[Federal Register Volume 60, Number 220 (Wednesday, November 15, 1995)] [Notices] [Pages 57435-57448] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 95-28172] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES [BPO-132-N] Medicare and Medicaid Programs; Quarterly Listing of Program Issuances and Coverage Decisions--Second Quarter 1995 AGENCY: Health Care Financing Administration (HCFA), HHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during April, May, and June of 1995 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. We are also providing the content of revisions to the Medicare Coverage Issues Manual published between April 1 and June 30, 1995. On August 21, 1989, we published the content of the Manual (54 FR 34555) and indicated that we will publish quarterly any updates. Adding to this listing the complete text of the changes to the Medicare Coverage Issues Manual allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals. FOR FURTHER INFORMATION CONTACT: Margaret Cotton, (410) 786-5255 (For Medicare instruction information). Pat Prete, (410) 786-3246 (For Medicaid instruction information). Nancy Ranels, (410) 786-8928 (For all other information). [[Page 57436]] SUPPLEMENTARY INFORMATION: I. Program Issuances The Health Care Financing Administration (HCFA) is responsible for administering the Medicare and Medicaid programs, which pay for health care and related services for 38 million Medicare beneficiaries and 36 million Medicaid recipients. Administration of these programs involves (1) Providing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public; and (2) effective communications with regional offices, State governments, State Medicaid Agencies, State Survey Agencies, various providers of health care, fiscal intermediaries and carriers who process claims and pay bills, and others. To implement the various statutes on which the programs are based, we issue regulations under authority granted the Secretary under sections 1102, 1871, and 1902 and related provisions of the Social Security Act (the Act) and also issue various manuals, memoranda, and statements necessary to administer the programs efficiently. Section 1871(c)(1) of the Act requires that we publish in the Federal Register at least every 3 months a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations. We published our first notice June 9, 1988 (53 FR 21730). Although we are not mandated to do so by statute, for the sake of completeness of the listing of operational and policy statements, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the 3-month timeframe. Since the publication of our quarterly listing on June 12, 1992 (57 FR 24797), we decided to add Medicaid issuances to our quarterly listings. Accordingly, we are listing in this notice Medicaid issuances and Medicaid substantive and interpretive regulations published from April 1 through June 1995. II. Medicare Coverage Issues We receive numerous inquiries from the general public about whether specific items or services are covered under Medicare. Providers, carriers, and intermediaries have copies of the Medicare Coverage Issues Manual, which identifies those medical items, services, technologies, or treatment procedures that can be paid for under Medicare. On August 21, 1989, we published a notice in the Federal Register (54 FR 34555) that contained all the Medicare coverage decisions issued in that manual. In that notice, we indicated that revisions to the Coverage Issues Manual will be published at least quarterly in the Federal Register. We also sometimes issue proposed or final national coverage decision changes in separate Federal Register notices. Readers should find this an easy way to identify both issuance changes to all our manuals and the text of changes to the Coverage Issues Manual. Revisions to the Coverage Issues Manual are not published on a regular basis but on an as-needed basis. We publish revisions as a result of technological changes, medical practice changes, responses to inquiries we receive seeking clarifications, or the resolution of coverage issues under Medicare. If no Coverage Issues Manual revisions were published during a particular quarter, our listing will reflect that fact. Not all revisions to the Coverage Issues Manual contain major changes. As with any instruction, sometimes minor clarifications or revisions are made within the text. We have reprinted manual revisions as transmitted to manual holders. The new text is shown in italics. We will not reprint the table of contents, since the table of contents serves primarily as a finding aid for the user of the manual and does not identify items as covered or not. III. How to Use the Addenda This notice is organized so that a reader may review the subjects of all manual issuances, memoranda, substantive and interpretive regulations, or coverage decisions published during the timeframe to determine whether any are of particular interest. We expect it to be used in concert with previously published notices. Most notably, those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) and the notice published March 31, 1993 (58 FR 16837), and those desiring information on the Medicare Coverage Issues Manual