<p> Washington Report –September, 2005</p><p>Bill Finerfrock Capitol Associates</p><p>Hurricanes Katrina and Rita have broad impact on Federal Agenda</p><p>Although it has been nearly a month since Hurricane Katrina slammed into the gulf coast and several weeks since Hurricane Rita hit the Texas coastline, the impact of these two storms on the federal legislative and regulatory agendas is still being felt. In addition to the scores of lives and millions of dollars in property damage, numerous federal initiatives have fallen victim to these natural disasters.</p><p>Throughout this issue of the Washington Report, you will see numerous references to stalled legislation or changes in timelines as a result of Katrina and Rita. In the rush to provide much needed assistance to the affected regions, billions in unbudgeted money was directed to the gulf region. Now, as the dust settles, Congress begins the unenviable task of figuring out how to pay for the disaster relief. </p><p>Congress could simply choose to add to the federal deficit or, as seems more likely, make cuts in both discretionary and entitlement programs to offset these unanticipated costs. However this budget battle shakes out, the impact of both Katrina and Rita on the federal, legislative and regulatory environment will be felt for years. The money spent on Katrina and Rita relief could impact programs ranging from health professions education to possible changes in the physician fee schedule. </p><p>The impact of Katrina and Rita are not only being felt at the pump in the form of higher gas prices, but could also be felt in the physician’s office in the form of lower Medicare payments. </p><p>Electronic Claims Attachments Proposal Put Forward</p><p>The Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking (NPRM) on September 23rd outlining possible standards for electronic claims attachments. </p><p>This rule proposes standards for electronically requesting and supplying particular types of additional health care information in the form of electronic attachments to support submitted health care claims data. It would implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).</p><p>Individuals and organizations wishing to submit comments on this proposal must deliver their comments to HHS by 5 p.m. on November 22, 2005.</p><p>On October 7, 2005, HBMA Board members Randy Roat (Government Affairs), Curt Cvikota (Website and Information Services Committee) and past-President Bob Burleigh conducted a conference call with a representative of the Office of E-Health Standards and Services staff at HHS to discuss the proposal and obtain additional information regarding the intent of various provisions. HBMA will be preparing comments on the proposed standards. Individual HBMA members are encouraged to review the proposal and, if appropriate, submit comments on the proposed standards. HBMA also asks that members preparing and submitting comments share their view with the organization as well. </p><p>Individuals wishing to comment can do so in four ways:</p><p>1. Electronically. You may submit electronic comments on specific issues in this regulation to http://www.cms.hhs.gov/regulations/ecomments. Attachments should be in Microsoft Word, WordPerfect, or Excel; however, CMS prefers Microsoft Word. (Editorial Note: Why is it we don’t need special requirements for comment attachments but we need special standards for medical claims attachments?</p><p>2. By mail. Mail written comments (one original and two copies) to the following address ONLY:</p><p>Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-0050-P P.O. Box 8014 Baltimore, MD 21244-8014.</p><p>Please allow sufficient time for mailed comments to be received before the close of the comment period.</p><p>3. By express or overnight mail. You may send written comments (one original and two copies) to the following address ONLY: </p><p>Centers for Medicare & Medicaid Services, Department of Health and Human Services Attention: CMS-0050-P Mail Stop C4-26-05 Baltimore, MD 21244-1850</p><p>4. By hand or courier. You may deliver your written comments (one original and two copies) before the close of the comment period to one of the addresses below. If you intend to deliver your comments to the Baltimore address, please call (410) 786-7195 in advance to schedule your arrival with a CMS staff person.