Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-April Through June 2013, 45233-45246 [2013-17967]
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Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
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consistent in quality with inpatient
surgical services.
• To meet the requirements at
§ 482.51(b)(5), CIHQ modified its
standards to require that the operating
room register be complete and up-todate.
• To meet the requirements at
§ 482.51(b)(6), CIHQ modified its
standards to address the requirement
that an operative report must be written
or dictated immediately following
surgery and signed by the surgeon.
• To meet the requirements at
§ 482.56(a)(2), CIHQ modified its
standards to include the reference to
part 484 of the Code of Federal
Regulations.
• To meet the survey process
requirements in Appendix A of the
SOM, CIHQ revised its policies
outlining the survey size and
composition to require that every survey
will include at least one registered nurse
with hospital survey experience.
• To meet the survey process
requirements in Appendix Q of the
SOM, CIHQ revised its policies to
require notification to CMS of an
immediate jeopardy situation, the
content of the CMS notification, and the
appropriate level of citation related to
immediate jeopardy findings.
• To meet the requirements found at
Section 2728B of the SOM, CIHQ
revised its policies to require a more
detailed monitoring plan that includes
frequency of monitoring, duration of
monitoring, sample size and target
threshold, as part of a hospital’s plan of
correction for deficiencies found on
survey.
• To meet the requirements found at
Section 2005A2 of the SOM, CIHQ
revised its policies to require the
issuance of an accreditation denial for
hospitals initially seeking participation
in the Medicare program when the
hospital has been found to be noncompliant with a condition of
participation.
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• To meet the requirements at
§ 498.13 and Section 2008D of the SOM,
CIHQ revised its policies to clearly state
that the final accreditation decision is
based on the final survey report in
which the provider meets all
requirements or the date, which the
provider is found to meet all conditions
but has lower level deficiencies and
CIHQ has received an acceptable plan of
correction.
• To meet the requirements at Section
3012 of the SOM, CIHQ revised its
policies to accurately reflect the
requirement that follow-up surveys
must be conducted within 45 calendar
days from the survey end-date of the
survey, which the condition level
finding was cited.
• To clarify the survey process and to
ensure the consistent application of
survey activities, CIHQ updated its
policies, survey tools and guidance to
surveyors related to tracer activities,
patient interviews, and staff interviews.
• To eliminate any real or perceived
conflict of interest between CIHQ’s
consulting services through
‘‘Accreditation Resource Services’’ and
its accreditation activities, CIHQ
updated its plan to ensure that both
entities are separated by a firewall and
that information is not shared.
B. Term of Approval
Based on our review and observations
described in section III of this final
notice, we have determined that CIHQ’s
requirements for hospitals meet or
exceed our requirements. Therefore, we
approve CIHQ as a national
accreditation organization for hospitals
that request participation in the
Medicare program, effective July 26,
2013. through July 26, 2017.
V. Collection of Information
Requirements
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
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45233
by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 35).
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program; No. 93.773 Medicare—Hospital
Insurance Program; and No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
Dated: July 2, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare &
Medicaid Services.
[FR Doc. 2013–18014 Filed 7–25–13; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–9080–N]
Medicare and Medicaid Programs;
Quarterly Listing of Program
Issuances—April Through June 2013
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This quarterly notice lists
CMS manual instructions, substantive
and interpretive regulations, and other
Federal Register notices that were
published from April through June
2013, relating to the Medicare and
Medicaid programs and other programs
administered by CMS.
FOR FURTHER INFORMATION CONTACT: It is
possible that an interested party may
need specific information and not be
able to determine from the listed
information whether the issuance or
regulation would fulfill that need.
Consequently, we are providing contact
persons to answer general questions
concerning each of the addenda
published in this notice.
SUMMARY:
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Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
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The Centers for Medicare & Medicaid
Services (CMS) is responsible for
administering the Medicare and
Medicaid programs and coordination
and oversight of private health
insurance. Administration and oversight
of these programs involves the
following: (1) Furnishing information to
Medicare and Medicaid beneficiaries,
health care providers, and the public;
and (2) maintaining effective
communications with CMS regional
offices, state governments, state
Medicaid agencies, state survey
agencies, various providers of health
care, all Medicare contractors that
process claims and pay bills, National
Association of Insurance Commissioners
(NAIC), health insurers, and other
stakeholders. To implement the various
statutes on which the programs are
based, we issue regulations under the
authority granted to the Secretary of the
Department of Health and Human
Services under sections 1102, 1871,
1902, and related provisions of the
Social Security Act (the Act) and Public
Health Service Act. We also issue
various manuals, memoranda, and
statements necessary to administer and
oversee the programs efficiently.
Section 1871(c) of the Act requires
that we publish a list of all Medicare
manual instructions, interpretive rules,
statements of policy, and guidelines of
general applicability not issued as
regulations at least every 3 months in
the Federal Register.
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II. Revised Format for the Quarterly
Issuance Notices
While we are publishing the quarterly
notice required by section 1871(c) of the
Act, we will no longer republish
duplicative information that is available
to the public elsewhere. We believe this
approach is in alignment with CMS’
commitment to the general principles of
the President’s Executive Order 13563
released January 2011entitled
‘‘Improving Regulation and Regulatory
Review,’’ which promotes modifying
and streamlining an agency’s regulatory
program to be more effective in
achieving regulatory objectives. Section
6 of Executive Order 13563 requires
agencies to identify regulations that may
be ‘‘outmoded, ineffective, insufficient,
or excessively burdensome, and to
modify, streamline, expand or repeal
them in accordance with what has been
learned.’’ This approach is also in
alignment with the President’s Open
Government and Transparency Initiative
that establishes a system of
transparency, public participation, and
collaboration.
Therefore, this quarterly notice
provides only the specific updates that
have occurred in the 3-month period
along with a hyperlink to the full listing
that is available on the CMS Web site or
the appropriate data registries that are
used as our resources. This information
is the most current up-to-date
information and will be available earlier
than we publish our quarterly notice.
We believe the Web site list provides
more timely access for beneficiaries,
providers, and suppliers. We also
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believe the Web site offers a more
convenient tool for the public to find
the full list of qualified providers for
these specific services and offers more
flexibility and ‘‘real time’’ accessibility.
In addition, many of the Web sites have
listservs; that is, the public can
subscribe and receive immediate
notification of any updates to the Web
site. These listservs avoid the need to
check the Web site, as notification of
updates is automatic and sent to the
subscriber as they occur. If assessing a
Web site proves to be difficult, the
contact person listed can provide
information.
III. How To Use the Notice
This notice is organized into 15
addenda so that a reader may access the
subjects published during the quarter
covered by the notice to determine
whether any are of particular interest.
We expect this notice to be used in
concert with previously published
notices. Those unfamiliar with a
description of our Medicare manuals
should view the manuals at https://
www.cms.gov/manuals.
Authority: (Catalog of Federal Domestic
Assistance Program No. 93.773, Medicare—
Hospital Insurance, Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program, and Program No. 93.714,
Medical Assistance Program)
Dated: July 19, 2013.
Kathleen Cantwell,
Director, Office of Strategic Operations and
Regulatory Affairs.
BILLING CODE 4120–01–P
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I. Background
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Addendum I: Medicare and Medicaid Manual Instructions
(April through June 2013)
The CMS Manual System is used by CMS program components,
partners, providers, contractors, Medicare Advantage organizations, and
State Survey Agencies to administer CMS programs. It offers day-to-day
operating instructions, policies, and procedures based on statutes and
regulations, guidelines, models, and directives. In 2003, we transformed the
CMS Program Manuals into a web user-friendly presentation and renamed
it the CMS Online Manual System.
