Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-October Through December 2018, 4805-4818 [2019-02672]
Download as PDF
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
services, reviewing stakeholder
comments, drafting final
recommendation documents, and
participating in workgroups on specific
topics and methods. Members can
expect to receive frequent emails, can
expect to participate in multiple
conference calls each month, and can
expect to have periodic interaction with
stakeholders. AHRQ estimates that
members devote approximately 200
hours a year outside of in-person
meetings to their USPSTF duties. The
members are all volunteers and do not
receive any compensation beyond
support for travel to in person meetings.
Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2019–02643 Filed 2–15–19; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Patient Safety Organizations:
Voluntary Relinquishment From
Healthcare Improvement, Inc. PSO
Agency for Healthcare Research
and Quality (AHRQ), Department of
Health and Human Services (HHS).
ACTION: Notice of delisting.
AGENCY:
The Patient Safety and
Quality Improvement Final Rule
(Patient Safety Rule) authorizes AHRQ,
on behalf of the Secretary of HHS, to list
as a patient safety organization (PSO) an
entity that attests that it meets the
statutory and regulatory requirements
for listing. A PSO can be ‘‘delisted’’ by
the Secretary if it is found to no longer
meet the requirements of the Patient
Safety and Quality Improvement Act of
2005 (Patient Safety Act) and Patient
Safety Rule, when a PSO chooses to
voluntarily relinquish its status as a
PSO for any reason, or when a PSO’s
listing expires. AHRQ has accepted a
notification of voluntary relinquishment
from the Healthcare Improvement, Inc.
PSO, PSO number P0123, of its status as
a PSO, and has delisted the PSO
accordingly.
DATES: The delisting was applicable at
12:00 Midnight ET (2400) on December
31, 2018.
ADDRESSES: The directories for both
listed and delisted PSOs are ongoing
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SUMMARY:
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and reviewed weekly by AHRQ. Both
directories can be accessed
electronically at the following HHS
website: https://www.pso.ahrq.gov/listed.
FOR FURTHER INFORMATION CONTACT:
Cathryn Bach, Center for Quality
Improvement and Patient Safety, AHRQ,
5600 Fishers Lane, MS 06N100B,
Rockville, MD 20857; Telephone (toll
free): (866) 403–3697; Telephone (local):
(301) 427–1111; TTY (toll free): (866)
438–7231; TTY (local): (301) 427–1130;
Email: pso@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Background
The Patient Safety Act, 42 U.S.C.
299b–21 to 299b–26, and the related
Patient Safety Rule, 42 CFR part 3,
published in the Federal Register on
November 21, 2008, 73 FR 70732–
70814, establish a framework by which
individuals and entities that meet the
definition of provider in the Patient
Safety Rule may voluntarily report
information to PSOs listed by AHRQ, on
a privileged and confidential basis, for
the aggregation and analysis of patient
safety events.
The Patient Safety Act authorizes the
listing of PSOs, which are entities or
component organizations whose
mission and primary activity are to
conduct activities to improve patient
safety and the quality of health care
delivery.
HHS issued the Patient Safety Rule to
implement the Patient Safety Act.
AHRQ administers the provisions of the
Patient Safety Act and Patient Safety
Rule relating to the listing and operation
of PSOs. The Patient Safety Rule
authorizes AHRQ to list as a PSO an
entity that attests that it meets the
statutory and regulatory requirements
for listing. A PSO can be ‘‘delisted’’ if
it is found to no longer meet the
requirements of the Patient Safety Act
and Patient Safety Rule, when a PSO
chooses to voluntarily relinquish its
status as a PSO for any reason, or when
a PSO’s listing expires. Section 3.108(d)
of the Patient Safety Rule requires
AHRQ to provide public notice when it
removes an organization from the list of
federally approved PSOs.
AHRQ has accepted a notification
from Healthcare Improvement, Inc. PSO,
a component entity of Inspirien
Insurance Company, to voluntarily
relinquish its status as a PSO.
Accordingly, Healthcare Improvement,
Inc. PSO, P0123, was delisted effective
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4805
at 12:00 Midnight ET (2400) on
December 31, 2018.
Healthcare Improvement, Inc. PSO
has patient safety work product (PSWP)
in its possession. The PSO will meet the
requirements of section 3.108(c)(2)(i) of
the Patient Safety Rule regarding
notification to providers that have
reported to the PSO and of section
3.108(c)(2)(ii) regarding disposition of
PSWP consistent with section
3.108(b)(3). According to section
3.108(b)(3) of the Patient Safety Rule,
the PSO has 90 days from the effective
date of delisting and revocation to
complete the disposition of PSWP that
is currently in the PSO’s possession.
More information on PSOs can be
obtained through AHRQ’s PSO website
at https://www.pso.ahrq.gov.
Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2019–02642 Filed 2–15–19; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–9112–N]
Medicare and Medicaid Programs;
Quarterly Listing of Program
Issuances—October Through
December 2018
Centers for Medicare &
Medicaid Services (CMS), HHS.
AGENCY:
ACTION:
Notice.
This quarterly notice lists
CMS manual instructions, substantive
and interpretive regulations, and other
Federal Register notices that were
published from October through
December 2018, relating to the Medicare
and Medicaid programs and other
programs administered by CMS.
SUMMARY:
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.
FOR FURTHER INFORMATION CONTACT:
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Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / 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
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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. Format for the Quarterly Issuance
Notices
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 website or the
appropriate data registries that are used
as our resources. This is the most
current up-to-date information and will
be available earlier than we publish our
quarterly notice. We believe the website
list provides more timely access for
beneficiaries, providers, and suppliers.
We also believe the website 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≥
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accessibility. In addition, many of the
websites have listservs; that is, the
public can subscribe and receive
immediate notification of any updates to
the website. These listservs avoid the
need to check the website, as
notification of updates is automatic and
sent to the subscriber as they occur. If
assessing a website 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.
