 
the OPPS. The Secretary or Administrator selects the Panel membership 
based upon either self-nominations or nominations submitted by Medicare 
providers and other interested organizations.
    All members must have technical expertise to enable them to 
participate fully in the Panel's work. Such expertise encompasses 
hospital payment systems; hospital medical care delivery systems; 
provider billing systems; APC groups; Current Procedural Terminology 
codes; and alpha-numeric Health Care Common Procedure Coding System 
codes; and the use of, and payment for, drugs, medical devices, and 
other services in the outpatient setting, as well as other forms of 
relevant expertise.
    All members shall have a minimum of 5 years experience in their 
area(s) of expertise, but it is not necessary that any member be an 
expert in all of the areas listed above. For purposes of this Panel, 
consultants or independent contractors are not considered to be 
representatives of providers. Panel members may serve for up to 4-year 
terms. A member may serve after the expiration of his/her term until a 
successor has been sworn in. All terms are contingent upon the renewal 
of the Panel by appropriate action prior to its termination.
    A Federal official shall serve as the Chair and shall facilitate 
the Panel meetings. The Secretary or designee shall select a Chair for 
the Panel. The Chair's term shall usually be for a period of 4 years, 
but it may be extended at the discretion of the Administrator or his/
her duly appointed designee.
    In order to conduct the business of the Panel, a quorum is 
required. A quorum exists when a majority of currently appointed 
members is present at full Panel or subcommittee meetings or is 
participating in conference calls.
    As necessary, standing and ad hoc subcommittees, composed of 
members from the parent Panel, may be established to perform functions 
within the Panel's jurisdiction with the approval of the Secretary or 
his/her designee.
    The FACA provides that each agency sponsoring a Federal advisory 
committee must appoint a Department Committee Management Officer 
(DCMO). The FACA also provides that a Designated Federal Official (DFO) 
be appointed to the Panel. The DFO maintains required records on costs 
and membership; ensures efficient operations; maintains records for 
availability to the public; provides copies of all reports to the DCMO 
who shall, in turn, forward them to the Library of Congress; notifies 
the DCMO when standing subcommittees are established, including the 
subcommittee's name, membership, function, and estimated frequency of 
meetings; and provides management support services for the Panel and 
its standing and ad hoc subcommittees.

Meetings

    Meetings shall be held up to three times a year at the call of the 
DFO. The agenda, which sets the boundaries for discussion, is developed 
by CMS and approved by the DFO. The agenda, which sets the boundaries 
for discussion, is developed by CMS and approved by the DFO. Meetings 
shall be open to the public, except as determined otherwise by the 
Secretary or other official to whom the authority has been delegated in 
accordance with the Government in the Sunshine Act (5 U.S.C. 552b(c)). 
Adequate advance notice of all meetings shall be published in the 
Federal Register, as required by applicable laws and Departmental 
regulations, stating reasonably accessible and convenient locations and 
times.

Compensation

    All members shall serve on a voluntary basis, without compensation, 
pursuant to advance written agreement. Members of the Panel shall be 
entitled to receive reimbursement for travel expenses and per diem in 
lieu of subsistence, in accordance with Standard Government Travel 
Regulations.

Annual Cost Estimate

    Estimated FY 2009 annual cost for operating the Panel, including 
travel expenses for members but excluding staff support, is $69,110. 
The estimated annual person-years of staff support required for the APC 
Panel is 1.0 FTE at an estimated annual cost of $94,025.

Reports

    In the event that a portion of a meeting is closed to the public, 
as determined by the Secretary, in accordance with the Government in 
the Sunshine Act (5 U.S.C. 552b(c)) and FACA, a report shall be 
prepared that shall contain, at a minimum, the following: a list of 
members and their business addresses, the Panel's or subcommittee's 
function, dates and places of meeting(s), and a summary of the Panel's/
subcommittee's activities and recommendations made during that meeting. 
Reports shall also be prepared after all open-to-the-public Panel 
meetings and any subcommittee meetings and submitted to the DCMO.

Termination Date

    Unless renewed by appropriate action prior to its expiration, the 
APC Panel shall terminate on November 21, 2010.

II. Provisions of This Notice

    This notice announces that the Secretary signed the APC Panel 
charter renewal on October 30, 2008.

III. Copies of the Charter

    You may obtain a copy of the APC Panel's charter by submitting a 
request to the DFO at the street or e-mail addresses listed above or by 
calling her at 410-786-4474.

IV. Collection of Information

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 35).

    Authority: Section 1833(t)(9)(A) of the Act (42 U.S.C. 
1395l(t)(9)(A)). The Advisory Panel on APC Groups (the Panel) is 
governed by the provisions of Pub. L. 92-463, the Federal Advisory 
Committee Act (FACA), as amended (5 U.S.C. Appendix 2), which sets 
forth standards for the formation and use of advisory panels.

    Dated: November 13, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E8-28179 Filed 11-26-08; 8:45 am]
BILLING CODE 4120-01-P