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Friday, April 29, 2005 Part II Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Part 418 Medicare Program; Proposed Hospice Wage Index for Fiscal Year 2006; Proposed Rule VerDate jul<14>2003 16:52 Apr 28, 2005 Jkt 205001 PO 00000 Frm 00001 Fmt 4717 Sfmt 4717 E:\FR\FM\29APP2.SGM 29APP2 22394 Federal Register / Vol. 70, No. 82 / Friday, April 29, 2005 / Proposed Rules DEPARTMENT OF HEALTH AND (Because access to the interior of the impending death of an individual HUMAN SERVICES HHH Building is not readily available to warrants a change in the focus from persons without Federal Government curative care to palliative care for relief Centers for Medicare & Medicaid identification, commenters are of pain and for symptom management. Services encouraged to leave their comments in The goal of hospice care is to help the CMS drop slots located in the main terminally ill individuals continue life 42 CFR Part 418 lobby of the building. A stamp-in clock with minimal disruption to normal [CMS–1286–P] is available for persons wishing to retain activities while remaining primarily in a proof of filing by stamping in and the home environment. A hospice uses RIN 0938–AN89 retaining an extra copy of the comments an interdisciplinary approach to deliver being filed.) medical, social, psychological, Medicare Program; Proposed Hospice Comments mailed to the addresses emotional, and spiritual services Wage Index for Fiscal Year 2006 indicated as appropriate for hand or through use of a broad spectrum of AGENCY: Centers for Medicare & courier delivery may be delayed and professional and other caregivers, with Medicaid Services (CMS), HHS. received after the comment period. the goal of making the individual as ACTION: Proposed rule. Submission of comments on physically and emotionally comfortable paperwork requirements. You may as possible. Counseling services and SUMMARY: This proposed rule would set submit comments on this document’s inpatient respite services are available forth the hospice wage index for fiscal paperwork requirements by mailing to the family of the hospice patient. year 2006 and identifies the revised your comments to the addresses Hospice programs consider both the labor market and metropolitan statistical provided at the end of the ‘‘Collection patient and the family as a unit of care. areas. This proposed rule would also of Information Requirements’’ section in Section 1861(dd) of the Social codify provisions of sections 408 and this document. Security Act (the Act) provides for 946 of the Medicare Prescription Drug, For information on viewing public coverage of hospice care for terminally Improvement, and Modernization Act of comments, see the beginning of the ill Medicare beneficiaries who elect to 2003. SUPPLEMENTARY INFORMATION section. receive care from a participating hospice. Section 1824(i) of the Act DATES: To be assured consideration, FOR FURTHER INFORMATION CONTACT: provides payment for Medicare- comments must be received at one of Terri Deutsch, (410) 786–9462. the addresses provided below, no later participating hospices. SUPPLEMENTARY INFORMATION: than 5 p.m. on June 28, 2005. Submitting Comments: We welcome 2. Medicare Payment for Hospice Care ADDRESSES: In commenting, please refer comments from the public on all issues Our regulations at 42 CFR part 418 to file code CMS–1286–P. Because of set forth in this rule to assist us in fully staff and resource limitations, we cannot establish eligibility requirements, considering issues and developing accept comments by facsimile (FAX) payment standards and procedures, policies. You can assist us by transmission. define covered services, and delineate You may submit comments in one of referencing the file code CMS–1286–P the conditions a hospice must meet to three ways (no duplicates, please): and the specific ‘‘issue identifier’’ that be approved for participation in the 1. Electronically. You may submit precedes the section on which you Medicare program. Part 418 subpart G electronic comments on specific issues choose to comment. provides for payment in one of four in this regulation to http:// Inspection of Public Comments: All prospectively-determined rate categories www.cms.hhs.gov/regulations/ comments received before the close of (routine home care, continuous home ecomments. (Attachments should be in the comment period are available for care, inpatient respite care, and general Microsoft Word, WordPerfect, or Excel; viewing by the public, including any inpatient care) to hospices based on however, we prefer Microsoft Word.) personally identifiable or confidential each day a qualified Medicare 2. By mail. You may mail written business information that is included in beneficiary is under a hospice election. a comment. CMS posts all electronic comments (one original and two copies) B. Hospice Wage Index to the following address ONLY: Centers comments received before the close of for Medicare & Medicaid Services, the