Dated: January 17, 2019.
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 1: Medicare and Medicaid Manual Instructions
(October through December 2018)
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 Internet-only Manuals (IOMs) are a replica of the Agency's
official record copy. Paper-based manuals are CMS manuals lhal were
officially released in hardcopy. The majority of these manuals were
transferred into the Internet-only manual (IOM) 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 IOM, 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
(703-605-6050). You can download copies of the listed material free of
charge at: https://cms.gov/manuals.
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 https://www.gpo.gov/libraries/
Tn 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 manual for Home Health Rural Add-on Payments
Based on County of Residence, use (CMS-Pub. 100-04)
Transmittal No. 4190.
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 al www .cms.gov /Manuals.
Manual/Subject/Publication Number
119
120
121
122
248
249
Issued to a specific audience, not posted to Internet/Intranet due to
Confidentialit of Instructions
Update to Medicare Deductible, Coinsurance and Premium Rates for 2019
Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct
Errors and Omissions SNF 2018 Q4
Issued to a specific audience, not posted to Internet/Intranet due to
Confidentiality of Instructions
Updated Instructions for the Change Request Implementation Report (CRIR)
and Technical Direction Letter
Report
Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity
of Instructions
Issued to a specific audience, not posted to Internet/Intranet due to
Confidentiality of Instructions
Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct
Errors and Omissions (SNF) (2018 Q4)
Medicare SJ\F PPS Overview
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
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 oft he previous four Quarterly Listing of Program Issuances notices
are: January 26, 2018 (83 FR 3716), May 4, 2018 (83 FR 19769), August
13,2018 (83 FR 40043) and November 2, 2018 (83 FR 55174). 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.
4807
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208
209
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Magnetic Resonance Imaging (MRI)
National Coverage Determination (NCD) 20.4 Implantable Cardiac
Implantable Cardioverter Defibrillators (!CD)
National Coverage Determination (NCD90.2): Next Generation Sequencing
(NGS)
National Coverage Detennination (NCD) 20.4 Implantable Cardiac
Defibrillators (ICDs)
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·'2019
' " Annual Update ofHealthcare Common Procedure Coding
System
(HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated
Billing (CB) Update
Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) and
Long Term Care Hospital (LTCH) PPS Changes
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instructions
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
ofTnstructions
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) Procedures
Payment Requirements
Medicare Summary Notices (MSN), Claim Adjustment Reason Codes
(CARCs), and Remittance Advice Remark Codes (RARCs)
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instructions
Issued to a specific audience, not posted to Internet/Intranet due to
Confidentiality of Instructions
Update to Bone Mass Measurements (l:lMM) Code 77085 Deductible and
Coinsurance Payment Methodology and HCPCS Coding Table of Preventive
and Screening Services
Issued to a specific audience, not posted to Internet/Intranet due to
Confidentiality of Instructions
Redesign of Hospice Periods -Additional Requirements
Kotice of Election (NOE)
Kotice of Termination/Revocation (NOTR)
Change of Provider/Transfer Notice
Cancellation of an Election
Change of Ownership Notice
Hospice Election Periods and Benefit Periods in Medicare Data Required on
the Institutional Claim to AlB MAC (HHH)
Incomplete Colonoscopies Billed with Modifier 53 for Critical Access
Hospital (CAH) Method II Providers
Incomplete Colonoscopies (Codes 44388, 45378, G0105 and G0121)
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instructions
Issued to a specific audience, not posted to Internet/Intranet due to
Confidentiality of Instructions
Hospital and Critical Access Hospital (CAH) Swing-Bed Manual
Revisions and Shared Systems Changes
Swing-Bed Services
100.2/Payment for CRNA or AA Services
Addendum A- Provider Specific File
Payment for CRNA Pass- Through Services
Payment for CRNA Services (Method II CAH only
Types of Facilities Subject to the Consolidated Billing Requirement for
SNFs
Issued to a specific audience, not posted to Internet/Intranet due to
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
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Three-Day Prior Hospitalization
Daily Skilled Services Defined
Services Furnished Under Arrangements With Providers
Implementation of Changes in the End-Stage Renal Disease (ESRD)
Prospective Payment System (PPS) and Payment for Dialysis Furnished for
ESRD PPS Case-Mix Adjustments Acute Kidney Injury (AKI) in ESRD
Facilities for Calendar Year (CY) 2019
Revision of Definition ofthe Physician Supervision of Diagnostic Procedures,
Clarification of DSMT Telehealth Services, and Establishing a Modifier for
Expanding the Use of Telehealth for Individuals with Stroke
Revision of Definition of the Physician Supervision of Diagnostic Procedures,
Clarification of DSMT Telehealth Services, and Establishing a Modifier for
Expanding the Use of Telehealth for Individuals with Stroke
Updates to the Inpatient Psychiatric Facility Benefit Policy Manual
Background
Statutory Requirements
Affected Medicare Providers
Conditions for Payment Under the IPF Prospective Payment System
Admission Requirements
Medical Records Reqnirements
Data
Psychiatric Evaluation
Certification and Recertification Requirements
Certification
Recertification
Delayed/Lapsed Certification and Recertification
Treatment Plan
Individualized Treatment or Diagnostic Plan
Services Expected to Improve the Condition or for Purpose of Diagnosis
Recording Progress
Discharge Planning and Discharge Summary
Director oflnpatient Psychiatric Services; Medical Staff