</p><p>Hubert H. Humphrey Building Room 445-G 200 Independence Avenue SW., Washington, DC 20201</p><p>OR</p><p>7500 Security Boulevard Baltimore, MD 21244-1850</p><p>To view a copy of the proposed standards, go to: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-18927.htm</p><p>Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible for Calendar Year 2006</p><p>In the September 23, 2005 Federal Register, the Centers for Medicare and Medicaid Services (CMS) announced the monthly actuarial rates for aged and disabled beneficiaries enrolled in Part B of the Medicare Supplementary Medical Insurance (SMI) program beginning January 1, 2006. In addition, the notice announced the monthly premium for aged and disabled beneficiaries and the annual deductible to be paid during 2006. </p><p>The Medicare Part B monthly actuarial rates applicable for 2006 are $176.90 for enrollees age 65 and over and $203.70 for disabled enrollees under age 65. The Part B monthly premium rate for 2006 is $88.50. The Part B annual deductible for 2006 is $124.00.</p><p>The Part B premium rate of $88.50 is 13.2 percent higher than the $78.20 premium rate for 2005. HHS estimates that this increase will cost approximately 40 billion Part B enrollees about $4.9 billion for 2006. In addition, they estimate that the increase in the annual deductible will cost approximately $0.4 billion in 2006.</p><p>If you would like to view the Federal Register notice announcing these rates, go to: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-18837.pdf.</p><p>Physician Fee Schedule Reduction Still Unresolved</p><p>For the past several years, physician participating in the Medicare Part B program have faced the prospect of reductions in the Medicare Fee Schedule. As a result of Congressional intervention, these cuts have been prevented and nominal increases have been approved. Once again, unless Congress intervenes, a 4.3% cut in the Medicare physician fee schedule is looming on the horizon. </p><p>Sections 1848(d) and (f) of the Medicare statute requires the Secretary of Health and Human Services to set the physician fee schedule update under the Sustainable Growth Rate (SGR) system. According to CMS current calculations, the forecast is for an update of -4.3 percent for 2006. CMS is also projecting additional negative updates in later years. </p><p>According to CMS, the vast majority of spending growth in 2004 is attributable to the following five areas:</p><p>1. An increase in spending for office visits, with a shift toward longer and more intense visits. 2. Greater utilization of minor procedures, including physical therapy and drug administration. 3. More patients receiving more frequent and more complex imaging services, such as MRIs and echocardiograms. 4. More laboratory and other physician-ordered tests. 5. Higher utilization of physician-administered prescription drugs.</p><p>CMS is reportedly working with various physician groups, including the AMA, the better understand these trends and the explanations behind them. For example, CMS has reported that “The AMA has provided us with several illustrations of recent trends in medical practice that it believes contribute to the overall growth in spending on physicians' services.” The CMS report goes on to not that, “the AMA points out that some payers are encouraging physicians to determine the left ventricular valve function of their patients with congestive heart failure using an echocardiogram. Also, five years ago, statin therapy to lower cholesterol levels was only recommended for patients as old as 79.” Now, according to the AMA, “patients as old as 86 years of age may receive statin therapy, resulting in additional laboratory tests.”