may wish to review the August 21, 1989 publication (54 FR 34555). To aid the reader, we have organized and divided this current listing into five addenda. Addendum I identifies updates that changed the Coverage Issues Manual. We published notices in the Federal Register that included the text of changes to the Coverage Issues Manual. These updates, when added to material from the manual published on August 21, 1989 constitute a complete manual as of June 30, 1995. Parties interested in obtaining a copy of the manual and revisions should follow the instructions in section IV of this notice. Addendum II identifies previous Federal Register documents that contain a description of all previously published HCFA Medicare and Medicaid manuals and memoranda. Addendum III of this notice lists, for each of our manuals or Program Memoranda, a HCFA transmittal number unique to that instruction and its subject matter. A transmittal may consist of a single instruction or many. Often it is necessary to use information in a transmittal in conjunction with information currently in the manuals. Addendum IV sets forth the revisions to the Medicare Coverage Issues Manual that were published during the quarter covered by this notice. For the revisions, we give a brief synopsis of the revisions as they appear on the transmittal sheet, the manual section number, and the title of the section. We present a complete copy of the revised material, no matter how minor the revision, and identify the revisions by printing in italics the text that was changed. If the transmittal includes material unrelated to the revised section, for example, when the addition of revised material causes other sections to be repaginated, we do not reprint the unrelated material. Addendum V lists all substantive and interpretive Medicare and Medicaid regulations and general notices published in the Federal Register during the quarter covered by this notice. For each item, we list the date published, the Federal Register citation, the title of the regulation, the parts of the Code of Federal Regulations (CFR) which have changed (if applicable), the agency file code number, the ending date of the comment period (if applicable), and the effective date (if applicable). IV. How to Obtain Listed Material A. Manuals An individual or organization interested in routinely receiving any manual and revisions to it may purchase a subscription to that manual. Those wishing to subscribe should contact either the Government Printing Office (GPO) or the National Technical Information Service (NTIS) at the following addresses: Superintendent of Documents, Government Printing Office, ATTN: New Order, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512- 1800, Fax number (202) 512-2250 (for credit card orders); or [[Page 57437]] National Technical Information Service, Department of Commerce, 5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630. In addition, individual manual transmittals and Program Memoranda listed in this notice can be purchased from NTIS. Interested parties should identify the transmittal(s) they want. GPO or NTIS can give complete details on how to obtain the publications they sell. B. Regulations and Notices Regulations and notices are published in the daily Federal Register. Interested individuals may purchase individual copies or subscribe to the Federal Register by contacting the GPO at the address indicated above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number. C. Rulings Rulings are published on an infrequent basis by HCFA. Interested individuals can obtain copies from the nearest HCFA Regional Office or review them at the nearest regional depository library. We also sometimes publish Rulings in the Federal Register. D. HCFA's Compact Disk-Read Only Memory (CD-ROM) HCFA's laws, regulations, and manuals are now available on CD-ROM, which may be purchased from GPO or NTIS on a subscription or single copy basis. The Superintendent of Documents list ID is HCLRM, and the stock number is 717-139-00000-3. The following material is contained on the CD-ROM disk:Titles XI, XVIII, and XIX of the Act. HCFA-related regulations. HCFA manuals and monthly revisions. HCFA program memoranda. The titles of the Compilation of the Social Security Laws are current as of January 1, 1993. The remaining portions of CD-ROM are updated on a monthly basis. The CD-ROM disk does not contain Appendix M (Interpretative Guidelines for Hospices). Copies of this appendix may be reviewed at a Federal Depository Library (FDL). Any cost report forms incorporated in the manuals are included on the CD-ROM disk as LOTUS files. LOTUS software is needed to view the reports once the files have been copied to a personal computer disk. V. How to Review Listed Material Transmittals or Program Memoranda can be reviewed at a local FDL. Under the FDL program, government publications are sent to approximately 1400 designated libraries throughout the United States. Interested parties may examine the documents at any one of the FDLs. Some may have arrangements to transfer material to a local library not designated as an FDL. To locate the nearest FDL, individuals should contact any library. In addition, individuals