l\ursing Services
Social Services
Benefit Limits in Psychiatric Hospitals
Benefits Exhaust
Implementation of Changes in the End-Stage Renal Disease (ESRD)
Prospective Payment System (PPS) and Payment for Dialysis Furnished for
Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2019
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Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Modifications to the National Coordination of Benefits Agreement (CORA)
Crossover Process
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Coordination of Benefits Agreement (COBA) Detailed Error Report
Notification Process
Coordination of Benefits Agreement (COBA) Eligibility File Claims
Recovery Process
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Instructions for Retrieving the 2019 Pricing and Healthcare Common
Procedure Coding System (HCPCS) Data Files through CMS' Mainframe
Telecommunications Systems
Calendar Year (CY) 2019 Participation Enrollment and Medicare
Participating Physicians and Suppliers Directory (MEDP ARD) Procedure
Revisions to Medicare Claims Processing Manual Reference to Burn
Medicare Severity-Diagnostic Related Groups (MS-DRGs) for Transfer
Policy
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code
(CARC), Medicare Remit Easv Print (MREP) and PC Print Update
Implement Operating Rules- Phase III Electronic Remittance Advice (ERA)
Electronic Funds Transfer (EFT):
Committee on Operating Rules for Information Exchange (CORE) 360
Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance
Advice Remark Codes (RARC) and Claim Adjustment CTroup Code (CAGC)
Rule- Update from Council for Affordable Quality Healthcare (CAQH)
CORE
New Waived Tests
Quarterly Update ofHCPCS Codes Used for Home Health Consolidated
Billing Enforcement
Instructions for Downloading the Medicare ZIP Code Files for April2019
Ambulance Inflation Factor for Calendar Year 2019 and Productivity
Adjustment
Revision of Definition of the Physician Supervision of Diagnostic Procedures,
Clarification of DSMT Telehealth Services, and Establishing a Modifier for
Expanding the Use of Telehealth for Individuals with Stroke
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Quarterly Update to the National Correct Coding Initiative (NCCI)
Procedure-to-Procedure (PTP) Edits, Version 25.0 EITeclive January I, 2019
4176
Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee
Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee
Payment Amount and Telehealth Services List, CT Modifier Reduction List,
and Preventive Services List
File Conversions Related to the Spanish Translation of the Healthcare
Common Procedure Coding System (HCPCS) Descriptions
Annual Update to the Per-Beneficiary Therapy Amounts
Combined Common Edits/Enhancements Modules (CCEM) Code Set Update
Issued to a specific audience, not posted to Intemet/Intranet due to Sensitivity
of Instructions
Calendar Year (CY) 2019 Update for Durable Medical Equipment,
Prosthetics, Orthotics and Supplies (DMEPOS) Fcc Schedule
Calendar Year (CY) 2019 Annual Update for Clinical Laboratory Fee
Schedule and Laboratory Services Subject to Reasonable Charge Payment
Claim Status Category and Claim Status Codes Update
New Physician Specialty Code for Undersea and Hyperbaric Medicine
January 2019 Integrated Outpatient Code Editor (I!OCE) Specifications
Version 20.0
Issued to a specific audience, not posted to Intemet/Intranet due to Sensitivity
of Instructions
Ensuring Only the Active Billing Hospice Can Submit a Revocation
Medicare Claims Processing Manual Chapter 23 - Fee Schedule
Administration and Coding Requirements
Updates to Innuunosuppressive Guidance
Home Health Rural Add-on Payments Based on County of Residence
January 2019 Update of the Ambulatory Surgical Center (ASC) Payment
System
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Notice of 'lew Interest Rate for Medicare Overpayments and Underpayments
-1st Qtr Notification for FY 2019
The Fiscal Year 2019 Updates for the Centers for Medicare & Medicaid
Services (CMS) Internet Only Manual (IOM) Publication (Pub.) 100-06,
Medicare Financial Management Manual, Chapter 7 - Internal Control
Requirements
New Physician Specialty Code for Undersea and Hyperbaric Medicine
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Revisions to the State Operations Manual (SOM) Chapter 7 Survey
Frequency: 15-Month Survey Interval and 12-Month State-wide Average
Setting the Mandatory 3-Month and 6-Month Sanction Time Frames
Mandatory Immediate Imposition of Federal Remedies Criteria for Mandatory
Immediate Imposition of Federal Remedies Prior to the Facility's Correction
of Deficiencies
Effective Dates for Immediate Imposition of Federal Remedies
Responsibilities of the State Survey Agency and the CMS Regional Office
(RO) when there is an Immediate Imposition of Federal Remedies
«
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838
Issued to a specific audience, not posted to Intemet/Intranet due to
Contldentiality of Instructions
New Instructions for Home Health Agency Misuse of Requests for
839
Anticipated Payments (RAPs)
Home Health Agency Misuse of Requests for Anticipated Payments
RAP Monitoring
Education and Additional Monitoring
Corrective Action Plans
Notification to the HHA
CAP Submission
CAP Acceptance and Monitoring
CAP Closeout
RAP Suppression
Notice of RAP Suppression
Monitoring During RAP Suppression
Resull oflnilial RAP Suppression Moniloring Period
Reinstatement of RAP Authorization
Continuation of RAP Suppression
Coordination and Referral to the UPIC
S40
Issued to a specific audience, not posted to lntemet/lntranet due to
Confidentiality of Instruction
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Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
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Confidentiality of Instructions
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Confidentiality of Instructions
844
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Confidentiality of Instructions
845
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Issued to a specific audience, not posted to Intemet/Intranet due to
846
Confidentiality of Instructions
847
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Update to Chapter 4, Section 4.18.1.4 and Exhibit 16 in Publication (Pub.)