</p><p>While nothing individually explains this phenomena, the collective effect of various changes in practice styles and coverage changes results in these formulaic reductions. While many in Congress understand the implications of the cuts, it will take a great deal of political lifting to prevent the reductions from taking place. </p><p>Recent federal expenditures to deal with the aftermath of hurricanes Katrina and Rita have caused the federal budget deficit to rise considerably. There is increasing pressure on Congress to offset these expenditures with cuts in other federal programs. The significance of this development is that in order to “fix” the fee schedule problem – even temporarily – results in an increase in federal expenditures of between $4 billion and $10 billion. </p><p>Thus, at a time when Congress is looking for ways to cut federal spending to pay for Katrina and Rita relief, we are asking Congress to authorize billions of additional spending for the Medicare Part B program. Under federal budget rules, this increase in Medicare spending must be offset by cuts in other federal programs. The combined impact of cuts to pay for both Katrina/Rita relief, as well as restoration of the fee schedule payments, could be devastating to the budget for other federal programs. </p><p>There is strong bi-partisan support for preventing the projected fee schedule cut from taking place, but it still remains to be seen how that increase in expenditures will be offset and what programs will get cut to pay for the Part B payment restoration.</p><p>Medicare/Medicaid Cuts on Hold</p><p>Under the Congressional Budget Resolution adopted earlier this year, the Congress was expected to make changes in the Medicaid law resulting in nearly $10 billion in savings over the next 5 years. However, increased spending for hurricanes Katrina and Rita, along with other pressing budget issues has put the whole idea of cutting the Medicaid program on hold. In addition, some are suggesting that if Congress is going to entertain cuts in Medicaid, it should also put cuts in Medicare on the table as well. </p><p>Some have noted with great irony that at the very time Congress and the Bush Administration were relaxing Medicaid eligibility criteria in Texas, Louisiana, Alabama, Florida and Mississippi, thus resulting in higher federal Medicaid payments, it was going to be proposing major cuts in the Medicaid budget that would negate the positive effect those Katrina/Rita related changes have had in the affected states. </p><p>Originally, the Committees were to report their budget savings proposals by mid-September but it now appears that Committees may not act until late October or early November – if at all. Although there is great interest in reducing federal spending, the details of how to achieve those savings have proven elusive. </p><p>Medicaid Options Put On Table</p><p>During House-Senate Budget negotiations over the Summer, the decision was made to have a government Commission recommend possible cuts in the Medicaid program. In late August, an HHS advisory panel submitted it’s recommendations to the Secretary of HHS for saving $11 billion (over 5 years) from the Medicaid budget. </p><p>In making its recommendations, the Commission drew heavily on recommendations by the National Governor’s Association (NGA). In all, 6 recommendations were sent forward to the Secretary. Some of the more significant recommendations were: </p><p>1. Restrict state intergovernmental transfer (IGT) authority of Medicaid dollars 2. New restrictions on income transfers 3. Reforming the way Medicaid pays for prescription drugs</p><p>The following are summaries of the major proposals adopted by the Commission. While all of these must be approved by Congress, it appears Congress is prepared to embrace these proposals.</p><p>One of the more interesting proposals has to do with so-called “intergovernmental transfers” where states “game” the Medicaid program to garner higher Medicaid payments from the federal government, but fail to put those increased payments into increased provider payments. </p><p>Intergovernmental Transfer Payments</p><p>The President’s 2006 budget proposes to improve the integrity of the Medicaid matching rate system by requiring the Centers for Medicare and Medicaid Services (CMS) to recover federal funds inappropriately retained by or returned from providers to the state. The proposal would base federal match to states on net expenditures, and would, according to the Congressional Research Service, provide federal matching funds to states only for payments retained by Medicaid providers. This proposal restricts intergovernmental transfers (IGTs). </p><p>1o States are allowed to finance up to 60 percent of the state share of Medicaid expenditures with local government funds. 