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How to Obtain Manuals
The Interuet-only Manuals (lOMs) are a replica ofthe Agency's
official record copy. Paper-based manuals are CMS manuals that were
officially released in hardcopy. The majority of these manuals were
transferred into the Internet-only manual (10M) or retired. Pub 15-1, Pub
15-2 and Pub 45 are exceptions to this rule and are still active paper-based
manuals. The remaining paper-based manuals are for reference purposes
only. If you notice policy contained in the paper-based manuals that was
not transferred to the 10M, send a message via the CMS Feedback tool.
Those wishing to subscribe to old versions of CMS manuals should
contact the National Technical Information Service, Department of
Commerce, 5301 Shawnee Road, Alexandria, VA 22312 Telephone (703605-6050). You can download copies of the listed material free of charge
at: hnIrJi!;.!.!lli:.gQYLlllil!l!!f1@.
How to Review Transmittals or Program Memoranda
Those wishing to review transmittals and program memoranda can
access this information at a local Federal Depository Library (FDL). Under
the FDL program, government publications are sent to approximately 1,400
designated libraries throughout the United States. Some FDLs may have
arrangements to transfer material to a local library not designated as an
FDL. Contact any library to locate the nearest FDL. This information is
available at hllR1LlY.Y~gm~QY1!!QJ@!}J;§l.
In addition, individuals may contact regional depository libraries
that receive and retain at least one copy of most federal government
publications, either in printed or microfilm form, for use by the general
public. These libraries provide reference services and interlibrary loans;
however, they are not sales outlets. Individuals may obtain information
about the location of the nearest regional depository library from any
library. CMS publication and transmittal numbers are shown in the listing
entitled Medicare and Medicaid Manual Instructions. To help FDLs locate
the materials, use the CMS publication and transmittal numbers. For
example, to find the Medicare Claims Processing publication titled Claim
Status Category and Claim Status Codes Update use CMS-Pub. 100-04,
Transmittal No. 2681.
Addendum I lists a unique CMS transmittal number for each
instruction in our manuals or program memoranda and its subject number.
A transmittal may consist of a single or multiple instruction(s). Often, it is
necessary to use information in a transmittal in conjunction with
information currently in the manual. For the purposes of this quarterly
notice, we list only the specific updates to the list of manual instructions
that have occurred in the 3-month period. This information is available on
our website at ~~&rr~SQYLMill:!!lJ1!1~.
Transmittal
Number
Manual/Subject/Publication Number
00
None
170
Updates to Medicare Coverage of Hepatitis B Vaccine and its Administration
and Medicare Coverage of the Annual Wellness Visit (AWV) Providing
Personalized Prevention Plan Services (PPPS)
Antigens
Immunizations
Annual Wellness Visit (A WV) Providing Personalized Prevention Plan
Services (PPPS)
Routine Services and Appliances
Implementation oethe End Stage Renal Disease (ESRD) Prospective Payment
System (PPS)
Definitions Relating to ESRD
Renal Dialysis Items and Services
Composite Rate Items and Services
Drugs and Biologicals
171
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18:54 Jul 25, 2013
Publication Dates for the Previous Four Quarterly Notices
We publish this notice at the end of each quarter reflecting
information released by CMS during the previous quarter. The publication
dates of the previous four Quarterly Listing of Program Issuances notices
are: May 18,2012 (77 FR 29648), August 17,2012 (77 FR 49799),
November 9, 2012 (77 FR 67368) and May 3, 2013 (78 FR 26038). For the
purposes of this quarterly notice, we are providing only the specific updates
that have occurred in the 3-month period along with a hyperlink to the
website to access this information and a contact person for questions or
additional information.
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Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds
Blood-Derived Products for Chronic Non-Healing Wounds
Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds
Blood-Derived Products for Chronic Non-Healing Wounds
Ocular Photodynamic Therapy (OPT) with Verteporfin for Macular
Degeneration
Photodynamic Therapy
Ocular Photodynamic Therapy (OPT)
Photosensitive Drugs
Verteporfin
Dala Repurting un !-Iume !-Icallh Prospc<.:tivc Payment System (HH PPS)
Claims
HH PPS Claims
Input/Output Record Layout
Claim Status Categorv and Claim Status Codes Update
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS) Competitive Bidding Program (CBP) - July 2013
Competitive Bidding Durable Medical Equipment, Prosthetics, Orthotics, and
Supplies (DMEPOS) Single Payment Amounts
Non-systems Internet Only Manual (10M) Changes
Common Edits and Enhancements Modules (CEM) Code Set Update
Issued to a specific, audience not posted to Internet/Intranet due to
Confidentialitv of Instruction
Remittance Advice Remark and Claims Adjustment Reason Code and
Medicare Remit Easy Print and PC Print Update
Clarify the definition of customized durable medical equipment (DME) Items
Reporting End Stage Renal Disease (ESRD) Drugs Administered Through the
Dialysate
National Coverage Determination (NCD) for Transcatheter Aortic Valve
Replacement (TA VR) Implementation of Mandatory Reporting of Clinical
Trial Number
Claims Processing Requirements for TA VR Services on Professional Claims
Claims Processing Requirements for TA VR Services on Inpatient Hospital
Claims
Billing Social Work and Psychological Services in Comprehensive Outpatient
Rehabilitation Facilities (CORFs)
Application of Financial Limitations
Notification for Beneficiaries Exceeding Financial Limitations
Procedure Payment Reductions for Outpatient Rehabilitation
Services
2693
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2695
2696
2697
2698
2699
2700
2701
2702
2703
2704
2705
2706
2707
Applicable Types of Bill
Billing for Biofeedback Training for the Treatment of Urinary Incontinence
Allowable Revenue Codes on CORF 75X Bill Types
Outpatient Mentalllealth Treatment Limitation
Billing for Social Work and Psychological Services in a CORF
Issued to a specific, audience not posted to Internet/Intranet due to
Confidentiality of Instruction
Issued to a specific, audience not posted to Internet/Intranet due to
Confidentiality ofInstruction
Issued to a specific, audience not posted to Internet/Intranet due to Sensitivity
of Instruction
Discontinuation of Home Health Type ofBill33X
Noncovered Charges on Outpatient Bills
Claim Submission and Processing
Chart Summarizing the Effects of RAP/Claim Actions on the HH PPS
Episode
File
Request for Anticipated Payment (RAP)/IfH PPS Claims
Collection of Deductible and Coinsurance from Patient
General
Medical and Other Health Services Not Covered Under the Plan of Care (Bill
Type 34X)
Osteoporosis Injections as HHA Benefit
Quarterly Healthcare Common Procedure Coding System (HCPCS)
Drug/Biological Code Changes - July 2013 Update
Issued to a specific, audience not posted to Internet/Intranet due to Sensitivity
of Instruction
New Non-Physician Specialty Code for Complimentary Insurer Nonphysician
Practitioner, Supplier, and Provider Specialty Codes
Issued to a specific, audience not posted to Internet/Intranet due to
Confidentiality of Instruction
Part B Claims Submission under the Indirect Payment Procedure (lPP)
Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 19.2,
Effective July 1,2013
Issued to a speciJic, audience not posted to Internet/Intranet due to
Confidentiality of Instruction.