848
100-0S
849
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
850
Medical Review of Diagnostic Laboratory Tests
851
Updates to Chapter 4 of Publication (Pub.) 100-08
852
Update to Chapter 12 (The Comprehensive Error Rate Testing (CERT)
Program) of Publication (Pub.) 100-08 (Medicare Program Integrity Manual)
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Medicare Contractor Beneficiary and Provider Communications Manual IOM
Pub. 100-09 Chapter 5 Correct Coding Initiative
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17:46 Feb 15, 2019
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Glossary of Acronyms
LCD Definition and Statutory Authority for LCDs
LCD Process
General LCD Process Overview
Requests
Informal Meetings
New LCD Requests
New LCD Request Requirements
Proposed LCD
Proposed Decision and Posting of LCD Summary Sheet
Public Comment
Contractor Advisory Committee (CAC
Open Meeting
Final Determination
Response lo Public Commenl
Notice Period
Reconsideration Request
Web site Requirements for the LCD Reconsideration Process
Valid LCD Reconsideration Request Requirements
Process Requirements
Challenge of an LCD
LCD Content
General Requirements
Consultation
Consultation Summary
CAC Recommendations
Evidentiary Content
Reasonable and Necessary Provision in an LCD
Public Comment
Final Decision
Record
Issued to a specitlc audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Update to Exhibit 16- Model Payment Suspension Letters in Publication
(Pub.) 100-08
Modification to Chapter 6, Section 6.3 (Medical Review of Certification and
Recertification of Residents in SNFs) of Publication (Pub.) 100-08
Medical Review of Certification and Recertification of Residents in S'IFs
Templates in Medical Review
Progress Notes and Templates
Order Requirements When Prescribing Practitioner is Also the Supplier and is
Permitted to Furnish Specific Items of Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS)
One-on-One Educalion
Medical Review of Diagnostic Laboratory Tests
Medical Review of Diagnostic Tests
Medical Review of Diagnostic Laboratory Tests
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
tkelley on DSKBCP9HB2PROD with NOTICES
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211
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2144
2145
2146
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2148
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2150
2151
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2153
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Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity
of Instructions
Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity
of Instructions
Next Generation Accountable Care Organization (ACO) Model2019 Benefit
Enhancement
Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity
of Instructions
Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity
of Instructions
Next Generation Accountable Care Organization (NGACO) Model Post
Discharge Home Visit HCPCS
Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity
of Instructions
Next Generation Accountable Care Organization (NGACO) Model Post
Discharge Home Visit HCPCS
Next Generation Accountable Care Organization (NGACO) Model Post
Discharge Home Visit HCPCS
·~i,;'!};i;{;;!. ; ,;.: "'i\1 0;:1\2·~·~'
,s;.;~~~'•·
User CR; FISS to Add Location/Statuses to the 6H File Fix
Shared System Enhancement 2018; Implementation of the Medicare
Summary Notice (MSN) Zip Code Analvzer Tool
Update to Common Working File (CWF) Benefit Period Logic for
Occurrence Code 22 on Skilled Nursing Facility (SNF) and Swing Bed
Inpatient Claims
Update to the Long Description for Spanish Records on The Procedure
Descriptor Master File for all Adds and Updates That Were Not Loaded with
Change Request (CR) 10286
Claim Based Incentive Programs- Non-Assigned Claim Update
Analysis to Implement the Skilled Nursing Facility (SNF) Patient Driven
Payment Model (PDPM)
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instructions
Updating Calendar Year (CY) 2019 Medicare Diabetes Prevention Program
(MDPP) Payment Rates
Procedures for Shared Systems to Handle Foreign (non US) Addresses
Medicare Cost Report E-Filing (MCReF)
Shared System Enhancement 2018; Streamline National Provider Identifier
(NPI) Processing in the VIPS Medicare System (V:v!S)
2159
2160
2161
2162
2163
2164
2165
2166
2167
2168
2169
2170
2171
2172
2173
2174
2175
2176
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instructions
Update to Common Working File (CWF) Edit of Medicare Advantage (MA)
Enrollees' Inpatient Claims from Approved Teaching Hospitals Billed with
Indirect Medical Education (IME) or Coverage with Evidence Development
(CEO
Systems Changes to Address Acute Kidney Injury (AKI) Claims and Outlier
Payments
Shared System Enhancement 2018; Establish Beneficiary Data Streaming
(BDS) Log Files
Shared System Enhancement 2018; Remove Remaining Obsolete Access
Restriction by Granular User Services (ARGUS) Processing
Shared System Enhancement2018; Eliminate action code logic
Correct the CWF Handling of Beneficiaries with 14+ MSP Occurrences for
HETS Shared System Enhancement 2018; Remove Default Automated
Development System (ADS) and Field ADS Questions
Modify Common Working File (CWF) Editing to Apply Code G0476 to
Female Beneficiaries Only
Shared System Enhancement 2018 ViPS Medicare Systems (VMS);
Streamline the use of Assembler Language Code (ALC) Modules
Shared System Enhancement 2018; Enhance Common Working File (CWF)
Data Exiract Process
Fiscal Intermediary Shared System (FISS) AGILE Development and
Implementation of Application Programming Interface (API) for Medicare
Administrative Contractors (MACs)
Shared System Enhancement 2018; Enhance Common Working File (CWF)
Internal Testing Facility (ITF) Response Records
Decommissioning of the Client Letter Application within VIPS Medicare
System (VMS)
Provider Enrollment Chain and Ownership System (PECOS) Data Source
Change
Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity
of Instructions
Analysis of the Combined Common Edits/Enhancements Module (CCEM)
and Intelligent Data Stream (IDS) Reporting Software to Ensure Effective
Operation Under Java Version 8
Analysis to Implement Changes to Regulations Allowing Inpatient
Prospective Payment System (IPPS)-Exduded Hospitals to Operate IPPSExcluded Units
Shared System Enhancement 2018; Remove Obsolete VIPS Medicare System
(VMS) logic Related to the ViPS Medicare Automated Parameter (VMAP)
Carrier Parameter Table
Shared System Enhancement 2018: Renovate 2029 Serial Date ProcessingAnalysis Only
Correction to Common Working File (CWF) Infonnational Unsolicited
Response (IUR) 7272 for Intervening Stay
Shared System Enhancement 2018: Establish a HMBI Query/Response Log