2o Medicaid’s open-ended financing structure encourages states to maximize the amount of Federal matching funds they receive without contributing the legally-determined state share. In some cases, states have required local government providers to use IGTs to transfer back to the state the federal Medicaid funds paid to these providers. 3o Through such mechanisms, federal funds intended to pay for health services are either retained by or returned to the state and “recycled” to draw additional federal dollars. 4o These financing strategies have led to dramatic increases in federal funding without a corresponding increase in Medicaid services. 5o States have a financial incentive to make excessive payments to government providers as part of a strategy to leverage additional federal funds. In many cases, the excessive payments do not remain with the government provider, but are instead transferred back to the state where they can be used for other purposes. </p><p>Income transfer proposal</p><p>Medicaid is the largest payer for long term care services in the country. Medicaid pays for long-term care services for persons who are poor and need long-term care, as well as for those who are made poor through paying privately the high cost of long-term care services. Determining eligibility for this later group presents a different challenge than for other Medicaid eligibility groups. </p><p>States determine financial eligibility for Medicaid coverage of nursing home care using a combination of state and federal statue and regulation. Personal income and assets must be below specified levels before eligibility can be established. Personal resources are sorted into two categories: those considered countable (those that must be spent down before eligibility criteria is met) and those considered non-countable (those that applicants can keep and still meet the eligibility criteria such as real estate). Some assets held in trust, annuities and promissory notes are also not counted. If it is determined that the applicant has excess countable assets, these must be spent before they can become eligible. Personal income is applied to the cost of care after a personal needs allowance and a community spouse allowance is deducted. </p><p>Federal law requires states to review the income and assets of Medicaid applicants for a period of thirty-six months prior to application or sixty months if a trust is involved. This period is known as the “look back period.” Financial eligibility screeners look for transfers from personal assets made during the look back period that appear to have been made for the purpose of obtaining Medicaid eligibility. Transfers made before the look back period are not reviewed. Some states and others maintain that thirty-six months is not a long enough time to discourage transfers. </p><p>Applicants are prohibited from transferring resources during the look back period for less than fair market value. Some transfers of resources are allowed, such as transfers between spouses. If a state eligibility screener finds a non-allowed transfer, current law (OBRA’93) requires the state to impose a “penalty period” during which Medicaid will not pay for long-term care. The length of the penalty period is calculated by dividing the amount transferred by the monthly private pay rate of nursing homes in the state. The penalty period starts from the date of the transfer. Using the date of the transfer as the start date provides an opportunity for applicants to preserve assets because some or all of the penalty period may occur while the applicant was not paying privately for long term care. Some elder law attorneys advise their clients on how to use the penalty period to retain assets. The Commission recommended moving the start date of the penalty period from the date of