Issued to a specific, audience not posted to Internet/Intranet due to Sensitivity
of Instruction
Amhulance Payment Reduction for Non-Emergency Basic Life Support
(BLS)
Transports to and from Renal Dialysis Facilities
Payment for Non-Emergency BLS Trips toltl'om ESRD Facilities
CMS Supplied National ZIP Code File and National Ambulance Fee Schedule
File
July 2013 Integrated Outpatient Code Editor (1/0CE) Specifications Version
14.2
Common Edits and Enhancements Modules (CEM) Code Set Update
Indian Health Services (IHS) Hospital Payment Rates for Calendar Year 2013
Instructions for Downloading the Medicare ZIP Code File for October 2013
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18:54 Jul 25, 2013
ESRD Prospective Payment System (PPS) Base Rate
Bad Debts
Reserved
Composite Rate Tests for Hemodialysis, IPD, CCPD, and Hemofiltration
Composite Rate Tests for CAPD
Brief History of ESRD Composite Payment Rates for Outpatient Maintenance
Dialysis
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Solicit the Views of the Provider
Make Determination and Notify Required Parties
Effect of a QIO Expedited Determination
Right to Pursue an Expedited Reconsideration
EITect ofQIO Determination on Continuation of Care
Right to Pursue the Standard Claims Appeal Process
Expedited Determination Notice Association with Advance Beneficiaty
Notices
Expedited Determination Notice Association with Advance Beneficiary
Notices
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October
2013
Claim Status Category and Claim Status Codes Update
Updates to Chapter 12 and Chapter 16 of the Medicare Claims Processing
Manual to Revise Instructions Regarding the Technical Component (TC) of
Pathology Services Furnished to Hospital Patients
Payment for Pathology Services
Technical Component (TC) of Physician Pathology Services to Hospital
Patients
October 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug
Pricing Files and Revisions (0 Prior Quarterly Pricing Files
Internet Only Manual (10M) Update to Payment for Medical or Surgical
Services Furnished by CRNAs. This CR rescinds and fully replaces CR 8027.
Qualified Nonphysician Anesthetist Services
Qualified Nonphysician Anesthetists
Entity or Individual to Whom Fee Schedule is Payable for Qualified
Nonphysician anesthetists
Anesthesia Fee Schedule Payment for Qualified Nonphysician Anesthetists
Conversion Factors Used on or After January I, 1997 for Qualified
Nonphysician Anesthetists
Anesthesia Time and Calculation of Anesthesia Time Units
Billing Modifiers
General Billing Instructions
Qualified Nonphysician Anesthetist Special Billing and Payment Situations
An Anesthesiologist and Qualified Nonphysician Anesthetist Work Together
Qualified Nonphysician Anesthetist and an Anesthesiologist in a Single
Anesthesia Procedure
Payment for Medical or Surgical Services Furnished by CRNAs
Conversion Factors for Anesthesia Services of Qualified Nonphysician
Anesthetists Furnished on or After January I, 1992
July 2013 Update ofthe Ambulatory Surgical Center (ASC) Payment System
July 2013 Update of the Hospital Outpatient Prospective Payment System
(OPPS)
Billing for Brachytherapy Sources - General
Payment for New Brachytherapy Sources
Pass-through Payments for Certified Registered Nurse Anesthetist Anesthesia
Services and Related Care
Pass-through Payments for Certified Registered Nurse Anesthetist Anesthesia
Services and Related Care
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July Update to the CY 2013 Medicare Physician Fee Schedule Database
(MPFSDB)
July Quarterly Update for 2013 Durable Medical Equipment, Prosthetics,
Orthotics, and Supplies (DMEPOS) Fee Schedule
Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS)
Fee Schedule
Quarterly Update Schedule For DMEPOS Fee Schedule Record Layout for
DMEPOS Fee Schedule
Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds
Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds
Policy
Healthcare Common Procedure Coding System (HCPCS) Codes and
Diagnosis
Coding
Types of Bill CroB)
Payment Method
Place of Service (POS) Professional Claims
Medicare Summary Notices (MSNs), Remittance Advice Remark Codes
(RARCs), Claim Adjustment Reason Codes (CARCs), and Group Codes
Expedited Determinations for Provider Service Terminations
Statutory Authority
Scope
Exceptions
Notice of Medicare Non-Coverage
Alterations to the NOMNC
Completing the NOMNC
Provider Delivery oflhe NOMNC
Required Delivery Timeframes
Refusal to Sign the NOMNC
Financial Liability for Failure to Deliver a Valid NOMNC
Amending the Date of the NOMNC
NOMNC Delivery to Representatives
Notice Retention for the NOMNC
Hours ofNOMNC Delivery
Expedited Determination Process
Beneficiary Responsibilities
Timeirame for Requesting an Expedited Determination
Provide Information to QIO
Obtain Physician Certification of Risk (Home Health and CORF services
only)
Beneficiary Liability During QIO Review
Untimely Requests for Review
Provider Responsibilities
The Detailed Explanation of Non-Coverage
QIO Responsibilities
Receive Beneficiary Requests for Expedited Review
Notify Providers and Allow Explanation of Why Covered Services Should
Eud
Validate Delivery of the NOMNC
Solicit the Views of the Beneficiary
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(PPS) Pricer Update FY 2014
;'~""'~i\
92
93
Medicare Contractors submission of Prescription Drug Inquiries and Common
Working File Assistance Requests to the Coordination of BeneJits Contractor
through the ECRS Web Portal
ECRS Web Quick Reference Card Version 5,2.2
ECRS Web User Guide Version
Medicare Contractors submission of Prescription Drug Inquiries and Common
Working File Assistance Requests to the Coordination of Benefits Contractor
through the ECRS Web Portal
ECRS Web Quick Reference Card Version 5,2,2
ECRS Web User Guide Version
...:"'i.,'i'
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458
459
460
461
1(.,'1
Notice of New Interest Rate for Medicare Overpayments and Underpayments
-3rd qtr Notfication for FY 20B
New Non-Physician Specialty Code for Complimentary Insurer
Removal ofPOR and PSOR instructions and the Glossary of Acronyms
from the Intel1let Only Manual, Publication 100,06, Chapter 3
New Non-Physician Specialty Code for Indirect Payment Procedure (IPP)
Non-Physician Practitioner/Supplier Specialty Codes
Revisions and Deletions to the Intel1let Only Manual, Publication 100-06,
Chapter 3, Overpayments; Section 140.2.3 - Filing Bankruptcy Draws a
Line in the Sand
Filing Bankruptcy Draws a Line in the Sand
Revisions to Appendix E and Chapter 2 sections 2290-2308 of the State
Operations Manual (SOM)
Revised Appendix A, Interpretive Guidelines for Hospitals, Appendix L,
Interpretive Guidelines for Ambulatory
Centers and Appendix W,
Guidelines for Critical Access J.j()<nibl<
Model Letter Revisions
Denials
Model Letter Guidance
Model Acknowledgement Letter
Acknowledgement Letter Example
Development Letter Guidance
Model Development Letter
Model Rejection Letter
Model Retul1led Application Letter
Model Revalidation Letter
esMD RC Public Announcement
Acceptable Submission Methods
Tax Identification Numbers of Foreign Owning and Managing Entities and
Individuals
Clarify the deJinition of customized durable medical equipment (OME) items
Definition of Customized DME
Update to Chapter 15 ofthe Program Integrity Manual (PIM) Clinical
Psychologists
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2720
Payment for CRNA Pass-Through Services
Payment for Anesthesia Services by a CRNA (Method II CAH only)
Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds
Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds
Policy
Healthcare Common Procedure Coding System (HCPCS) Codes and
Diagnosis
Coding
Types of Bill (TOB) Payment Method
Place of Service (POS) Professional Claims
Medicare Summary Notices (MSNs), Remittance Advice Remark Codes
(RARCs), Claim Adjustment Reason Codes (CARCs), and Group Codes
New Non-Physician Specialty Code for Indirect Payment Procedure (IPP)
Non-physician Practitioner, Supplier, and Provider Specialty Codes
Changes to Contractor Designation in Processing Foreign, Emergency and
Shipboard Claims
Contractors Designated to Process Foreign Claims
Source of Part B Claims
Designated Contractors
None
July 2013 Integrated Outpatient Code Editor (1I0CE) Specifications Version
14.2
Corrections to the Medicare Claims Processing Manual
Foreword
Line-Item Modifiers Related to Reporting of Non-covered Charges When
Covered and Non-covered Services Are on the Same Outpatient Claim
Liability Considerations for Bundled Services
Coding That Results from Processing Noncovered Charges
Claims Processing Requirements for Financial Limitations
Physician Fee Schedule Payment Policy Indicator File Record Layout
General Billing Requirements
Payment
CWF General Information
Coding Requirements for Laboratory Specimen Collection Update
Medicare Contractor Annual Update of the International Classification of
Diseases, Ninth Revision, Clinical ModiJication (ICD-9-CM)
Ocular Photodynamic Therapy (OPT) with Verteporfin for Macular
Degeneration
Billing Requirements for Ocular Photodynamic Therapy (OPT) with
Verteporfin
Coding Requirements for OPT with VerteporJin
Claims Processing Requirements for OPT with Verteporfin Services on
Professional Claims and Outpatient Facility Claims
Claims Processing Requirements for OPT with VerteporJin Services on
Inpatient Facility Claims
Medicare Summary Notice (MSN) and Remittance Advice (RA) Messages
Appeals Revisions-Final Regulation
Coding Requirements for Laboratory Specimen Collection Update
Coding Requirements for Specimen Collection
Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System
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III
112
Chapter 9, Employer/Union-Sponsored Group Health Plans
Adding MSP Validity Indicator to the CWF to MBD Feed Working Aged
Adjustment
Chapter 12, Effect of Change of Ownership
Entire Chapter
Risk Adjustment
Entire Chapter
1220
1221
1222
1223
113
114
Fmt 4703
00
Nunc
00
1224
1225
1226
1227
1228
';I'"
None
1229
1230
;.,':0(,,:~\:?,,:
1205
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1207
E:\FR\FM\26JYN1.SGM
1209
1210
26JYN1
1214
1208
1211
1212
1213
1215
1216
1217
1218
1219
Incentive Payment Related to Prior Authorization for Power Mobility Devices
(PMD).