Revision of Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits
for Ambulance Services Rendered to Beneficiaries in a Part A SNF Stay
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
None
4811
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2191
2192
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19FEN1
2194
2195
2196
2197
2198
2199
EN19FE19.007
2200
2202
2203
2204
2205
2206
2207
22Qg
2209
2210
2211
2212
2213
2214
2215
2216
2217
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80
81
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International Classification of Diseases, Tenth Revision (ICD-10) and Other
Coding Revisions to National Coverage Determinations (NCDs)
International Classification of Diseases, lOth Revision (ICD-10) and Other
Coding Revisions to National Coverage Determination (NCDs)
User CR: FISS to Add Location/Statuses to the 6H File Fix
Update to the Long Description for Spanish Records on T11e Procedure
Descriptor Master File for all Adds and Updates That Were Not Loaded with
Change Request (CR) 10286
Issued to a specific audience, not posted to Intemet/Intranet due to Sensitivity
of Instructions
Implementation of a Bundled Payment for Multi-Component Durable Medical
Equipment (DME)
Targeted Probe and Educate
Implementing the Insertion of a Sheet of Paper Promoting the Electronic
Medicare Summary Notices (eMSNs) into Mailed Medicare Summary
Notices (MSNs)
Implementing the Insertion of a Sheet of Paper Promoting the Electronic
Medicare Summary Notices (eMSNs) into Mailed Medicare Summary
Notices (MSNs)
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Update
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Update
New CWF Edit for Part A Outpatient .\i!edicare Advantage (MA), Health
Maintenance Organization (liMO)
Implementing the Revised Patient's Request for Medical Payment Form
CMS-1490S, Version 01/18
Transitioning the Pricing, Data Analysis and Coding (PDAC) to the New
Contractor
Analysis of the Combined Common Edits/Enhancements Module (CCEM)
and MSSQL and Oracle Relational Data Base Management Systems
Clarification of Part B Recovery Audit Contractor (RAC) Appeals Case File
Sharing Process
Multi-CaiTier System (MCS) Prepayment Review File
.,;;~.,,;~:?~!.
~l!~ililfi~~~(;l\~
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
Issued to a specific audience, not posted to Intemet/Intranet due to
Confidentiality of Instructions
·Iii'
:~1illli15l'•\'3~t:~+·<·;~~~·\J,
None
Addendum II: Regulation Documents Published
in the Federal Register (October through December 2018)
Regulations and Notices
Regulations and notices are published in the daily Federal
Register. To purchase individual copies or subscribe to the Federal
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
2178
Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity
of Instructions
Removal of the Provider Requirement for Reporting on an Institutional Claim
a Value Code (VC) 05- Professional Component-Split Implementation
User Change Request (CR): ViPS Medicare System (VMS) Changes to Edit
Dispensing and Supply Fcc Codes Allowed when Related Drug Codes arc
Denied in Batch
FISS Integrated Outpatient Code Editor (IOCE) Claim and Return Buffer
Interface Changes Related to new Contractor Line Level Bypass Updates
User CR: ViPS Medicare System (VMS) Changes to Bypass Claim Edit 0192
on an Adjustment Claim when Payment was Suppressed on the Previous
Adjustment
User Change Request (CR): Multi-CaiTier System (MCS)- Analysis to
Enhance the Maximum Claim Counter Process for Edits and Audits
Shared System Enhancement 2018: Move Authorized Reason Code OveiTide
Processing to FSSBSTUF
Issued to a specific audience, not posted to Intemet/Intranet due to Sensitivity
of Instructions
User Change Request (CR): Multi-Carrier System (MCS)- Enhance System
Control Facility (SCF) to Add Fraud Prevention System (FPS) Criteria
Redesign of Flu Vaccines in Fiscal Intermediary Shared System (FISS)
Shared System Enhancement 2018: Analysis to Minimize Data for Medicare
Beneficiary Database (MBD) Extract
Shared System Enhancement 2018: Rewrite Fiscal Intermediary Shared
System (FISS) module FSSB6001, Common Working File (CWF)
Unsolicited Response Function
Fiscal Intermediary Standard System (FISS) Prepayment Review Report
User CR: Update FISS Utility to Retain Original Claim Receipt Date
Shared System Enhancement 201 S: Improve Organization of the International
Code of Diseases, Tenth Revision (ICD-10) File durin<> Creation
Multi-CaiTier System (MCS) Prepayment Review File
Implementation ofHealthcare Common Procedure Coding System (HCPCS)
Code J3591 and Additional Changes for End Stage Renal Disease (ESRD)
Claims
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Update
Medicare Cost Report E-Filing (MCReF)
Analysis to Discuss and Resolve the Challenges Around the Design of (Pre/Post-Pay) Electronic Medical Documentation Requests (e.\i!DR) via the
Electronic Submission of Medical Documentation (esMD) System
Analysis to Create a Standard Coded List of Document Types to be used by
Review Contractors (RC) for Requesting Documentation in Pre-Pay and PostPay Additional Documentation Request (ADR) Letters (and/or Electronic
Medical Documentation Requests (eMDR) via the Electronic Submission of
Medical Documentation (esMD) System)
ViPS Medicare Svstem (VMS) Prepayment Review File
Enhancing the Verification Process of Common Working File (CWF) Part A
Provider Inquiries
Appeon PowerBuilder Upgrade Analysis Only
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Addendum III: CMS Rulings
(October through December 2018)
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 of the 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 mq,ut w\~ w .~.uD.t;uvl "C!?uwuuu::-.For questions or additional information,
contact Tiffany Lafferty (410-786-7548).
19FEN1
Addendum IV: Medicare National Coverage Determinations
(October through December 2018)
Addendum IV includes completed national coverage
determinations (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 determination 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 determination of the code, if
any, that is assigned to a particular covered item or service, or payment
determination for a particular covered item or service. The entries below
include information concerning completed decisions, as well as sections on
program and decision memoranda, which also mmounce 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 are providing only the specific updates that have occurred in the 3montl1 period. There were no national coverage detenninations (NCDs), or
reconsiderations of completed NCDs published in the 3-month period. This
information is available at: www.cms.gov/medicare-coverage-database/.