the transfer to the date of application for Medicaid or the nursing home admission date whichever is later. Changing this date extends the time during which Medicaid applicants who made transfers are financially responsible for the cost of their care. Such a change decreases Medicaid expenditures and increases private payment. </p><p>Tiered Co-pays for Prescription Drugs</p><p>States should be given the ability to develop effective tiered co-pay structures to encourage cost- effective drug utilization where appropriate for all beneficiaries, regardless of income. Although states may currently operate tiered co-pays, Medicaid’s current cost sharing rules, with an unenforceable maximum co-pay of $3 per drug is not conducive to encouraging cost-effective utilization. States should be able to increase co-pays on non preferred drugs beyond nominal amounts when a preferred drug is available, to encourage beneficiaries to fill the least costly effective prescription for treatment. Such co-pays must be enforceable to be meaningful. </p><p>For beneficiaries at or below the federal poverty level, co-pays for preferred drugs would remain nominal, although they would be enforceable. For this population, states would be able to increase these enforceable co-pays beyond nominal amounts for a non preferred drug. States should be given broad authority to waive these co-pays in cases of true hardship or where failure to take a preferred drug might create serious adverse health effects. </p><p>1o There are approximately 6.3 million Medicaid beneficiaries who are currently eligible for or receiving benefits through both Medicare and Medicaid. Medicaid will no longer be responsible for providing prescription drug coverage to these beneficiaries beginning January 1, 2006. 2 3o On average 24% of all individuals eligible for Medicaid pharmacy benefit management managed care, utilize prescription benefits.</p><p>Pay-For-Performance Still Possible</p><p>Congressional advocates for incorporating a “pay-for-performance” (P4P) component into Medicare payments remain optimistic that some movement in that direction is possible in the 1st Session of the current Congress. While pay for performance should, in theory, be revenue neutral (money is moved around within the program, but aggregate amounts remain the same) some P4P proposals would actually result in an overall reduction in Medicare outlays. </p><p>The fact that some P4P plans would result in a savings to the federal government means that the reform intended to improve quality could instead be used to “offset” increased government expenditures related to hurricanes Katrina and Rita. </p><p>Medicare & Medicaid 2005 Program Transmittals Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual. The cover page (or transmittal page) summarizes the new changed material, specifying what is changed. </p><p>Effective File SUBJECT Date R695CP General Appeals Process in Initial Determinations (Implementation Dates 1/9/2006 for FI Initial Determinations Issued on or After May 1, 2005, and Carrier Initial Determinations Issued on or After January 1, 2006). R696CP 2006 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) 1/3/2006 Consolidated Billing (CB) for the Common Working File (CWF), Medicare Carriers and Fiscal Intermediaries (FIs) R697CP Appeals of Claims Decisions: Redeterminations and Reconsiderations 1/9/2006 (implementation date May 1, 2005). R698CP The Supplemental Security Income (SSI) Medicare Beneficiary Data for 11/5/2005 Fiscal Year 2006 for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) R699CP Competitive Acquisition Program (CAP) for Part B Drugs 4/3/2006 R702CP Manualization for Physician/Practitioner/Supplier Participation N/A Agreement and Assignment Carrier Claims and Carrier Rules for Limiting Charge R701CP New Diagnosis Code Requirements for Method II Home Dialysis Claims 11/7/2005 R700CP Revision to Chapter 31 - Attestation 11/7/2005 R703CP IPPS Outlier Reconciliation 11/7/2005 R704CP Discontinuation of Biannual Recertification List for Certified Registered 11/7/2005 Nurse Anesthetist (CRNA) Services R705CP Modification to Reporting of Diagnosis Codes for Screening 7/5/2005 