Direct Mailing to Referral Agents about the DMEPOS Competitive Bidding
Program Round 2 and National Mail-Order for Diabetic Testing Supplies
Use ofQ6 Modifier for Locum Tenens by Providing Performing Provider
NPT "FOR ANAL YSIS ONLY"
Recovery of Annual Wellness Visit (A WV) Overpayments
Implementing the Recompetition Award for the Jurisdiction C Durable
Medical Equipment (DME) Medicare Administrative Contractor (MAC)
Workload
Modification to Change Request (CR)7254
MCS Prepayment Review Report
Updating the Shared Systems and Common Working File (CWF) to no
Longer Create Veteran Affairs (VA) "I" records in the Medicare Secondary
Payer (MSP) Auxiliary File
Medicare System Update to Include Line Level National Provider Identifier
(NPI) Sanction Editing on Critical Access Hospital (CAH) Method II
Outpatient Claims
VMS Prepayment Review Report
Applying Multiple Procedure Payment Reductions to Therapy Cap Amounts
for Critical Access Hospital Claims
CWF Editing for Vaccines Furnished at Hospice
American Recovery and Reinvestment Act of2009 Electronic Health Record
(EHR) Incentive: New Critical Access Hospital Banking Information File
Transfer for Eligible Professional Payment
National Competitive Bidding Program (CBP): Instructions for Processing
CBP Oxygen and Capped Rentalltem Claims with the Start of the Round One
1231
1232
1233
1234
1235
1236
1237
1238
1239
1240
1241
1242
1243
1244
1245
Recompete
Health Insurance Portability and Accountability Act (HIPAA) EDI Front End
Updates for October 2013
Issued to a speci fic audience, not posted to Internet/Intranet due to
Confidentiality of Instruction
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instruction
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instruction
Phase III ERA Eurollment Operating Rules
Reporting of Principal and Interest when returning previously recouped
money - Analysis
Issued to a specific audience, not posted to Internet/Intranet due to
Confidentiality of Instruction
Update to the Common Working File (CWF) Qualirying Stay Edit for Skilled
Nursing Facility (SNF) and Swing Bed (SB) Providers
Debts Referred to Treasury through the Healthcare Integrated General Ledger
Accounting System (HIGLAS)
Issued to a specific audience, not posted to Internet/Intranet due to
Contidentiality of Instruction
Issued to a speciflc audience, not posted to Internet/Intranet due to
Confidentiality of Instruction
Common Working File (CWF) Infonnational Unsolicited Response (lUR) or
Reject Jor a new patient visit billed by the same physician or physician group
within the past three years.
New Healthcare Common Procedure Coding System (HCPCS) Codes for
Customized Durable Medical Equipment
Standardizing the standard - Operating Rules for code usage in Remittance
Advice
MSP Claims and use ofCARC 23 - Analysis and Design
Phase TIl ERA Enrollment Operating Rules
Standardizing the Standard - Phase 1
Analysis and Design of VMS for implementing system changes tor handling
Bankrupt Suppliers
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instruction
New Healthcare Common Procedure Coding System (HCPCS) Codes for
Customized Durable Medical Equipment
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instruction
Issued to a Specific audience not posted to Internet/Intranet due to
Confidentiality of Instruction
Change in Creation Date for CMS Standard Edit/Audit/Reason Code Reports
Implementation ofCMS Ruling 1455-R (Medicare Program; Part B Billing in
Hospitals)
Common Working File (CWF) Infonnational Unsolicited Response (IUR) or
Reject for a new patient visit billed by the same physician or physician group
within the past three years.
Implementing the Recompetition Award for the Jurisdiction L (formerly
Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
18:54 Jul 25, 2013
462
463
Practice Location Infonnation
Movement of Providers and Suppliers into the High Level
Reconsideration Requests
Update to Chapter 15 of the Program Integrity Manual (PIM)
Model Letter Revisions
45239
EN26JY13.005</GPH>
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Addendum II: Regulation Documents Published
in the Federal Register (April through June 2013)
Regulations and Notices
Regulations and notices are published in the daily Federal
Register. To purchase individual copies or subscribe to the Federal
Register, contact GPO at
When ordering individual
copies, it is necessary to cite either the date of publication or the volume
number and page number.
The Federal Register is available as an online database through
GPO Access. The online database is updated by 6 a.m. each day the
Federal Register is published. The database includes both text and
graphics from Volume 59, Number 1 (January 2, 1994) through the present
date and can be accessed at
The
following website
provides
infonnation on how to access electronic editions, printed editions, and
reference copies.
This infonnation is available on our website at:
For questions or additional infonnation, contact Terri Plumb
(410-786-4481).
26JYN1
Addendum III: CMS Rulings
CMS Rulings are decisions of the Administrator that serve as
precedent final opinions and orders and statements of policy and
interpretation. They provide clarification and interpretation of complex or
ambiguous provisions ofthe law or regulations relating to Medicare,
Medicaid, Utilization and Quality Control Peer Review, private health
insurance, and related matters.
The rulings can be accessed at
For questions or
additional infonnation, contact Tiffany Lafferty (410-786-7548).
Addendum IV: Medicare National Coverage Determinations
(April through June 2013)
Addendum IV includes completed national coverage
detenninations (NCDs), or reconsiderations of completed NCDs, from the
quarter covered by this notice. Completed decisions are identified by the
section of the NCD Manual (NCDM) in which the decision appears, the
title, the date the publication was issued, and the effective date of the
decision. An NCD is a detennination by the Secretary for whether or not a
particular item or service is covered nationally under the Medicare Program
(title XVIII of the Act), but does not include a detennination of the code, if
any, that is assigned to a particular covered item or service, or payment
detennination for a particular covered item or service. The entries below
include infonnation concerning completed decisions, as well as sections on
program and decision memoranda, which also announce decisions or, in
some cases, explain why it was not appropriate to issue an NCD.
Information on completed decisions as well as pending decisions has also
been posted on the CMS website. For the purposes of this quarterly notice,
we list only the specific updates that have occurred in the 3-month period.