For questions or additional information, contact Wanda Belle, MP A
(410-786-7491)
Title
Supervised Exercise
Therapy (SET) for
Symptomatic Peripheral
Artery
National Coverage
Determination
(NCD90.2): Next
Generation Sequencing
(NGS)
NCDM
Section
NCD 20.35
NCD90.2
Transmittal
Number
Issue Date
211
12/13/2018
210
11130/2018
Effective
Date
02/15/2018
03/16/2018
Addendum V: FDA-Approved Category B Investigational Device
Exemptions (IDEs) (October through December 2018)
(Inclusion of this addenda is under discussion internally.)
Addendum VI: Approval Numbers for Collections of Information
(October through December 2018)
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 information is available at
www.reginfo.gov/public/do/PRAMain. For questions or additional
information, contact William ParhaiU (410-786-4669).
Addendum VII: Medicare-Approved Carotid Stent Facilities,
(October through December 2018)
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
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
Register, contact GPO at www.gpo.gov/fdsys. 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 https://www.gpoaccess.gov/fr/. The
following website https://www.archives.gov/federal-register/ provides
information on how to access electronic editions, printed editions, and
reference copies.
This information is available on our website at:
https://www. ems. govI quarterlyprovidempdates/downloads/Re gs3Ql8QPU.pdf
For questions or additional information, contact Terri Plumb
(410-786-4481 ).
4813
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4814
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(~18/.i
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Northside Hospital - Forsyth
1200 Northside Forsyth Drive
Cummings, GA 30041
Northside Hospital - Cherokee
450 Northside Cherokee Boulevard
Canton, GA 30115
Blessing Hospital
1005 Broadway Quincy, IL 62301
New York-Presbyterian/Weill
Cornell Medical Center (NYP/WC)
525 East 68th Street
New York, NY 10021
12:{;,:
Provider
Number
Effective Date
State
110005
10/15/2018
110008
10/15/2018
GA
1760571699
11130/2018
IL
330101
05/05/2005
'IY
.';.;;(i ~;;:I~::/~~?;;.
GA
H>\•
~;:.
19FEN1
330101
05/05/2005
New York-Presbyteriau/Columbia
University Medical Center
622 West 168th Street
New York, NY 10032
: ...·.
.....
·The folll>willl!fllellitv.has been removed:
Tennova Healthcare -Physicians
440120
10/1112005
Regional Medical Center
900 E. Oak Hill Avenue
Knoxville, TN 37917
'IY
.·
TN
Addendum VIII:
American College of Cardiology's National Cardiovascular Data
Registry Sites (October through December 2018)
The initial data collection requirement through the American
College of Cardiology's National Cardiovascular Data Registry (ACCNCDR) has served to develop and improve the evidence base for the use of
EN19FE19.009
ICDs in certain Medicare beneficiaries. The data collection requirement
ended with the posting of the final decision memo for Implantable
Cardioverter Defibrillators on February 15, 2018.
For questions or additional information, contact Sarah Fulton,
MHS (410-786-2749).
Addendum IX: Active CMS Coverage-Related Guidance Documents
(October through December 2018)
CMS issued a guidance document on November 20, 2014 titled
"Guidance for the Public, Industry, and CMS Staff: Coverage with
Evidence Development Document". Although CMS has several policy
vehicles relating to evidence development activities including the
investigational device exemption (IDE), the clinical trial policy, national
coverage determinations and local coverage determinations, this guidance
document is principally intended to help the public understand CMS' s
implementation of coverage with evidence development (CED) through the
national coverage determination process. The document is available at
https://www. ems. gov/medicare-coverage-database/details/medicarecoverage-document-details.aspx?MCDid=27. There are no additional
Active CMS Coverage-Related Guidance Documents for the 3-month
period. For questions or additional information, contact
JoAnna Baldwin, MS (410-786-7205).
Addendum X:
List of Special One-Time Notices Regarding National Coverage
Provisions (October through December 2018)
There were no special one-time notices regarding national
coverage provisions published in the 3-month period. This information is
available at www.cms.hhs.gov/coverage. For questions or additional
information, contact JoAnna Baldwin, MS (410-786 7205).
Addendum XI: National Oncologic PET Registry (NOPR)
(October through December 2018)
Addendum XI 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
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
carotid artery stenting with embolic protection is reasonable and necessary
only if performed in facilities that have been determined to be competent in
performing 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:
https://www. ems. gov/MedicareApprovedF acilitie/CASF/list. asp#TopOfPage
For questions or additional information, contact Sarah Fulton, MHS
(410-786-27 49).
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Addendum XII: Medicare-Approved Ventricular Assist Device
(Destination Therapy) Facilities (October through December 2018)
Frm 00053
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19FEN1
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 V ADs for the
clinical indication of destination therapy. We determined that VADs used
as destination therapy are reasonable and necessary only if performed in
facilities that have been determined 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 V ADs implanted as
destination therapy.
For the purposes of tlris quarterly notice, we are providing only the
specific updates to the list of Medicare-approved facilities that meet our
standards that have occurred in the 3-month period. This information is
available at
https://www. ems. gov/MedicareApprovedF acilitie/VAD/list.asp#TopOfPage.
For questions or additional information, contact David Dolan, JD,
(410-786-3365).
Facility
f.i~C\;i!i!''····>q:.