may contact regional depository libraries, which 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. Superintendent of Documents numbers for each HCFA publication are shown in Addendum III, along with the HCFA publication and transmittal numbers. To help FDLs locate the instruction, use the Superintendent of Documents number, plus the HCFA transmittal number. For example, to find the Carriers Manual, Part 2-- Program Administration (HCFA-Pub. 14-2) transmittal entitled ``Beneficiary Services,'' use the Superintendent of Documents No. HE 22.8/7-3 and the HCFA transmittal number 132. VI. General Information It is possible that an interested party may have a specific information need and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing information contact persons to answer general questions concerning these items. Copies are not available through the contact persons. Copies can be purchased or reviewed as noted above. Questions concerning Medicare items in Addenda III may be addressed to Margaret Cotton, Bureau of Program Operations, Issuances Staff, Health Care Financing Administration, S3-01-27, 7500 Security Blvd., Baltimore, MD 21244-1850, Telephone (410) 786-5255. Questions concerning Medicaid items in Addenda III may be addressed to Pat Prete, Medicaid Bureau, Office of Medicaid Policy, Health Care Financing Administration, C4-25-02, 7500 Security Boulevard, Baltimore, MD 21244-1850, Telephone (410) 786-3246. Questions concerning all other information may be addressed to Nancy Ranels, Bureau of Policy Development, Office of Regulations, Health Care Financing Administration, C5-09-05, 7500 Security Blvd., Baltimore, MD 21244-1850, Telephone (410) 786-8928. (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: November 3, 1995. Bruce C. Vladeck, Administrator, Health Care Financing Administration. Addendum I This addendum lists the publication dates of the most recent quarterly listing of program issuances and coverage decision updates to the Coverage Issues Manual. For a complete listing of the quarterly updates to the Coverage Issues Manual published between March 20, 1990 through November 14, 1994, please refer to the January 3, 1995 update (60 FR 134). January 3, 1995 (60 FR 132) April 6, 1995 (60 FR 17538) July 26, 1995 (60 FR 38344) Addendum II--Description of Manuals, Memoranda, and HCFA Rulings An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the Medicare Coverage Issues Manual was published on August 21, 1989, at 54 FR 34555. A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992, at 57 FR 47468. [[Page 57438]] Addendum III.--Medicare and Medicaid Manual Instructions [April through June 1995] ------------------------------------------------------------------------ Trans. No. Manual/Subject/Publication No. ------------------------------------------------------------------------ Intermediary Manual Part 2--Audits, Reimbursement Program Administration (HCFA-Pub. 13-2) (Superintendent of Documents No. HE 22.8/6-1) ------------------------------------------------------------------------ The patient must be an insulin-treated diabetic; The patient's physician states that the patient is capable of being trained to use the particular device prescribed in an appropriate manner. In some cases, the patient may not be able to perform this function, but a responsible individual can be trained to use the equipment and monitor the patient to assure that the intended effect is achieved. This is permissible if the record is properly documented by the patient's physician; and The device is designed for home rather than clinical use. There is also a blood glucose monitoring system designed especially for use by those with visual impairments. The monitors used in such systems are identical in terms of reliability and sensitivity to the standard blood glucose monitors described above. They differ by having such features as voice synthesizers, automatic timers, and specially designed arrangements of supplies and materials to enable the visually impaired to use the equipment without assistance. These special blood glucose monitoring systems are covered under Medicare if the following conditions are met: The patient and device meet the four conditions listed above for coverage of standard home blood glucose monitors; and The patient's physician certifies that he or she has a visual impairment severe enough to require use of this special monitoring system. The additional features and equipment of these special systems justify a higher reimbursement amount than allowed for standard blood glucose monitors. Separately identify claims for such devices and establish a separate reimbursement amount for them. For those carriers using HCPCS, the procedure code and definition is: EO609--Blood Glucose Monitor--with special features (e.g., voice synthesizers, automatic timer). Transmittal No. 76; sections 50-36--50-39.1 Positron Emission Tomography (PET or PETT) Scans--New Implementing Instructions-- Effective Date: Services furnished on or after March 14, 1995. Section 50-36, Positron Emission Tomography (PET or PETT) Scans.