This infonnation is available at: ~)!}Y,g]~~@~i£9l!£:fQYQ!M~
For questions or additional infonnation, contact Wanda Belle
(410-786-7491 ).
Title
TA VR Mandatory Clinical
Trail Number
OPT with Vetieporfin for
Macular Degeneration
Autologous Platelet-Rich
Plasma (PRP) for Chronic
Non-Healing Wounds
Transmittal
Number
Issue Date
Effective
Date
TN2689
05/03/2013
07/1/2013
NCD80.3.1
TNl55
06114/2013
04/03/2013
NCD270.3
TNI54
0611 01/2013
08102/2012
NCDM
Section
NCD20.32
Addendum V: FDA-Approved Category B Investigational Device
Exemptions (IDEs) (April through June 2013)
Addendum V includes listings ofthe FDA-approved
investigational device exemption (IDE) numbers that the FDA assigns. The
listings are organized according to the categories to which the devices are
assigned (that is, Category A or Category B), and identified by the IDE
number. For the purposes of this quarterly notice, we list only the specific
updates to the Category B IDEs as of the ending date of the period covered
Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
18:54 Jul 25, 2013
EN26JY13.006</GPH>
1246
Jurisdiction 12) Part AlPart B Medicare Administrative Contractor (AlB
MAC) Workload
Implementation of the Award for the Jurisdiction K (JK) Part A and Part B
Medicare Administrative Contractor (AlB MAC) to National Government
Services
Implementation ofCMS Ruling 1455-R (Medicare Program; Part B Billing in
Hospitals)
Multi Carrier System (MCS) Modifications to Liability Assignment
Regarding Therapy Cap Claim Denials
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26JYN1
IDE
0130054
0130056
0130055
0120243
0120053
0130007
0130068
Gl20172
0120266
0130012
Gl30069
0120275
0130073
0130078
G130077
Gl30084
GI30087
0130082
0130048
G120160
GI20254
G130046
0130093
0130095
G130094
G130097
G130081
0120300
G130099
G130141
G120263
Gl20235
GI30108
Device
luvederm Volbella XC
Sensor Optimization of CRT Response (SOCR) Study
Neuroport Array and Neuroport System
Abdominal Compression Elastic Support (ACES)
Perceval S Heart Valve
Model 9005 Lutonix DCB
Ulthera System
Mguard Prime Micronet Covered Coronary Stent System
Angel Catheter
9.4 Tesla 80 CM MR Scanner
Pantaprazole 13C Breath Test (PTZ-BT)
Enlightn Renal Denervation System
NRAS Q61 Mutation test
Gel-One
Brava Systems
EPI-Sense-AF Guided Coagulation System with Visitrax
Oastric Emptying Breath Test (GEBT)
Cortical Recording and Stimulation Array System
MECT A 5000Q Feast Drive
Direct Flow Medical Trans Catheter Aortic Valve System
VORTXRX
Magnamosis Magnetic Compression Anastomosis Device
Veni RF Plus Endovenous Ablation System
Lap-Band & MetFonnin
Dermaveil
Multimodality Image-Guided (MIMIO) System
Intuitive Surgical Da Vinci Single-Site Instruments And
Accessories
GE Datex-Ohmeda AISYS With Smartflow
Exablate 2000 MROHIFU System
Cook Cervical Ripening Balloon
Portico Transcatheter Aortic Valve Implant
Entrainment Based Mechanical Ventilation
Rezum Generator, Rezum Delivery Device, Rezum Accessory
Start Date
04/03/2013
04/03/2013
04/04/2013
04/11/2013
04112/2013
04118/2013
04/19/2013
04119/2013
04119/2013
04/24/2013
04/24/2013
04/25/2013
04/26/2013
04/26/2013
04/26/2013
05/03/2013
05/08/2013
05110/2013
05/15/2013
0511512013
05/22/2013
05/23/2013
05/24/2013
05/28/2013
05/29/2013
05/30/2013
05/3112013
05/3112013
06/04/2013
06/04/2013
06/05/2013
06/06/2013
06/06/2013
0130100
0130111
GIIOO72
0130110
G130113
0130024
G070038
GI20015
G130105
0130120
G130080
G130130
G130123
GI30126
Pack
Neural Prosthetic System 2 (NPS2)
AxialifSystem
Perclot Polysacharide Hemostatis System
Essure System For Permanent Birth Control
Integrated Bracanalysis
Perfusion-Induced Systemic-Hyperthermia (PISH)
Aethlon ONA Hemopurifier
Croma Eyefill Viscoelastic Device
Medtronic Application Card For Spinal Cord Stimulation Model
8870
Gore Tag Thoracic Branch Endoprosthesis
PantoPrazole-C Breath Test (PTZ-BT)
DAKO MET 2 Pharmdx Kit
Tristan 621 Biomagnctometer
tvtedtro_nic Sylnplicity~enal[)enervation System
06/12/2013
06114/2013
06/14/2013
06114/2013
06114/2013
06/18/2013
06/20/2013
06/20/2013
06/20/2013
06/2112013
06/27/2013
06/27/2013
06/28/2013
06/29/2013
Addendum VI: Approval Numbers for Collections of Information
(April through June 2013)
All approval numbers are available to the public at Reginfo.gov.
Under the review process, approved information collection requests are
assigned OMB control numbers. A single control number may apply to
several related information collections. This infonnation is available at
For questions or additional
information, contact Mitch Bryman (410-786-5258).
Addendum VII: Medicare-Approved Carotid Stent Facilities,
(April through June 2013)
Addendum VII includes listings of Medicare-approved carotid
stent facilities. All facilities listed meet CMS standards for performing
carotid artery stenting for high risk patients. On March 17,2005, we issued
our decision memorandum on carotid artery stenting. We determined that
carotid artery stenting with embolic protection is reasonable and necessary
only if performed in facilities that have been determined to be competent in
perfonning the evaluation, procedure, and follow-up necessary to ensure
optimal patient outcomes. We have created a list of minimum standards for
facilities modeled in part on professional society statements on competency.
All facilities must at least meet our standards in order to receive coverage
for carotid artery stenting for high risk patients. For the purposes of this
quarterly notice, we are providing only the specific updates that have
occurred in the 3-month period. This information is available at:
Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
18:54 Jul 25, 2013
by this notice and a contact person for questions or additional information.
For questions or additional information, contact John Manlove (410-7866877).
Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c) devices
fall into one of three classes. To assist CMS under this categorization
process, the FDA assigns one of two categories to each FDA-approved
investigational device exemption (IDE). Category A refers to experimental
IDEs, and Category B refers to non-experimental IDEs. To obtain more
information about the classes or categories, please refer to the notice
published in the April 21, 1997 Federal Register (62 FR 19328).