Mammography Claims R706CP Payment Methodology for Rehabilitation Services in IHS/Tribally Owned 1/3/2006 and/or Operated Hospitals and Hospital-Based Facilities R79FM Discovery Code Indication for Recovery Audit Contractor (RAC) Non- 1/3/2006 MSP Identified Overpayments R690CP Fiscal Year (FY) 2006 Payment for Services Furnished in Ambulatory 10/3/2005 Surgical Centers (ASCs) R691CP October 2005 Update of the Hospital Outpatient Prospective Payment 10/3/2005 System (OPPS) R692CP Fiscal Year (FY) 2006 Inpatient Prospective Payment System (IPPS) and 10/3/2005 Long Term Care Hospital (LTCH PPS) Changes R693CP Updates to the IRF and SNF Provider Specific File and Changes in 10/31/2005 Inpatient Rehabilitation Facility Prospective Payment System For FY 2006 R694CP Update to the Healthcare Provider Taxonomy Codes (HPTC) Version 5.1 10/31/2005 R36MSP Update to the Healthcare Provider Taxonomy Codes (HPTC) Version 5.1 11/30/2005 R78FM Coordination of Benefits Agreement (COBA) Process for Contractor 10/31/2005 Financial Staff Notification R125PI Medical Review Additional Documentation Requests 12/30/2005 R70MCM Beneficiary Enrollment and Disenrollment Requirements for Medicare N/A Advantage Plans R71MCM Deletion of MCM Chapter 19 - The Enrollment and Payment User's N/A Guide, and Chapter 20 - Managed Care and MA Systems Business Requirements. R72MCM Changes in Manual Instructions for Benefits and Beneficiary Protections N/A R73MCM Changes in Manual Instructions for Intermediate Sanctions N/A R35MSP Updates to the Group Health Plan Identification and Recovery Processes 10/26/2005 R685CP Discontinuation of the Skilled Nursing Facility (SNF) HCPCS Help File 12/27/2005 and Notification to Fiscal Intermediaries (FIs) and Providers of the Redesigned SNF Consolidated Billing (CB) Annual Update File Posted on CMS Web Site R684CP Correction to Chapter 17, Section 80.2.3, MSN/ANSI X12 Denial 12/23/2005 Messages for Anti-Emetic Drugs R686CP Common Working File (CWF) Unsolicited Response Adjustments for 1/3/2006 Certain Claims Denied Due to an Open Medicare Secondary Payer (MSP) Group Health Plan (GHP) Record Where the GHP Record was Subsequently Deleted R687CP Appeals of Claims Decisions: Redeterminations and Reconsiderations N/A (Implementation Dates for FI Initial Determinations Issued on or After May 1, 2005 and Carrier Initial Determinations Issued on or After January 1, 2006) R688CP Appeals of Claims Decisions: Redeterminations and Reconsiderations N/A (Implementation Dates for All Requests for Redetermination Received by FIs on or After May 1, 2005, And All Requests for Redetermination Received by Carriers on or After January 1, 2006) R689CP One Time Update To The NCPDP Companion Document Regarding 1/3/2006 Crossover Claims To Medicaid R123PI Chapter 3, MMA Section 935 10/24/2005 R124PI Evidence of Medical Necessity: Wheelchair and Power Operated Vehicle N/A (POV) Claims R28DEMO The Medicare Care Management for High Cost Beneficiaries (CMHCB) 10/3/2005 Demonstration R181OTN National Modifier and Condition Code To Be Used To Identify Disaster N/A Related Claims R683CP October 2005 Outpatient Prospective Payment System Code Editor (OPPS 10/3/2005 OCE) Specifications Version 6.3 R674CP Fiscal Year (FY) 2006 Inpatient Prospective Payment System (IPPS) and 10/3/2005 Long Term Care Hospital (LTCH PPS) Changes R675CP Changes to Appeals of Claims Decisions: Redeterminations and 10/3/2005 Reconsiderations (Implementation Date October 1, 2005) R676CP 2006 Healthcare Common Procedure Coding System (HCPCS) Annual 1/3/2006 Update Reminder R677CP Appeals of Claims Decisions: Redeterminations and Reconsiderations N/A (Implementation Dates for FI Initial Determinations Issued on or After May 1, 2005 and Carrier Initial Determinations Issued on or After January 1, 2006) R678CP Appeals of Claims Decisions: Redeterminations and Reconsiderations N/A (Implementation Dates for All Requests for Redetermination Received by FIs on or After May 1, 2005, And All Requests for Redetermination Received by Carriers on or After January 1, 2006) R679CP Medicare Redetermination Notice and Effect of the Redetermination N/A R680CP Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective 