Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups, 78246-78247 [2010-31372]

Agencies

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

[Federal Register Volume 75, Number 240 (Wednesday, December 15, 2010)]
[Notices]
[Pages 78246-78247]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-31372]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1574-N]


Medicare Program; Re-Chartering of the Advisory Panel on 
Ambulatory Payment Classification (APC) Groups

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces the re-chartering of the Advisory Panel 
on Ambulatory Payment Classification (APC) Groups (the Panel). The 
Secretary of the Department of Health and Human Services (the 
Secretary) re-chartered the Panel on November 21, 2010, for 2 years 
with the new Charter effective through November 21, 2012.

FOR FURTHER INFORMATION CONTACT: Shirl Ackerman-Ross, (410) 786-4474.

SUPPLEMENTARY INFORMATION:

I. Background

A. 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), to consult with an expert, outside advisory 
panel on the clinical integrity of the groups referred to as Ambulatory 
Payment Classification (APC) groups and their associated weights 
established under the Medicare hospital Outpatient Prospective Payment 
System (OPPS).

B. Statutory Authority

    Section 1833(t)(9)(A) of the Act (42 U.S.C. 1395l(t)(9)(A)). The 
Advisory Panel on APC Groups is governed by the provisions of Public 
Law 92-463, the Federal Advisory Committee Act (FACA) (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. The Panel is re-chartered in accordance with 
section 14(b)(2) of FACA.

C. Panel Functions

    The Panel must advise the Secretary and the CMS Administrator (the 
Administrator) 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 must deal with the 
following issues:
     Addressing whether procedures within an APC group are 
similar both clinically and in terms of resource use.
     Reconfiguring APCs (for example, splitting of APCs, moving 
Healthcare Common Procedure Coding System (HCPCS) codes from one APC to 
another, and moving HCPCS codes from new technology APCs to clinical 
APCs).
     Evaluating APC group weights.
     Reviewing packaging the cost of some items and services, 
including drugs and devices, into procedures and services, including 
the methodology for packaging and the impact of packaging on APC group 
structure and payment.
     Removing procedures from the inpatient list for payment 
under the OPPS.
     Using claims and cost report data for CMS' determination 
of APC group costs.
     Addressing other technical issues concerning APC group 
structure.
    The subject matter before the Panel must 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, revisions to the cost report, pass-through 
payments, correct code usage, and provider payment 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 is advised of all matters pertaining to 
the Panel (that is, membership, recommendations, subcommittees, and 
meetings).

D. Structure of the Panel

    The Panel must be fairly balanced in its membership in terms of the 
points of view represented and the functions to be performed. The Panel 
consists of up to 15 members who are representatives of providers. 
Members are selected by the Secretary or Administrator among the fields 
of hospital payment systems; hospital medical care delivery systems; 
provider billing and accounting systems; APC groups; Current Procedural 
Terminology codes; HCPCS codes; the use of, and payment for, drugs, 
medical devices, and other services in the outpatient setting; and 
other forms of relevant expertise. All members must 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. Panel 
members are full-time employees of hospitals, hospital systems, or 
other Medicare providers subject to payment under the OPPS.
    For purposes of this Panel, consultants or independent contractors 
are not considered to be representatives of providers. All members must 
serve on a voluntary basis, without compensation, pursuant to advance 
written agreement. Members of the Panel must be entitled to receive 
reimbursement for travel expenses and per diem in lieu of subsistence, 
in accordance with Standard Government Travel Regulations. Panel 
members may serve for up to 4-year terms. A member may serve after the 
expiration of his or

[[Page 78247]]

her term until a successor has been sworn in.
    A Federal official, designated by the Secretary or the 
Administrator, must serve as the Chair and facilitate the Panel 
meetings. The Chair's term must usually be for a period of 4 years, but 
it may be extended at the discretion of the Administrator or his or 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.
    With the approval of the Secretary or designee, subcommittees 
consisting of two or more Panel members may be established to perform 
functions within the Panel's jurisdiction. One of the members will be 
designated by his or her peers as chair of the subcommittee. The 
Department Committee Management Officer will be notified upon 
establishment of each subcommittee and will be provided information on 
its name, membership, function, and estimated frequency of meetings. 
The advice or recommendations of a subcommittee or working group must 
be deliberated by the Panel. A subcommittee may not report directly to 
a Federal official, but rather it must report to the parent Panel.
    The FACA provides that a Designated Federal Officer (DFO) must be 
appointed to a Federal advisory committee to attend each Panel meeting 
and to ensure that all procedures adhere to applicable statutory, 
regulatory, and DHHS General Administration Manual directives. The DFO 
approves and prepares all meeting agendas; calls all Panel or 
subcommittee meetings; adjourns any meeting when he or she determines 
adjournment to be in the public interest; and chairs meetings when 
directed to do so by the Secretary or the Administrator. The DFO or his 
or her designee must be present at all full Panel and subcommittee 
meetings. The CMS must also provide management and support services to 
the Panel.

E. APC Panel Meetings

    Meetings must 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. Meetings are 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)) and FACA. The Panel Chair must 
facilitate all Panel meetings.
    Adequate advance notice of all meetings must be published in the 
Federal Register, as required by applicable laws and departmental 
regulations, stating reasonably accessible and convenient locations and 
times. Meetings must be conducted, and records of the proceedings kept, 
as required by applicable laws and departmental regulations. The 
records of the Panel and established subcommittees must be managed in 
accordance with General Records Schedule 26, Item 2, or other approved 
Agency records disposition schedule. These records must be available 
for public inspection and copying, subject to the Freedom of 
Information Act (5 U.S.C. 552).

F. Compensation

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

G. Annual Cost Estimate

    Estimated fiscal year (FY) 2011 annual cost for operating the 
Panel, including travel expenses for members but excluding staff 
support, is $77,000. The estimated annual person-years of staff support 
required for the APC Panel is 1.0 full-time equivalent (FTE) at an 
estimated annual cost of $105,575. Estimated FY 2012 annual cost for 
operating the Panel, including travel expenses for members but 
excluding staff support, is $80,000. The estimated annual person-years 
of staff support required for the APC Panel is 1.0 FTE at an estimated 
annual cost of $107,650.

H. Termination Date

    Unless renewed by appropriate action prior to its expiration, the 
APC Panel must terminate 2 years from the date the charter is filed.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance Program; and No. 93.774, Medicare-
Supplementary Medical Insurance Program)

    Dated: December 2, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2010-31372 Filed 12-14-10; 8:45 am]
BILLING CODE 4120-01-P