45241
EN26JY13.007</GPH>
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26JYN1
Facility
Provider
Number
Effective
Date
State
Northside Hospital Atlanta
1000 Johnson Ferry Road, NE
Atlanta, GA 30342
MemoriallIospital
3625 University Boulevard South
Jacksonville, FL 32216
Saint Mary's Regional Medical Center
235 West Sixth Street
Reno, NV 89503
Good Samaritan Regional Health Center
1 Good Samaritan Way
Mt. Vernon, IL 62864
Wayne Memorial Hospital
2700 Wayne Memorial Drive
Goldsboro, NC 27534
Lowell General Hospital
295 Varnum Avenue
Lowell, MA 01854
ARH Regional Medical Center
100 Medical Center Drive
Hazard, KY 41701
Providence Holy Cross Medical Center
15031 Rinaldi Street
P.O. Box 9600
Mission Hills, CA 91346
Memorial Hospital at Gulfport
4500 13 th Street
Gulfport, MS 39501
Kaiser Foundation llospital Redwood City
1150 Veterans Boulevard
901 Marshall Building 3td Floor
Redwood City, CA 94063
University of South Alabama Medical Center
2451 Fillingim Street
Mobile, AL 36617
1457396079
04/25/20\3
GA
1447206438
04/25/20\3
FL
1801152566
04/25/20\3
NV
441221
04/25/2013
IL
1750353462
04/25/2013
NC
220063
05/17/2013
MA
180002
05/17/2013
KY
1477587632
05117/2013
CA
1639401318
06/05/2013
MS
050541
06105/2013
CA
010087
06/26/2013
AL
340047
06/27/2005
NC
140030
11118/2005
IL
"c'"
Wake Forest Baptist Medical Center
Medical Center Boulevard
Winston-Salem, NC 27157
Sherman Health
1425 North Randall Road
Elgin, IL 60123
EN26JY13.008</GPH>
Addendum VIII:
American College of Cardiology's National Cardiovascular Data
Registry Sites (April through June 2013)
Addendum VIII includes a list of the American College of
Cardiology's National Cardiovascular Data Registry Sites. We cover
implantable cardioverter defibrillators (ICDs) for certain clinical
indications, as long as infonnation about the procedures is reported to a
central registry. Detailed descriptions ofthe covered indications are
available in the NCD. In January 2005, CMS established the lCD
Abstraction Tool through the Quality Network Exchange (QNet) as a
temporary data collection mechanism. On October 27,2005, CMS
announced that the American College of Cardiology's National
Cardiovascular Data Registry (ACC-NCDR) lCD Registry satisfies the data
reporting requirements in the NCD. Hospitals needed to transition to the
ACC-NCDR ICD Registry by April 2006.
Effective January 27, 2005, to obtain reimbursement, Medicare
NCD policy requires that providers implanting ICDs for primary prevention
clinical indications (that is, patients without a history of cardiac arrest or
spontaneous arrhythmia) report data on each primary prevention ICD
procedure. Details of the clinical indications that are covered by Medicare
and their respective data reporting requirements are available in the
Medicare NCD Manual, which is on the CMS website at
A provider can use either of two mechanisms to satisfY the data
reporting requirement. Patients may be enrolled either in an Investigational
Device Exemption trial studying ICDs as identified by the FDA or in the
ACC-NCDR ICD registry. Therefore, for a beneficiary to receive a
Medicare-covered lCD implantation for primary prevention, the beneficiary
must receive the scan in a facility that participates in the ACC-NCDR lCD
registry. The entire list offacilities that participate in the ACC-NCDR ICD
registry can be found at :l:YY~Jlftill:.:!m~@TIf!;!lli~[ill1Q!l
For the purposes of this quarterly notice, we are providing only the
specific updates that have occurred in the 3-month period. This infonnation
is available by accessing our website and clicking on the link for the
American College of Cardiology's National Cardiovascular Data Registry
at:
For questions or additional
infonnation, contact Marie Casey, BSN, MPH (410-786-7861).
Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
18:54 Jul 25, 2013
For questions or additional infonnation, contact Lori Ashby
(410-786-6322).
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City
State
Verdugo Hills Hospital
Forest Hills Hospital
Spring Valley Hospital
The Hospital at Westlake Medical Center
Carondelet St Mary's Hospital
Soin Medical Center
Gulf Breeze Hospital
Florida Hospital Heartland
Saint Mary's Ilealth Center
Women and Children's Hospital
Palms West Hospital
Children's Medical Center of Dallas
Sumner Regional Medical Center
Waccamaw Community Hospital
Delnor Hospital
Newman Regional Health
Health Alliance Hospital
Mercy Western Hills
Glendale
Forest Hills
Las Vegas
Austin
Tucson
Beavercreek
Gulf Breeze
Sebring
Jefferson City
Lake Charles
Loxahatchee
Dallas
Gallatin
Murrells Inlet
Geneva
Emporia
Leominster
Cincinnati
CA
NY
NV
TX
AZ
OH
FL
FL
MO
LA
FL
TX
TN
SC
IL
KS
MA
OH
Greene Memorial Hospital
Xenia
OH
For questions or additional information, contact Stuart Caplan, RN, MAS
(410-786-8564)
New Facility
E:\FR\FM\26JYN1.SGM
Addendum IX: Active CMS Coverage-Related Guidance Documents
(April through June 2013)
There are no CMS coverage-related guidance documents published
in the April through June 20 l3 quarter. To obtain the document, visit the
CMS coverage website at h!!pjC!L~~~gQYi1~ik<.l!1:~~:TIll~
For questions or additional information, contact Lori Ashby (410-7866322).
26JYN1
Addendum X:
List of Special One-Time Notices Regarding National Coverage
Provisions (April through June 2013)
There were no special one-time notices regarding national
coverage provisions published in the April through June 2013 quarter. This
For questions or
information is available at
additional information, contact Lori Ashby (410-786-6322).
Addendum XI: National Oncologic PET Registry (NOPR)
University Radiology Associates, LLP
550 Harrison Street
Suite #100; Telephone: 315-464-2226
"""'MUM NY 13202
Old name: Medcenter One
New name: Sanford Health Bismarck
300 North 7th Street
Bismarck, ND 58506-5525
Old name: Hackensack Medical and Molecular
Imaging
New name: American Imaging
155 State Street
Hackensack, NJ 07601
Provider
Number
38874A
Effective
Date
05/15/2013
NY
1538245634
07/24/2013
ND
1306944657
01i29/2010
NJ
State
Addendum XII: Medicare-Approved Ventricular Assist Device
(Destination Therapy) Facilities (April through June 2013)
Addendum XII includes a listing of Medicare-approved facilities
that receive coverage for ventricular assist devices (VADs) used as
destination therapy. All facilities were required to meet our standards in
order to receive coverage for VADs implanted as destination therapy. On
October 1, 2003, we issued our decision memorandum on VADs for the
Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
18:54 Jul 25, 2013
Facility
(April through June 2013)
Addendum Xl includes a listing of National Oncologic Positron
Emission Tomography Registry (NOPR) sites. We cover positron emission
tomography (PET) scans for particular oncologic indications when they are
performed in a facility that participates in the NOPR.
In January 2005, we issued our decision memorandum on positron
emission tomography (PET) scans, which stated that CMS would cover
PET scans for particular oncologic indications, as long as they were
performed in the context of a clinical study. We have since recognized the
National Oncologic PET Registry as one of these clinical studies.
Therefore, in order for a beneficiary to receive a Medicare-covered PET
scan, the beneficiary must receive the scan in a facility that participates in
the registry. There were no updates to the listing of National Oncologic
Positron Emission Tomography Registry (NOPR) in the January through
March 2013 quarter. This information is available at
45243
EN26JY13.009</GPH>
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(4lO-786-7861 ).
Frm 00076
Facilitv
Provider Number
Date Approved
State
~\,,"
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E:\FR\FM\26JYN1.SGM
Memorial Hermann Hospital
6411 Fannin Street
Houston TX 77030
450068
04110/2013
TX
From: University Hospital
To: University Cincinnati Medical
Center
234 Goodman Street
Cincinnati, OH 45219
360003
0111112012
OH
26JYN1
Addendum XIII: Lung Volume Reduction Surgery (LVRS)
(April through June 2013)
Addendum XIII includes a listing of Medicare-approved facilities
that are eligible to receive coverage for lung volume reduction surgery.
Until May 17,2007, facilities that participated in the National Emphysema
Treatment Trial were also eligible to receive coverage. The following three
types of facilities are eligible for reimbursement for Lung Volume
Reduction Surgery (LVRS):
• National Emphysema Treatment Trial (NETT) approved (Beginning
05/07/2007, these will no longer automatically qualifY and can qualify only
with the other programs);
• Credentialed by the Joint Commission (fonnerly, the Joint
Commision on Accreditation of Healthcare Organizations (JCAHO» under
their Disease Specific Certification Program for LVRS; and
• Medicare approved for lung transplants.