10/3/2005 Payment System (PPS) Pricer Changes for FY 2006 R681CP Guidelines For Payment of Vaccines (Pneumococcal Pneumonia Virus 1/3/2006 (PPV), Influenza Virus, And Hepatitis B Virus) and Their Administration Provided by Indian Health Service (IHS)/Tribally Owned and/or Operated Hospitals and Hospital Based Facilities R77FM Non-Medicare Secondary Payer (Non-MSP) Debt Referral and Debt 10/17/2005 Collection Improvement Act of 1996 (DCIA) Activities R122PI Medical Review Collection Number Requirements 10/17/2005 R179OTN Calculation of the Interim Payment of Indirect Medical Education (IME) N/A Through the Inpatient PPS PRICER for Hospitals That Received an Increase to Their Full-time Equivalent Resident Caps Under Section 422 of the Medicare Modernization Act (MMA), P.L. 108-173 R121PI Evidence of Medical Necesity: Wheelchair and Power Operated Vehicle N/A (POV) Claims R672CP October Update to the 2005 Medicare Physician Fee Schedule Database 10/3/2005 R671CP Updated Manual Instructions for the Medicare Claims Processing Manual, 10/3/2005 Regarding Smoking and Tobacco-Use Cessation Counseling Services R673CP Manual Update on Medical Nutrition Therapy (MNT) Services - N/A Manualization R1P239 Chapter 39, Form CMS 287-05 N/A R34MSP Manualization: Long-Standing MSP Policy in Chapter 1 of the Medicare N/A Secondary Payer (MSP) Internet Only Manual (IOM) R666CP Updates to the Coordination of Benefits Contractor (COBC) Detailed 10/3/2005 Error Report File Layouts R667CP Home Care and Domiciliary Care Visits (Codes 99321 - 99350) 12/5/2005 R669CP Schedule for Completing the Calendar Year 2006 Fee Updates and the 9/2/2005 Participating Physician Enrollment Procedures. R668CP Enforcement of Hospital Inpatient Bundling: Carrier Denial of Ambulance 1/3/2006 Claims during an Inpatient Stay R665CP October Quarterly Update for 2005 Durable Medical Equipment, 10/3/2005 Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule R670CP Realignment of States and Medicare Claims Processing Workload from 7/3/2006 DMERC Regions A, B, C and D to the DME MAC Jurisdictions A, B, C, and D R68MCM Initial Publication of Chapter 1 - General Provisions N/A R69MCM Revisions to Chapter 12, "Effect of Change of Ownership," and Chapter N/A 14, "Contract Determination and Appeals" R177OTN Termination of Existing Crossover Agreements As Trading Partners 10/3/2005 Transition to the National Coordination of Benefits Agreement (COBA) Program R664CP October 2005 Outpatient Prospective Payment System Code Editor (OPPS 10/3/2005 OCE) Specifications Version 6.3 R29GI 2005 Scheduled Release for October Updates to Software Programs and 9/26/2005 Pricing/Coding Files R657CP Quarterly Update to Correct Coding Initiative (CCI) Edits, Version V11.3, 10/3/2005 Effective October 1, 2005 R658CP Billing for Devices Under the Hospital Outpatient Prospective Payment 10/3/2005 System (OPPS) R659CP Instructions for Downloading the Medicare Zip Code File 1/3/2006 R661CP October Update to the 2005 Medicare Physician Fee Schedule Database 10/3/2005 R660CP October 2005 Outpatient Prospective Payment System Code Editor (OPPS 10/3/2005 OCE) Specifications Version 6.3 R662CP October 2005 Update of the Hospital Outpatient Prospective Payment 10/3/2005 System (OPPS) R663CP Update To The Hospice Payment Rates, Hospice Cap, Hospice Wage 10/3/2005 Index and the Hospice Pricer For FY 2006 R120PI Correction to Change Request (CR) 3222: Local Medical Review Policy/ N/A Local Coverage Determination Medicare Summary Notice (MSN) Message Revision R175OTN Common Working File (CWF) Calculation of Next Eligible Date for 10/3/2005 Preventive Services R176OTN Change of the CareFirst Part A Plan to Highmark in the State of Maryland 10/3/2005 and Washington, DC R38BP Services Not Provided Within United States 11/17/2005 R651CP Changes to the Laboratory National Coverage Determination (NCD) Edit 10/3/2005 Software for October 2005 R652CP October Update to the 2005 Medicare Physician Fee Schedule Database 10/3/2005 R653CP October 2005 Quarterly Average Sales Price (ASP) Medicare Part B Drug 10/3/2005 Pricing File, Effective October 1, 2005 and Revisions to April 2005 and July 