comment period on its public The hospice wage index is used to Department of Health and Human website as soon as possible after they adjust payment rates for hospice Services, Attention: CMS–1286–P, P.O. have been received. Hard copy agencies under the Medicare program to Box 8012, Baltimore, MD 21244–8012. comments received timely will be reflect local differences in area wage Please allow sufficient time for mailed available for public inspection as they levels. The original hospice wage index comments to be received before the are received, generally beginning was based on the 1981 Bureau of Labor close of the comment period. approximately 3 weeks after publication Statistics hospital data and had not been 3. By hand or courier. If you prefer, of a document, at the headquarters of updated since 1983. In 1994, because of you may deliver (by hand or courier) the Centers for Medicare & Medicaid disparity in wages from one your written comments (one original Services, 7500 Security Boulevard, geographical location to another, a and two copies) before the close of the Baltimore, Maryland 21244, Monday committee was formulated to negotiate comment period to one of the following through Friday of each week from 8:30 a wage index methodology that could be addresses. If you intend to deliver your a.m. to 4 p.m. To schedule an accepted by the industry and the comments to the Baltimore address, appointment to view public comments, government. This committee, please call telephone number (410) 786– phone 1–800–743–3951. functioning under a process established 9994 in advance to schedule your by the Negotiated Rulemaking Act of I. Background arrival with one of our staff members. 1990, was comprised of national Room 445–G, Hubert H. Humphrey A. General hospice associations; rural, urban, large, Building, 200 Independence Avenue, and small hospices; multisite hospices; SW., Washington, DC 20201; or 7500 1. Hospice Care consumer groups; and a government Security Boulevard, Baltimore, MD Hospice care is an approach to representative. On April 13, 1995, the 21244–1850. treatment that recognizes that the Hospice Wage Index Negotiated VerDate jul<14>2003 16:52 Apr 28, 2005 Jkt 205001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E:\FR\FM\29APP2.SGM 29APP2 Federal Register / Vol. 70, No. 82 / Friday, April 29, 2005 / Proposed Rules 22395 Rulemaking Committee signed an 1983 wage index to what would be paid period of high patient loads, staffing agreement for the methodology to be using current rates and new wage index. shortages due to illness or other events, used for updating the hospice wage Raw wage index values below 0.8 are or temporary travel of a patient outside index. adjusted by the greater of: (1) The a hospice program’s service area, * * * hospice budget neutrality adjustment ‘‘to enter into arrangements with 1. Updates to the Hospice Wage Index factor; or (2) the hospice wage index another hospice program to provide In the August 8, 1997 Federal floor (a 15 percent increase) subject to services to beneficiaries. Section 946(b) Register (62 FR 42860), we published a a maximum wage index value of 0.8. of the MMA provides that ‘‘in the case final rule implementing a new C. Hospice Provisions of the Medicare of hospice care provided by a hospice methodology for calculating the hospice program under arrangement under Prescription Drug, Improvement, and wage index based on the section 1861(dd)(5)(D) made by another Modernization Act of 2003 recommendations of the negotiated hospice program, the hospice program rulemaking committee. The committee On December 8, 2003, the Congress that made the arrangements shall bill statement was included in the appendix enacted the Medicare Prescription Drug, and be paid for the hospice care.’’ In of that final rule (62 FR 42883). The Improvement, and Modernization Act section II.B.2 of this proposed rule, we provisions of the final rule specified (MMA) of 2003 (Pub. L. 108–173). This discuss our proposal to revise the that the revised hospice wage index was legislation provided for the following regulations to implement payment for to be— (1) calculated using the most provisions affecting hospice services: hospice services made under current available hospital wage data; • Section 408, Recognition of arrangements. We will address the and (2) phased in over a 3-year Attending Nurse Practitioners as implementation of section 946(a) of the transition period. For the first year of Attending Physicians to Serve Hospice MMA in a future rulemaking document. the transition period, October 1, 1997 Patients. through September 30, 1998, a blended • Section 512, Coverage of Hospice II. Provisions of the Proposed Rule index was calculated by adding two- Consultation Services. A. Hospice Wage Index for FY 2006 thirds of the 1983 index value for an • Section 946, Authorizing Use of area to one-third of the revised wage Arrangements to Provide Core Hospice 1. Revised OMB Definition for index value for that area.