Only the first two types are in the list. There were no additions to
the listing of facilities for lung volume reduction surgery published in the
April through June 2013 quarter. This infonnation is available at
For
questions or additional infonnation, contact Marie Casey, BSN, MPH
(410-786-7861 ).
Addendum XIV: Medicare-Approved Bariatric Surgery Facilities
(April through June 2013)
Addendum XIV includes a listing of Medicare-approved facilities
that meet minimum standards for facilities modeled in part on professional
society statements on competency. All facilities must meet our standards in
order to receive coverage for bariatric surgery procedures. On February 21,
2006, we issued our decision memorandum on bariatric surgery procedures.
We detennined that bariatric surgical procedures are reasonable and
necessary for Medicare beneficiaries who have a body-mass index (BMI)
greater than or equal to 35, have at least one co-morbidity related to obesity
and have been previously unsuccessful with medical treatment for obesity.
This decision also stipulated that covered bariatric surgery procedures are
reasonable and necessary only when performed at facilities that are: (1)
certified by the American College of Surgeons (ACS) as a Levell Bariatric
Surgery Center (program standards and requirements in effect on February
15,2006); or (2) certified by the American Society for Bariatric Surgery
(ASBS) as a Bariatric Surgery Center of Excellence (BSCOE) (program
standards and requirements in effect on February 15,2006).
For the purposes of this quarterly notice, we list only the specific
updates to Medicare-approved facilities that meet CMS's minimum facility
standards for bariatric surgery and have been certified by ACS and/or
ASMBS in the 3-month period. This information is available at
For
questions or additional information, contact Kate Tillman, RN, MAS
(410-786-9252).
Facility
Provider Number
Date
Approved
State
MedStar Washington Hospital Center
110 Irving Street NW
Washington, DC 20010
Kenneth Alexander (202) 877-3152
Crouse Hospital
736 Irvine Avenue
1548378235
02/20/2013
DC
1033107743
031l 9120 13
NY
\,,' ;c,,'c;
Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
18:54 Jul 25, 2013
EN26JY13.010</GPH>
clinical indication of destination therapy. We detennined that VADs used
as destination therapy are reasonable and necessary only if perfonned in
facilities that have been detennined to have the experience and
infrastructure to ensure optimal patient outcomes. We established facility
standards and an application process. All facilities were required to meet
our standards in order to receive coverage for VADs implanted as
destination therapy.
For the purposes of this quarterly notice, we are providing only the
specific updates that have occurred to the list of Medicare-approved
facilities that meet our standards in the 3-month period. This infonnation is
available at
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26JYN1
St. Vincent's Medical Center
13500 North Meridian Street
Carmel, IN 46032
Ted Eads (317) 582-7737
Boston Medical Center
732 Harrison Avenue, 2"d Floor
Boston, MA 02118
Melody Route (617) 414-6833
The Ohio State University Hospital
410 W. 10th Avenue
Columbus, OH 43210
Etene Terrell (614) 293-3504
Bradley Needleman (614) 293-3504
University of Alabama at Birmingham
Hospital
1813 6th Avenue South, MEB 300, zip 3293
Birmingham, AL 35294-0016
Deborah Thedford (205) 996-6984
St. Vincent's Medical Center
I ShircliffWay
Jacksonville, FL 32204
Kalherine Jewell (904) 308-3664
Penrose- St. Francis Health Services
2222 North Nevada Avenue
Colorado Springs, CO 80907
ASMBS (719) 776-5359
The Methodist Hospital
6565 Fannin, NBI-OOI
Houston, TX 77030
Marietta Schmid (713) 441-5970
Carolinas Medical Center Mercy
1437176203
310014
04111/2013
04/30/2013
MJ
NJ
1528158573
04/02/2013
IL
100206
08/30/2011
FL
1639124134
05/18/2010
IN
2608 E 7th Street
Charlotte, NC 28204
Constance Simms (704) 446-4075
William Beaumont Hospital- Royal Oak
360 I West Thirteen Mile Road
Royal Oak, MI 48073-6769
Elizabeth Gates (248) 551-9705
Meriter Hospital (NPI#)
202 South Park Street
Madison, WI 53715
ASMBS (608) 890-9996
230130/1689653305
04/2112013
MI
520089
12115/2006
WI
Addendum XV: FDG-PET for Dementia and Neurodegenerative
Diseases Clinical Trials (April through June 2013)
There were no FDG-PET for Dementia and Neurodegenerative
Diseases Clinical Trials published in the April through June 2013 quarter.
This information is available on our website at
For questions or additional information, contact Stuart Caplan, RN, MAS
(410-786-8564).
220031/1346218294
12119/2012
MA
360085
01101/2010
OH
1154435824
12/08/2012
AL
1134117575
12114/20012
FL
060031
02/24/2006
CO
450358
03/23/2013
TX
1497792550
04/01/2013
Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
18:54 Jul 25, 2013
Syracuse, NY
(315) 470-711l; ASMBS
Crittenton Hospital Medical Center (CHMC)
1101 W. University Drive
Rochester, MI 48307
Moe Gamal (248) 643-4646
Cooper University Hospital
1 Cooper Plaza
Camden, NJ 08103
ASMBS
Herrin Hospital
20 I S 14th Street
Herrin, IL 62948
ASMBS
Memorial Hospital of Florida LP
12901 Swann Avenue
Tampa, FL 33609-4056
AS~BS;(813)342-1429
NC
45245
EN26JY13.011</GPH>
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Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices
administering program functions related
to HIV/AIDS.
[FR Doc. 2013–17967 Filed 7–25–13; 8:45 am]
BILLING CODE 4120–01–C
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Indian Health Service
Office of Clinical and Preventive
Services National HIV Program:
Enhanced HIV/AIDS Screening and
Engagement in Care
Announcement Type: New.
Funding Announcement Number:
HHS–2013–IHS–OCPS–HIV–0001.
Catalog of Federal Domestic
Assistance Number: 93.933.
Key Dates
Application Deadline Date: August
26, 2013.
Review Date: August 29, 2013.
Earliest Anticipated Start Date:
September 15, 2013.
Signed Tribal Resolutions Due Date:
August 26, 2013.
Proof of Non-Profit Status Due Date:
August 26, 2013.
I. Funding Opportunity Description
II. Award Information
Statutory Authority
The Indian Health Service (IHS) is
accepting competitive cooperative
agreement applications for Enhanced
HIV/AIDS Screening and Engagement in
Care. This program is funded by the
Office of the Secretary (OS), Department
of Health and Human Services (HHS).
Funding for the HIV/AIDS award will be
provided by OS via an IntraDepartmental Delegation of Authority
dated 07/17/13 to IHS to permit
obligation of funding appropriated by
the Department of Defense, Military
Construction and Veterans Affairs, and
Full-Year Continuing Appropriations
Act, 2013, Public Law 113–6. This
program is described in the Catalog of
Federal Domestic Assistance under
93.933.
tkelley on DSK3SPTVN1PROD with NOTICES
Background
The IHS Office of Clinical and
Preventive Services (OCPS), National
Human Immunodeficiency Virus/
Acquired Immunodeficiency Syndrome
(HIV/AIDS) Program serves as the
primary source for national education,
policy development, budget
development, and allocation for clinical,
preventive, and public health HIV/AIDS
programs for the IHS, Area Offices, and
Service Units. It provides leadership in
articulating the clinical, preventive, and
public health needs of American Indian/
Alaska Native (AI/AN) communities and
developing, managing, and
VerDate Mar<15>2010
18:54 Jul 25, 2013
Jkt 229001
Purpose
The purpose of this cooperative
agreement is to meet community needs
for the enhancement of HIV/AIDS
testing activities and the provision of
HIV/AIDS-related services among AI/
AN people. Such programs are
necessary to reduce the incidence of
HIV/AIDS and improve quality of life
for People Living with HIV/AIDS
(PLWHA). The main goals are to:
increase the number of AI/AN with
awareness of his/her HIV status; and,
improve engagement and retention in
care among PLWHA. Awardee activities
will seek to: increase access to HIV
related services, reduce stigma, make
HIV testing routine, and improve
engagement in care. Emphasis should be
placed on increasing routine HIV
screening for adults as per 2006 Centers
for Disease Control and Prevention
(CDC) guidelines, provide pre- and posttest counseling (when indicated), and
developing or deploying strategies for
engaging PLWHA in appropriate,
culturally responsive HIV-related care.