2005 Quarterly ASP Medicare Part B Drug Pricing File R654CP Services Not Provided Within United States 11/17/2005 R655CP Update To The Hospice Payment Rates, Hospice Cap, Hospice Wage 10/3/2005 Index and the Hospice Pricer For FY 2006 R656CP Full Replacement of Change Request 3607, Payment Edits in Applicable 10/3/2005 States for DMEPOS Suppliers of Prosthetics and Certain Custom- Fabricated Orthotics. Change Request 3607 is rescinded (DMERC only) R174OTN Fiscal Intermediary Shared System (FISS) Modification 1/3/2006 R173OTN Overnight Oximetery Testing 1/1/2006 R28GI Conforming Changes for Change Request 3648 to Pub. 100-01 9/12/2005 R37BP Conforming Changes for Change Request 3648 to Pub. 100-02 9/12/2005 R649CP Competitive Acquisition Program for Part B Drugs - Coding, Testing, and 1/3/2006 Implementation R647CP The Supplemental Security Income (SSI)/Medicare Beneficiary Data for 10/3/2005 Fiscal Year 2004 for Inpatient Prospective Payment System (IPPS) Hospitals R646CP Update to the Inpatient Provider Specific File (PSF) and the Outpatient 1/3/2006 PSF to Retain Provider Information R643CP Nature and Effect of Assignment on Carrier Claims 11/14/2005 R644CP October 2005 Non-Outpatient Prospective Payment System Code Editor 10/3/2005 (Non-OPPS OCE) Specifications Version 21 R650CP Manual Update on Medical Nutrition Therapy Services - Manualization N/A R33MSP Working Aged Exception for Small Employers in Multi-Employer Group 5/20/2005 Health Plans (GHPs) R75FM New Thresholds for 2nd Demand Letter for Physicians/Suppliers 9/6/2005 R76FM Development of New Report to Capture BIPA and MMA Appeals Data 4/3/2006 R10SOM Revision - Appendix J - Interpretive Guidelines Intermediate Care 8/12/2005 Facilities With Mental Retardation R11SOM Revised Chapter 2--"The Certification Process," Sections 2180E thru 8/12/2005 2200F, and Appendix B--"Interpretive Guidelines: Home Health Agencies" R118PI Various Benefit Integrity (BI) Clarifications 9/12/2005 R67MCM Changes in Requirements for Periodic Surveys of Current and Former N/A Enrollees, and in the CMS Method for Calculating Interest on Overpayments and Underpayments to HMOs, CMPs and HCPPS. R27DEMO The Medicare Chronic Care Improvement, "Medicare Health Support," 10/20/2005 Program R639CP Cessation of Additional $50 Payment for New Technology Intraocular 10/3/2005 Lenses (NTIOLs) R636CP Instructions for Implementation of CMS Ruling 05-01; Presbyopia- 9/6/2005 Correcting Intraocular Lens (P-C IOLs) R635CP Financial Liability for Services Subject to Home Health Consolidated 11/3/2005 Billing R640CP Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment 10/3/2005 System (PPS) Pricer Update FY 2006 R638CP New Medicare Summary Notice (MSN) Messages 1/3/2006 R641CP October 2005 Quarterly Update to Skilled Nursing Facility (SNF) 10/3/2005 Consolidated Billin R642CP New Waived Tests 10/3/2005 R32MSP Exception for Small Employers in Multi-Employer Group Health Plans 9/6/2005 (GHP) R74FM Discovery Code Indication for Recovery Audit Contractor (RAC) Non- 1/3/2006 MSP Identified Overpayments R73FM New Thresholds for 2nd Demand Letter for Physicians/Suppliers 9/6/2005 R9SOM Revision of Appendix P and certain Exhibits of the State Operations 8/5/2005 Manual R117PI Revise the Medicare Contractor System (MCS) and the VIPS Medicare 1/3/2006 System (VMS) to Allow Update of the Comprehensive Error Rate Testing (CERT) Program Resolution File Within Five Business Days of a CERT Request R13COM Provider Contact Centers Training Program 9/1/2005 R66MCM Beneficiary Enrollment and Disenrollment Requirements for Medicare N/A Advantage Plans R171OTN Preliminary system updates in preparation for ending the Medicare 10/3/2005 contingency plan in October 2005 R633CP Guidelines For Payment of Vaccines (Pneumococcal Pneumonia Virus 1/3/2006 (PPV), Influenza Virus, And Hepatitis B Virus) and Their Administration Provided by Indian Health Service (IHS)/Tribally Owned and/or Operated Hospitals and Hospital Based Facilities. R634CP Guidelines for Payment of Vaccines (Pneumococcal Pneumonia Virus 1/3/2006 (PPV), Influenza Virus, and Hepatitis B Virus) and their Administration at Renal Dialysis Facilities (RDFs) </p>