-- This section is revised to provide limited coverage of positron emission tomography scans. Previously, PET scans were considered experimental by HCFA. PET scans are covered for use in noninvasive imaging of the perfusion of the heart for diagnosis and management of patients with known or suspected coronary artery disease. Coverage is limited to scans which employ Rubidium-82, done on equipment approved by the Food and Drug Administration, and when done in place of, but not in addition to a single photon emission computed tomography (SPECT) scan. PET centers must file claims for Medicare beneficiaries using specific G codes, and provide information regarding the results of previous tests. PET centers are also expected to maintain patient records for each Medicare patient with sufficient information to substantiate the need for the scan. [[Page 57446]] 50-36 Positron Emission Tomography (Pet or Pett) Scans (Effective for Services Performed on or After March 14, 1995) Positron emission tomography (PET), also known as positron emission transverse tomography (PETT), is a noninvasive imaging procedure that assesses perfusion and the level of metabolic activity in various organ systems of the human body. A positron camera (tomograph) is used to produce cross-sectional tomographic images by detecting radioactivity from a radioactive tracer substance (radiopharmaceutical) that is injected into the patient. Until recently Medicare considered PET scans experimental and, therefore, not covered. HCFA has now concluded that one use of PET scans, imaging of the perfusion of the heart using Rubidium 82 (Rb 82), is no longer experimental, and may be covered, provided that several conditions, outlined below, are met. This conditional coverage is dictated by two significant factors that apply to PET scans. First, although PET is no longer considered experimental for this single use, it duplicates other covered forms of diagnostic testing, and the degree to which PET scans may substitute as primary tests for such uses, as compared to a confirming or medically necessary additional test, is not as clear as is preferable. For example, in the case of imaging perfusion of the heart, body size and type may result in a technically uninterpretable single photon emission computed tomography (SPECT) test in some cases, necessitating a PET scan in order to produce clearer images and allow diagnosis and treatment of the patient. Second, the Food and Drug Administration (FDA) has approved only Rubidium 82 for general PET scan use. The FDA considers radiopharmaceuticals drugs, subject to all of the requirements for manufacture, testing and approval (including approval for certain specific uses) that the FDA applies to all drugs. Thus some uses of PET cannot be considered for coverage due to the lack of approval of the radiopharmaceuticals involved in those uses. Although the FDA has approved another radiopharmaceutical (deoxy-2- Fluoro-D-glucose (FDG)), that approval is very limited and is restricted to a single PET site at this time. The FDA currently requires each site to submit its version of FDG for testing and approval as a new drug. In view of these restrictions, coverage of PET with FDG is not being considered at this time. HCFA will continue to monitor the use of PET with FDG, with a view toward considering coverage of such uses when they appear appropriate. The following coverage requirements must be met to assure that PET scans (1) are medically necessary, (2) do not unnecessarily duplicate other covered diagnostic tests, and (3) do not involve investigational drugs or procedures using investigational drugs. A. Approved Sites.--PET scans may be covered only at PET imaging centers with PET scanners that have been approved by the FDA. Medicare contractors must determine, prior to making payment for any PET scans, whether the center applying for payment has an FDA-approved scanner. B. Use of Rubidium 82 (Rb 82) and Related Tests.--Coverage of PET scans under Medicare is currently limited to rest alone or rest with pharmacologic stress PET scans used for noninvasive imaging of the perfusion of the heart for the diagnosis and management of patients with known or suspected coronary artery disease using the FDA-approved radiopharmaceutical Rubidium 82 (Rb 82). Coverage is further limited to scans that meet either one of the following conditions: The PET scan, whether rest alone or rest with stress, is used in place of, but not in addition to, a single photon emission computed tomography (SPECT); or The PET scan, whether rest alone or rest with stress, is used following a SPECT that was found inconclusive. In these cases, the PET scan must have been considered necessary in order to determine what medical or surgical intervention is required to treat the patient. (For purposes of this requirement, an inconclusive test is a test(s) whose results are equivocal, technically uninterpretable, or discordant with a patient's other clinical data.) Note: PET scans using Rubidium 82, whether rest or stress are not covered by Medicare for routine screening of asymptomatic patients, regardless of the level of risk factors applicable to such patients. C. Submission of Claims Data.