Type of Award
Cooperative Agreement.
Estimated Funds Available
The total amount of funding
identified for the current fiscal year
2013 is approximately $320,000.
Individual award amounts are
anticipated to be between $60,000 and
$90,000. All competing and
continuation awards issued under this
announcement are subject to the
availability of funds. In the absence of
funding, the IHS is under no obligation
to make any awards selected for funding
under this announcement.
Anticipated Number of Awards
Approximately four awards will be
issued under this program
announcement. OS and IHS will concur
on the final decision as to who will
receive awards.
Project Period
The project period will be for five
years and will run consecutively from
September 1, 2013 to August 31, 2018.
Cooperative Agreement
In the Department of Health and
Human Services (HHS), a cooperative
agreement is administered under the
same policies as a grant. The funding
agency (OS) is required to have
substantial programmatic involvement
in the project during the entire award
PO 00000
Frm 00078
Fmt 4703
Sfmt 4703
segment. Below is a detailed description
of the level of involvement required for
both the funding agency and the
grantee. OS, through IHS, will be
responsible for activities listed under
section A and the awardee will be
responsible for activities listed under
section B as stated:
Substantial Involvement Description for
Cooperative Agreement
A. IHS Programmatic Involvement
Provide funded organizations with
ongoing consultation and technical
assistance to plan, implement, and
evaluate each component of the
comprehensive program as described
under Grantee Cooperative Agreement
Award Activities below. Consultation
and technical assistance will include,
but not be limited to, the following
areas:
(1) Interpretation of current scientific
literature related to epidemiology,
statistics, surveillance, Healthy People
2020 Objectives, and other HIV disease
control activities;
(2) Design and implementation of
program components (including, but not
limited to, program implementation
methods, surveillance, epidemiologic
analysis, outbreak investigation,
development of programmatic
evaluation, development of disease
control programs, and coordination of
activities);
(3) Implementation of program
management best practices;
(4) Conduct site visits to assess
program progress and provide
programmatic technical assistance as
travel funds allow; and
(5) Coordination of these activities
with all IHS HIV activities on a national
basis.
B. Grantee Cooperative Agreement
Award Activities
• Assist AI/AN communities and
Tribal organizations in increasing the
number of AI/ANs with awareness of
their HIV status. The grantee will assist
and facilitate reporting of HIV diagnoses
to local and State public health
authorities in the region as required by
applicable law.
• Test at least one previously
untested (not tested in the prior five
years) patient for every $75.00 in
cooperative agreement funds received,
inclusive of all ancillary and indirect
costs.
• Collaborate with national IHS
programs by providing standardized,
anonymous HIV surveillance data on a
quarterly basis, and in identifying and
documenting best practices for
implementing routine HIV testing.
E:\FR\FM\26JYN1.SGM
26JYN1
]]>Agencies
[Federal Register Volume 78, Number 144 (Friday, July 26, 2013)]
[Notices]
[Pages 45233-45246]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-17967]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9080-N]
Medicare and Medicaid Programs; Quarterly Listing of Program
Issuances--April Through June 2013
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This quarterly notice lists CMS manual instructions,
substantive and interpretive regulations, and other Federal Register
notices that were published from April through June 2013, relating to
the Medicare and Medicaid programs and other programs administered by
CMS.
FOR FURTHER INFORMATION CONTACT: It is possible that an interested
party may need specific information and not be able to determine from
the listed information whether the issuance or regulation would fulfill
that need. Consequently, we are providing contact persons to answer
general questions concerning each of the addenda published in this
notice.
[[Page 45234]]
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I. Background
The Centers for Medicare & Medicaid Services (CMS) is responsible
for administering the Medicare and Medicaid programs and coordination
and oversight of private health insurance. Administration and oversight
of these programs involves the following: (1) Furnishing information to
Medicare and Medicaid beneficiaries, health care providers, and the
public; and (2) maintaining effective communications with CMS regional
offices, state governments, state Medicaid agencies, state survey
agencies, various providers of health care, all Medicare contractors
that process claims and pay bills, National Association of Insurance
Commissioners (NAIC), health insurers, and other stakeholders. To
implement the various statutes on which the programs are based, we
issue regulations under the authority granted to the Secretary of the
Department of Health and Human Services under sections 1102, 1871,
1902, and related provisions of the Social Security Act (the Act) and
Public Health Service Act. We also issue various manuals, memoranda,
and statements necessary to administer and oversee the programs
efficiently.
Section 1871(c) of the Act requires that we publish a list of all
Medicare manual instructions, interpretive rules, statements of policy,
and guidelines of general applicability not issued as regulations at
least every 3 months in the Federal Register.
II. Revised Format for the Quarterly Issuance Notices
While we are publishing the quarterly notice required by section
1871(c) of the Act, we will no longer republish duplicative information
that is available to the public elsewhere. We believe this approach is
in alignment with CMS' commitment to the general principles of the
President's Executive Order 13563 released January 2011entitled
``Improving Regulation and Regulatory Review,'' which promotes
modifying and streamlining an agency's regulatory program to be more
effective in achieving regulatory objectives. Section 6 of Executive
Order 13563 requires agencies to identify regulations that may be
``outmoded, ineffective, insufficient, or excessively burdensome, and
to modify, streamline, expand or repeal them in accordance with what
has been learned.'' This approach is also in alignment with the
President's Open Government and Transparency Initiative that
establishes a system of transparency, public participation, and
collaboration.
Therefore, this quarterly notice provides only the specific updates
that have occurred in the 3-month period along with a hyperlink to the
full listing that is available on the CMS Web site or the appropriate
data registries that are used as our resources. This information is the
most current up-to-date information and will be available earlier than
we publish our quarterly notice. We believe the Web site list provides
more timely access for beneficiaries, providers, and suppliers. We also
believe the Web site offers a more convenient tool for the public to
find the full list of qualified providers for these specific services
and offers more flexibility and ``real time'' accessibility. In
addition, many of the Web sites have listservs; that is, the public can
subscribe and receive immediate notification of any updates to the Web
site. These listservs avoid the need to check the Web site, as
notification of updates is automatic and sent to the subscriber as they
occur. If assessing a Web site proves to be difficult, the contact
person listed can provide information.
III. How To Use the Notice
This notice is organized into 15 addenda so that a reader may
access the subjects published during the quarter covered by the notice
to determine whether any are of particular interest. We expect this
notice to be used in concert with previously published notices. Those
unfamiliar with a description of our Medicare manuals should view the
manuals at https://www.cms.gov/manuals.
Authority: (Catalog of Federal Domestic Assistance Program No.
93.773, Medicare--Hospital Insurance, Program No. 93.774, Medicare--
Supplementary Medical Insurance Program, and Program No. 93.714,
Medical Assistance Program)
Dated: July 19, 2013.
Kathleen Cantwell,
Director, Office of Strategic Operations and Regulatory Affairs.
BILLING CODE 4120-01-P
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[FR Doc. 2013-17967 Filed 7-25-13; 8:45 am]
BILLING CODE 4120-01-C