George Washington University
Hospital
900 23rd Street, NW
Washington, DC 20037
Provider
Number
Date of
Initial
Certification
090001
09/12/2018
Date of
Recertification
State
··• •:: s~~ •~ \'\ ·~·;r\;\''
DC
Facility
Other information: Joint
Commission ID # 6310
Jersey Shore University
Medical Center
1945 Route 33
Neptune City, NJ 07753
Other information: DNV
Certificate#: 277447-2018VAD
Rochester General Hospital
1425 Portland Avenue
Rochester, NY 14621
Pro">ider
Number
Date of
Initial
Certification
310073
10/16/2018
NJ
330125
10/29/2018
NY
500030
09/17/2014
••;~~•• i •;,i.•• :c;• ·''~~ .cl ••;.:
10118/2016
WA
520177
08/01/2012
08/08/2018
WI
100038
08/20/2014
08/15/2018
FL
DNV GL Certitlcate #:
278376-2018-VAD
••••..
'•(ii:::'''.~\3l•.,:.t.{
PeaceHealth St. Joseph
Medical Center
2901 Squalicum Pakrway
Bellingham, W A 98225
Date of
Recertification
State
Other information: Joint
Commission ID #9574
Joint Commission
Withdrawal Date: 2018-10-01
Froedtert Memorial Lutheran
Hospital
9200 West Wisconsin Avenue
Milwaukee, WI 53226
Other information: Joint
Commission ID #7718
Previous Re-certification Dates:
2014-07-08; 2016-08-09
FROM: South Broward
Hospital District DBA
Memorial Regional Hospital
TO: Memorial Regional
Hospital
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
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 additions, deletions, or editorial changes to the
listing of National Oncologic Positron Emission Tomography Registry
(NOPR) in the 3-month period. This information is available at
https://wwwcms.gov/}.AedicareApprovedFacilitie/NOPR!list.asp#TopOfPage.
For questions or additional information, contact Stuart Caplan, RN, MAS
(410-786-8564 ).
3 50 I Johnson Street
Hollywood, FL 33021
Other Information:
4815
EN19FE19.010
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4816
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Facility
Date of
Recertification
State
Jkt 247001
Previous Re-certification Dates:
2016-08-11
FROM: University Hospitals
and Health System
TO: University of Mississippi
Medical Center
2500 North State Street
Jackson, MS 39216
PO 00000
Frm 00054
Other information:
Joint Commission ID #8064
Advocate Christ Medical
Center.
4440 W. 95th Street
Oak Lawn, IL 60505
Fmt 4703
Sfmt 4725
DNV Certificate#: 2773502018-VAD
Sharp Memorial Hospital
7901 Frost Street
San Diego, CA 92123
250001
140208
050100
08/17/2016
09/28/2005
12/01/2003
08/08/2018
10/01/2018
08/15/2018
MS
IL
CA
Other information:
Joint Commission ID #3910
E:\FR\FM\19FEN1.SGM
19FEN1
Other information:
Joint Commission ID #9880
VAD Previous Re-certification
Dates: 20 14-09-09; 2016-10-08
Maimonides Medical Center
4S02 Tenth Avenue
Brooklyn, NY 11219
Other information:
Joint Commission ID #5734
050324
11116/2012
10/24/2018
DC
Facility
V AD Previous Re-certification
Dates: 20 14-07-29; 2016-09-13
Kaiser Sunnyside Medical
Center
10180 SE Sunnyside Road
Clackamas, OR 97015
Other information:
Joint Commission ID #4858
University of .\i!aryland
Medical Center
22 S Greene Street
Baltimore, MD 21201
08/24/2012
10/1112018
NY
Date of
Initial
Certification
Date of
Recertification
State
380091
09/14/2016
09/19/2018
OR
210002
11/12/2003
09/26/2018
MD
340002
09/28/2016
09/19/2018
IN
Other information:
Joint Commission ID #6264
V AD Previous Re-certification
Dates: 2008-09-16; 2010-08-25;
2012-08-15; 2014-08-19; 201609-20
FROM: Indiana University
Health, Inc. (Methodist
Hospital)
TO: Indiana University
Health Methodist Hospital
1701 N. Senate Boulevard
Indianapolis, IN 46206
Other information:
Joint Commission ID #188549
V AD Previous Re-certification
Dates: 2008-10-06; 2010-08-17;
2012-08-17; 2014-08-19; 201610-04
330194
Pro-.ider
Number
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
Date of
Initial
Certification
Joint Commission 6811
Previous Re-certification Dates:
2008-07-18; 2010-06-29; 201208-14; 2014-09-09; 2016-08-09
Scripps Memorial Hospital- La
Jolla
9SSS Genesee Avenue
La Jolla, CA 92037
EN19FE19.011
Provider
Number
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Number
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Date of
Recertification
State
330106
Date of
Initial
Certification
09/28/2016
FROM: North Shore
University Health System
TO: North Shore University
Hospital
300 Community Drive
'v!anhasset, NY 11030
09/19/2018
NY
200009
02/03/2009
10/03/2018
ME
260065
02/11/2015
04/04/2017
MO
Other information:
Joint Commission ID #2091
Previous Re-ceitification
Dates: 2008-03-27; 2010-0318; 2012-03-07; 2014-02-04;
2016-03-15
'v!aine Medical Center
22 Bramhall Street
Portland, ME 04102
Other information:
Joint Commission ID #5445
E:\FR\FM\19FEN1.SGM
VAD Previous Re-certification
Dates: 2016-09-28
'v!ercy Hospital Springfield
123 5 East Cherokee
Springfield, MO 65804
Other information:
Joint Commission ID #4234
Joint Commission
Withdrawal Date: 2018-12-06
19FEN1
Addendum XIII: Lung Volume Reduction Surgery (LVRS)
(October through December 2018)
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 (L VRS):
• 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 (formerly, the Joint
Commision on Accreditation of Healthcare Organizations (JCAHO)) under
their Disease Specific Certification Program for L VRS; and
• Medicare approved for lung transplants.