--Claims for PET scans must include the following information. Failure to submit this information may result in denial of a claim. The PET center must, for any PET scan for which payment is claimed, complete all required information on the claim form (including proper codes and modifiers) to indicate the results of the PET scan, as well as information as to whether the PET scan was done after an inconclusive noninvasive cardiac test. The information submitted with respect to the previous cardiac test must specify the type of test done prior to the PET scan and whether it was inconclusive or unsatisfactory. These explanations are in the form of special G codes used for billing PET scans. D. Maintenance of Patient Record Data Onsite.--In view of these limitations on coverage, HCFA may decide to conduct some post-payment reviews to determine that the use of PET scans is consistent with this instruction. PET centers must keep patient record information on file for each Medicare patient for whom a PET scan claim is made. These medical records will be used in any post-payment reviews and must include the information necessary to substantiate the need for the PET scan. The records must include standard information (e.g., age, sex, and height) along with any annotations regarding body size or type which indicated a need for a PET scan to determine that patient's condition (i.e., any reason the nature of the patient's body size or type mandated the use of a PET scan in order to continue treatment). Transmittal No. 77; sections 60-16--60-19 (Cont.) Pneumatic Compression Devices (Used for Lymphedema) CLARIFICATION--Effective Date: Not Applicable. Section 60-16, Pneumatic Compression Devices (Used for Lymphedema).--This section is revised to clairfy (1) That the nonsegmented and segmented pump without manual control of pressure in each chamber is considered the least costly alternative that meets the clinical needs of the individual for this type of durable medical equipment (HCPCS codes E0650 and E0651), unless there is documentation that warrants payment of the more costly manual control pump (HCPCS code E0652); (2) the documentation needed for determination of the type of pump to be used for the treatment of lymphedema; and (3) which pneumatic compression pump is appropriate for chronic venous insufficiency. 60-16 Pneumatic Compression Devices (used for Lymphedema) Lymphedema is the swelling of subcutaneous tissues due to the accumulation of excessive lymph fluid. The accumulation of lymph fluid results from an impairment to the normal clearing function of the lymphatic system and/or from an excessive production of lymph. It is a relatively uncommon, chronic condition which may be due to many causes, e.g., surgical removal of lymph nodes, post radiation fibrosis, scarring of lymphatic [[Page 57447]] channel, onset of puberty (Milroy's Disease), and congenital anomalies. In the home setting, both the segmental and nonsegmental pneumatic compression devices are covered only for the treatment of generalized, refractory lymphedema. Pneumatic compression devices are only covered as a treatment of last resort, i.e., other less intensive treatments must have been tried first and found inadequate. Such treatments would include leg or arm elevation and custom fabricated gradient pressure stockings or sleeves. Pneumatic compression devices may be covered only when prescribed by a physician and when they are used with appropriate physician oversight, i.e., physician evaluation of the patient's condition to determine medical necessity of the device, suitable instruction in the operation of the machine, a treatment plan defining the pressure to be used and the frequency and duration of use, and ongoing monitoring of use and response to treatment. The determination by the physician of the medical necessity of a pneumatic compression device must include (1) The patient's diagnosis and prognosis; (2) symptoms and objective findings, including measurements which establish the severity of the condition; (3) the reason the device is required, including the treatments which have been tried and failed; and (4) the clinical response to an initial treatment with the device. The clinical response includes the change in pre- treatment measurements, ability to tolerate the treatment session and parameters, and ability of the patient (or caregiver) to apply the device for continued use in the home. In general, the nonsegmented (HCPCS code E0650) or segmented (HCPCS code E0651) compression device without manual control of pressure in each chamber is considered the least costly alternative that meets the clinical needs of the individual. Therefore, when a claim for a segmented pneumatic compression device which allows for manual control in each chamber is received, payment must be made for the least expensive medically appropriate device. If the patient medically needs a segmented device but does not need manual controls, payment must be made for HCPCS code E0651. The segmented device with manual control (HCPCS code E0652) is covered only when there are unique characteristics that prevent the individual from receiving satisfactory pneumatic treatment using a less costly device, e.g., significant sensitive skin scars or the presence of contracture or pain caused by a clinical condition that requires the more costly manual control device. The use of pneumatic compression devices may be medically appropriate only for those patients with generalized, refractory edema from venous insufficiency with lymphatic obstruction (i.e., recurrent cellulitis with secondary scarring of the lymphatic system) with significant ulceration of the lower extremity(ies) who have received repeated, standard treatment from a physician using such methods as a compression bandage system or its equivalent, but fail to heal after 6 months of continuous treatment. The exact nature of the medical problem must be clear from the medical evidence submitted. If, after obtaining this information, a question of medical necessity remains, the contractor's medical staff resolves the issue. Addendum V.