[Federal Register Volume 65, Number 5 (Friday, January 7, 2000)]
[Proposed Rules]
[Pages 1081-1082]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-423]



Health Care Financing Administration

42 CFR Part 405


Medicare Program; Meetings of the Negotiated Rulemaking Committee 
on the Ambulance Fee Schedule

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice of meeting.


SUMMARY: In accordance with section 10(a) of the Federal Advisory 
Committee Act, this notice announces the dates and locations for the 
eighth meeting of the Negotiated Rulemaking Committee on the Ambulance 
Fee Schedule. This meeting is open to the public.
    The purpose of this committee is to develop a proposed rule that 
would establish a fee schedule for the payment of ambulance services 
under the Medicare program through negotiated rulemaking, as mandated 
by section 4531(b) of the Balanced Budget Act of 1997 (BBA '97).

DATES: The eighth meeting is scheduled for January 24, 2000 from 9:00 
a.m. until 5:00 p.m., January 25, 2000 from 9 a.m. until 5 p.m., and 
January 26, 2000 from 8:30 a.m. until 4 p.m.

ADDRESSES: The 3-day January meeting will be held at the Turf Valley 
Hotel, 2700 Turf Road, Ellicott City, Maryland 21042; (410) 465-1500.

FOR FURTHER INFORMATION CONTACT: Inquiries regarding these meetings 
should be addressed to Bob Niemann ((410) 786-4569) or Margot Blige 
((410) 786-4642) for general issues related to ambulance services or to 
Lynn Sylvester ((202) 606-9140) or Elayne Tempel ((207) 780-3408), 

SUPPLEMENTARY INFORMATION: Section 4531(b)(2) of the Balanced Budget 
Act of 1997 (BBA '97) added a new section 1834(l) to the Social 
Security Act (the Act) which mandates by January 1, 2000, 
implementation of a national fee schedule for payment of ambulance 
services furnished under Medicare Part B. The fee schedule is to be 
established through negotiated rulemaking. Section 4531(b)(2) of the 
BBA '97 also provides that, in establishing such fee schedule, the 
Secretary will--
     Establish mechanisms to control increases in expenditures 
for ambulance services under Part B of the program;
     Establish definitions for ambulance services that link 
payments to the type of services furnished;
     Consider appropriate regional and operational differences;
     Consider adjustments to payment rates to account for 
inflation and other relevant factors; and
     Phase in the fee schedule in an efficient and fair manner.
    The Negotiated Rulemaking Committee on the Ambulance Fee Schedule 
has been established to provide advice and make recommendations to the 
Secretary with respect to the text and content of a proposed rule that 
would establish a fee schedule for the payment of ambulance services 
under Part B of the Medicare program.
    The first and second meetings were for organizational purposes 
solely. There were no significant decisions made in these two meetings.
    The Committee held its third meeting on May 24 and 25, 1999. At 
this meeting, the Committee heard presentations from HCFA staff, 
including a data presentation. The Committee requested another 
presentation by HCFA's Office of the

[[Page 1082]]

Actuary to obtain clarification about its calculation of the fee 
schedule payment cap. Additionally, a Medical Issues workgroup was 
    The Committee held its fourth meeting on June 28 and 29, 1999. At 
this meeting a presentation was made by a HCFA Office of the Actuary 
staff member. The presentation clarified that budget neutrality will be 
evaluated by using all ambulance claims for the most current year and 
comparing the results of the proposed models with those paid claims. 
HCFA staff presented more historical Medicare hospital and supplier 
ambulance billing data. Consensus was reached on one possible basic 
structure for the fee schedule. HCFA indicated that the fee schedule 
must be effective as soon as operationally possible after January 1, 
2000. Subcommittees were formed to produce, by July 19, 2000 proposals 
    (1) A rural/urban adjustment; and
    (2) A fee schedule model based on the structure agreed to at the 
June meeting, combined with relative values.
These proposals, along with the results of the medical issues 
workgroup, were to serve as the basis for the Committee's next meeting.
    The Committee held its fifth meeting on August 2 and 3, 1999. At 
this meeting the Committee heard presentations from HCFA staff on the 
Medicare Physician Fee Schedule's Geographic Practice Cost Index (GPCI) 
and hospital wage index. The Committee is considering the GPCI and 
hospital wage index for possible use as a geographic cost adjuster for 
the ambulance fee schedule. The second presenter, a member of the HCFA 
negotiated rulemaking team, presented additional historical Medicare 
hospital and ambulance supplier billing data. The Committee was advised 
in a letter signed by HCFA's Deputy Administrator, Michael M. Hash, 
that it has until February 15, 2000 to conclude its business. The 
Committee reached consensus on the definitions for Basic Life Support, 
Advanced Life Support (ALS) Level-1, ALS Level-2, and the criteria that 
the service must meet in order for the emergency response modifier 
amount to be paid. During the October meeting, the Committee planned to 
work on defining the geographic and rural modifiers and establishing 
the relative values of the different levels of service.
    The seventh meeting of the Negotiated Rulemaking Committee was held 
December 6 through 8, 1999. The Committee reached consensus on the 
relative values to be used for the different levels of ambulance 
service to be modeled for evaluation purposes. The physicians' fee 
schedule Geographic Practice Cost Index (practice expense component) 
will be used as the ambulance fee schedule geographic adjuster. An 
additional payment will be made for ambulance services if the point of 
pickup is in a rural area. Rural is defined as a location in a non-MSA 
(with Goldsmith modification, if possible). An additional payment for 
an emergency response will be paid if the condition as presented was an 
emergency condition and the supplier responded ``immediately''.
    The Committee is expected to conclude its work by February 15, 
2000. The main items remaining include evaluating the results of the 
rural modifier and preparing the Committee's official report.
    The announced meeting is open to the public without advanced 
registration. Public attendance at the meeting may be limited to space 
available. Mail written statements to the following address: Federal 
Mediation and Conciliation Service, 2100 K Street, NW., Washington, DC 
20427, Attention: Lynn Sylvester. Notice of future meetings will be 
published in the Federal Register. A summary of all proceedings will be 
available for public inspection in room 443-G of the Department's 
offices at 200 Independence Avenue, SW., Washington, DC on Monday 
through Friday of each week from 8:30 a.m. to 5 p.m. (Phone: (202) 690-
7890), and can be accessed through the HCFA Internet site at http://
www.hcfa.gov/medicare/ambmain.htm. Additional information related to 
the Committee will also be available on the web site.

    Authority: Section 1834(l) of the Social Security Act (42 U.S.C. 

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

    Dated: January 4, 2000.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 00-423 Filed 1-6-00; 8:45 am]