Only the first two types are in the list. There were no editorial
updates to the listing of facilities for lung volume reduction surgery
published in the 3-month period. This information is available at
www.cms.gov/MedicareApprovedFacilitie/L VRS/list.asp#TopOfPage. For
questions or additional information, contact Sarah Fulton, MHS
(410-786-27 49).
Addendum XIV: Medicare-Approved Bariatric Surgery Facilities
(October through December 2018)
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 determined 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 (ESCOE) (program
standards and requirements in effect on February 15, 2006).
There were no additions, deletions, or editorial changes to
Medicare-approved facilities that meet CMS' minimum facility standards
for bariatric surgery that have been certified by ACS and/or ASMBS in the
3-month period. This infonnation is available at
www. ems. gov/MedicareApprovedF acilitie/B SF/list.asp#TopOfPage. For
questions or additional information, contact Sarah Fulton, MHS
(410-786-27 49).
Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
17:46 Feb 15, 2019
Facility
4817
EN19FE19.012
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Federal Register / Vol. 84, No. 33 / Tuesday, February 19, 2019 / Notices
Centers for Medicare & Medicaid
Services
[CMS–3364–FN]
Application From the Joint
Commission (TJC) for Continued
Approval of Its Psychiatric Hospital
Accreditation Program
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final notice.
AGENCY:
This final notice announces
our decision to approve the Joint
Commission for continued recognition
as a national accrediting organization
for psychiatric hospitals that wish to
participate in the Medicare or Medicaid
programs.
DATES: The approval announced in this
final notice is effective February 25,
2019 through February 25, 2023.
FOR FURTHER INFORMATION CONTACT:
Mary Ellen Palowitch (410) 786–4496,
Monda Shaver (410) 786–3410, Tara
Lemons (410) 786–3030.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
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Under the Medicare program, eligible
beneficiaries may receive covered
services from a psychiatric hospital
provided certain requirements are met.
Section 1861(f) of the Social Security
Act (the Act) establishes distinct criteria
for facilities seeking designation as a
psychiatric hospital. Regulations
concerning provider agreements are at
42 CFR part 489 and those pertaining to
activities relating to the survey and
certification of facilities are at 42 CFR
part 488. The regulations at 42 CFR part
482 subparts A, B, C and E specify the
minimum conditions that a psychiatric
hospital must meet to participate in the
Medicare program, the scope of covered
services and the conditions for Medicare
payment for psychiatric hospitals.
Generally, to enter into an agreement,
a psychiatric hospital must first be
certified by a State Survey Agency as
complying with the conditions or
requirements set forth in part 482
subpart A, B, C and E of our regulations.
Thereafter, the psychiatric hospital is
subject to regular surveys by a State
Survey Agency to determine whether it
continues to meet these requirements.
There is an alternative, however, to
surveys by State agencies.
Section 1865(a)(1) of the Act provides
that, if a provider entity demonstrates
through accreditation by an approved
national accrediting organization that all
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applicable Medicare conditions are met
or exceeded, we may treat the provider
entity as having met those conditions,
that is, we may ‘‘deem’’ the provider
entity as having met the requirements.
Accreditation by an accrediting
organization is voluntary and is not
required for Medicare participation.
If an accrediting organization is
recognized by the Secretary of the
Department of Health and Human
Services as having standards for
accreditation that meet or exceed
Medicare requirements, any provider
entity accredited by the national
accrediting body’s approved program
may be deemed to meet the Medicare
conditions. A national accrediting
organization applying for approval of its
accreditation program under part 488,
subpart A, must provide the Centers for
Medicare & Medicaid Services (CMS)
with reasonable assurance that the
accrediting organization requires the
accredited provider entities to meet
requirements that are at least as
stringent as the Medicare conditions.
Our regulations concerning the approval
of accrediting organizations are set forth
at § 488.5. The regulations at
§ 488.5(e)(2)(i) require accrediting
organizations to reapply for continued
approval of its accreditation program
every 6 years or sooner as determined
by CMS.
The Joint Commission’s current term
of approval for their psychiatric hospital
accreditation program expires February
25, 2019.
II. Application Approval Process
Section 1865(a)(3)(A) of the Act
provides a statutory timetable to ensure
that our review of applications for CMSapproval of an accreditation program is
conducted in a timely manner. The Act
provides us 210 days after the date of
receipt of a complete application, with
any documentation necessary to make
the determination, to complete our
survey activities and application
process. Within 60 days after receiving
a complete application, we must
publish a notice in the Federal Register
that identifies the national accrediting
body making the request, describes the
request, and provides no less than a 30day public comment period. At the end
of the 210-day period, we must publish
a notice in the Federal Register
approving or denying the application.
III. Provisions of the Proposed Notice
On August 15, 2018, we published a
proposed notice in the Federal Register
(83 FR 40514), announcing the Joint
Commission’s (TJC’s) request for
continued approval of its Medicare
psychiatric hospital accreditation
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EN19FE19.013
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agencies
[Federal Register Volume 84, Number 33 (Tuesday, February 19, 2019)]
[Notices]
[Pages 4805-4818]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-02672]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9112-N]
Medicare and Medicaid Programs; Quarterly Listing of Program
Issuances--October Through December 2018
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 October through December 2018,
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 4806]]
[GRAPHIC] [TIFF OMITTED] TN19FE19.001
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. Format for the Quarterly Issuance Notices
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 website or the appropriate data
registries that are used as our resources. This is the most current up-
to-date information and will be available earlier than we publish our
quarterly notice. We believe the website list provides more timely
access for beneficiaries, providers, and suppliers. We also believe the
website 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 websites have listservs; that is, the public can
subscribe and receive immediate notification of any updates to the
website. These listservs avoid the need to check the website, as
notification of updates is automatic and sent to the subscriber as they
occur. If assessing a website 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.
Dated: January 17, 2019.
Kathleen Cantwell,
Director, Office of Strategic Operations and Regulatory Affairs.
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