--Regulation Documents Published in the Federal Register -------------------------------------------------------------------------------------------------------------------------------------------------------- FR Vol. 60 End of comment Publication date page CFR part File code Regulation title period Effective date -------------------------------------------------------------------------------------------------------------------------------------------------------- 04/06/95................ 17538-17547 .............. BPO-130-N............... Medicare and Medicaid Programs; .............. 04/06/95 Quarterly Listing of Program Issuances and Coverage Decisions-- Fourth Quarter 1994. 04/10/95................ 18136-18137 .............. MB-084-N................ Medicaid Program; Rescission of the .............. .............. Guidelines for Documenting Medicaid Recipient Access to Immunizations Under the Vaccines for Children (VFC) Program. 04/20/95................ 19753 .............. OFHR-001-N.............. New Address and Telephone Numbers of .............. 05/22/95 the Office of Acquisition and Grants, Office of Financial and Human Resources. 04/21/95................ 19856-19862 440, 441 MB-041-F................ Medicaid Program; Required Coverage .............. 05/22/95 Of Nurse Practitioner Services. 04/24/95................ 20035-20051 493 HSQ-216-FC.............. CLIA Program; Categorization of 06/23/95 04/24/95 Tests and Personnel Modifications. 05/01/95................ 21048 421 BPO-083-F............... Medicare Program; Revisions to .............. 05/01/95 Criteria and Standards for Evaluating Intermediaries and Carriers (Correction). 05/03/95................ 21824-21825 .............. HSQ-227-N............... Medicaid Program; Peer Review .............. 05/03/95 Organization Contracts: Solicitation of Statements of Interest From In-State Organizations-Alaska, Delaware, the District of Columbia, Idaho, Kentucky, Maine, Nebraska, Nevada, South Carolina, Vermont, and Wyoming. 05/08/95................ 22533-22535 406 BPD-738-F............... Medicare Program; Clarification of .............. 06/07/95 Resumption of Entitlement Rules for Medicare Patients With End-Stage Renal Disease (ESRD). 05/25/95................ 27736 .............. OPL-005-N............... Medicare Program; June 12, 1995 .............. 05/25/95 Meeting of the Practicing Physicians Advisory Council. 06/02/95................ 29202-29434 412, 485, 413, BPD-825-P............... Medicare Program; Changes to the 08/01/95 .............. 489, 424 Hospital Inpatient Prospective Payment Systems and Fiscal Year 1996 Rates. 06/12/95................ 30877-30891 .............. BPD-832-N............... Medicaid Program; HHS' Approval of .............. 08/11/95 NAIC Statements Relating to Duplication of Medicare Benefits. [[Page 57448]] 06/13/95................ 31158-31161 .............. ORD-075-N............... New and Pending Demonstration .............. 06/13/95 Project Proposals Submitted Pursuant to Section 1115(a) of the Social Security Act: February and March 1995. 06/27/95................ 31126-31137 .............. BPD-366-F............... Medicare Program; Clarification of .............. 07/27/95 Medicare's Accrual Basis of Accounting Policy. 06/27/95................ 33123-33126 413 BPD-689-F............... Medicare Program; Uniform Electronic .............. 07/27/95 Cost Reporting System for Hospitals. 06/27/95................ 33262-33298 417, 483, 430, BPD-718-F............... Medicare and Medicaid Programs; .............. 07/27/95 484, 431, 489, Advance Directives. 434 06/27/95................ 33137-33143 .............. BPD-794-F............... Medicare Program; Date for Filling .............. 06/27/95 Medicare Cost Reports. 06/27/95................ 33221-33224 .............. ORD-076-N............... New and Pending Demonstration .............. 06/27/95 Project Proposals Submitted Pursuant to Section 1115(a) of the Social Security Act: April 1995. -------------------------------------------------------------------------------------------------------------------------------------------------------- * GN--General Notice; PN--Proposed Notice; FN--Final Notice; P--Notice of Proposed Rulemaking (NPRM); F--Final Rule; FC--Final Rule with Comment Period; CN--Correction Notice; SN--Suspension Notice; WN--Withdrawal Notice; NR--Notice of HCFA Ruling. [FR Doc. 95-28172 Filed 11-14-95; 8:45 am] BILLING CODE 4120-01-P